Document ID: chunk:federal_register_of_legislation:F2024C01114:clause:7_3:p1
Version: federal_register_of_legislation:F2024C01114
Segment Type: clause
Provision Reference: sch 7 cl 3 (pt 1/2)
Character Range: 21002–24009

3                      A policy under which a person is covered, wholly or partly, for hospital‑substitute treatment where:                                                                                                                                                   The provision of the medical device or human tissue product.
                       (a) the treatment includes the provision of a medical device or human tissue product of a kind listed in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules, made under the Act, as in force from time to time; and
                         (b) a medicare benefit is payable in respect of the professional service associated with the provision of the medical device or human tissue product.

       Note: The Private Health Insurance (Medical Devices and Human Tissue Products) Rules set out the benefit requirements for medical devices and human tissue products listed in those Rules.

      (2) For the avoidance of doubt, a policy of a kind mentioned in the table may also be a policy that covers other types of treatment, unless excluded by rules made for the purpose of subsection 69‑1 (3).

8A Benefit requirement―nursing‑home type patients

      (1) For paragraph 72‑1 (1) (b) of the Act, the requirement in subrule (2) is a benefit requirement for a policy that covers hospital treatment.

      (2) The requirement is that the amount of benefit payable under the policy in respect of hospital treatment at a hospital for a nursing‑home type patient must not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment less the amount of the patient contribution in relation to the patient for each day on which the patient is a nursing‑home type patient at the hospital.

      (3) In this rule:

     nursing‑home type patient has the same meaning as in the Private Health Insurance (Benefit Requirements) Rules, made under section 333‑20 of the Act, as in force from time to time.

     patient contribution, for each day on which the patient is a nursing‑home type patient at the hospital, means:
           (a) in relation to a nursing‑home type patient at a public hospital, the following amount for the State or Territory in which the hospital is located:
 (i) Australian Capital Territory ‑ $75.55;
 (ii) New South Wales ‑ $78.65;
 (iii) Northern Territory ‑ $78.65;
 (iv) Queensland ‑ $78.65;
 (v) South Australia ‑ $78.65;
 (vi) Tasmania ‑ $78.60;
 (vii) Victoria ‑ $78.65; and
 (viii) Western Australia ‑ $78.65.
           (b) in relation to a nursing‑home type patient at a private hospital, $78.65.

     9. Waiting periods―former gold card holders

      (1) The waiting period requirements in subsection 75‑1 (1) of the Act are modified in relation to insured persons referred to in subrule (2) by specifying the conditions set out in that subrule.

      (2) A policy that covers a person who:
           (a) held a gold card, or was entitled to treatment under a gold