Document ID: chunk:federal_register_of_legislation:F2025C00117:body:0:p24
Version: federal_register_of_legislation:F2025C00117
Segment Type: other
Provision Reference: 
Character Range: 68660–71704

a hospital not later than 7 days after receiving hospital treatment at that hospital or another hospital; or
            (b) is otherwise admitted to a hospital for hospital treatment at the hospital.

      (2) If subclause (1) does not apply to a patient, the definition of 'nursing‑home type patient' in these Rules before the commencement of the Private Health Insurance (Benefit Requirements) Amendment Rules 2007 (No. 4) continues to apply to that patient.

            Note: Clause 4 deals with nursing‑home type patients whose care needs change to requiring acute care.

4. Provision of acute care

     If a nursing‑home type patient is provided with acute care at the hospital (the first hospital), or at another hospital, the patient:
            (a) ceases to be a nursing‑home type patient only for the days on which the acute care is provided; and
            (b) again becomes a nursing‑home type patient when the provision of acute care ends and the patient is then provided with accommodation and nursing care as an end in itself, whether at the first hospital or another hospital.

5. Ceasing and resuming hospital treatment

     If a nursing‑home type patient, or a person referred to in paragraph 4(a), leaves hospital but returns to a hospital, whether or not at the same hospital, not more than 7 days later and is provided with hospital treatment at the hospital, the patient is a nursing‑home type patient for each subsequent day that the patient is provided with accommodation and nursing care, as an end in itself, until the patient ceases to be provided with hospital treatment at a hospital for a period of more than 7 days.

          Note: If the relevant period of hospitalisation is broken by more than 7 days, clause 2 of this Schedule may again apply to the person.

6. Minimum benefit

     The minimum benefit for hospital treatment provided in the circumstances described in this Schedule is the amount set out in Table 1 or 2 of this Schedule for that hospital treatment.

Table 1
Public hospital: State/Territory  Minimum benefit per night
Australian Capital Territory      $147.45
New South Wales                   $179.10
Northern Territory                $155.59
Queensland                        $145.80
South Australia                   $146.00
Tasmania                          $188.75
Victoria                          $160.00
Western Australia                 $152.85

Table 2
Private hospitals  $32.45

Schedule 5―Second‑tier default benefits

1. Interpretation

      (1) In this Schedule:

     authorised officer means a departmental officer authorised by the Secretary of the Department to make a determination under subclause 1A (2), (3) or (4) or to review a determination under subclause 1B(3).

     comparable has the meaning given by subclause 1A(6).

     Hospital Casemix Protocol Data has the meaning given by rule 4 of the Private Health Insurance (Health Insurance Business) Rules 2018.

     second‑tier eligible hospital means a hospital in the class set out in rule 7A of the