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Private Health Insurance (Benefit Requirements) Rules 2011
made under item 3A of the table in section 333‑20 of the

Private Health Insurance Act 2007

Compilation No. 98

Compilation date: 31 January 2025

                Includes amendments: F2025L00021

About this compilation

This compilation

This is a compilation of the Private Health Insurance (Benefit Requirements) Rules 2011 that shows the text of the law as amended and in force on 31 January 2025 (the compilation date).

The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.

Uncommenced amendments

The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the Register for the compiled law.

Application, saving and transitional provisions for provisions and amendments

If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.

Editorial changes

For more information about any editorial changes made in this compilation, see the endnotes.

Modifications

If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the Register for the compiled law.

Self‑repealing provisions

If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.

Contents
Part 1 Preliminary
1. Name of Rules
3. Definitions
Part 2 Minimum benefit requirements
4. Psychiatric care, rehabilitation and palliative care
5. Other hospital treatments
6. Benefit not to exceed hospital fees or charges
Schedule 1―Overnight accommodation:  private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania
Part 1 General
1. Circumstances
2. Minimum benefit
Part 2 Type A procedures
3. Interpretation
4. Advanced surgical patient
5. Obstetric patient
6. Surgical patient
7. Psychiatric patient
8. Rehabilitation patient
9. Other patient
Part 3 Certified Type B procedures and certified overnight Type C procedures
10. Certified Type B procedures
11. Certified overnight Type C procedures
Schedule 2 ‑ Overnight shared ward accommodation for private patients at public hospitals in the Australian Capital Territory, New South Wales, Northern Territory, Queensland, South Australia and Western Australia
1. Circumstances
2. Minimum benefit
Schedule 3―Same‑day accommodation:  hospitals in all States/Territories