Document ID: chunk:federal_register_of_legislation:F2024C01114:schedule:5
Version: federal_register_of_legislation:F2024C01114
Segment Type: schedule
Provision Reference: sch 5
Character Range: 99587–101201

Schedule 5—Clinical categories
Note 1: Rule 11F is the principal provision that deals with what must be covered by an insurance policy that covers hospital treatment. The operation of rule 11F relies on this Schedule, as well as Schedule 6 and Schedule 7.
Note 2: The treatments that must be covered are any hospital treatments that are in the scope of cover of a clinical category in relation to which the policy provides cover. The scope of cover includes, without limitation:
        any hospital treatment involving the provision of an MBS item number listed in column 3 below; and
        except for the clinical category "Podiatric surgery (provided by a registered podiatric surgeon)"—any hospital treatment:
         – that is provided in relation to a treatment within the scope of cover of a particular clinical category or that involves the provision of an MBS item number listed in column 3 below; and
         – that involves the provision of an MBS item number listed in Schedule 6 (common treatments) or Schedule 7 (support treatments).
Note 3: MBS items are mentioned in the table below against a clinical category, or in the common treatments or support treatments lists in Schedules 6 and 7. Where an MBS item is mentioned for a clinical category in column 3 in the table below, the treatment including that MBS item is most likely to be provided under that clinical category, or a clinical category in the same or a higher product tier (according to Schedule 4). However, the mention of an MBS item against a particular category does not mean it is only covered under that clinical category.