Document ID: chunk:federal_register_of_legislation:F2025C00117:body:0:p29
Version: federal_register_of_legislation:F2025C00117
Segment Type: other
Provision Reference: 
Character Range: 81768–84807

all comparable private hospitals in the State in which the second‑tier eligible hospital is located.

      (7) In subclause (4), for the purpose of calculating the average charge for the equivalent episode of hospital treatment in a State:
            (a) the charge will include the sum of the amount payable by the insurer under that insurer's negotiated agreement and any excess or co‑payment amounts payable by members, in accordance with the insurer's rules; and

                Note: Policy holders' financial obligations under such levels of cover will still apply.
            (b) must not include any charges:
                (i) referred to in the insurer's negotiated agreements for medical devices and human tissue products; and
                (ii) that are minimum benefits for medical devices and human tissue products as specified for the purpose of item 4 of the table in subsection 72‑1(2) of the Act, and
                (iii) referred to in the insurer's negotiated agreements for hospital treatment provided to nursing‑home type patients.

      (8) Subject to subclause (2), if an insurer has less than 5 negotiated agreements in force on 1 August of the first year with a particular category of comparable private hospitals in a State, then all of that insurer's negotiated agreements with all classes of private hospitals in that State are to be used to calculate the minimum benefit.

4. Transitional

      (1) If a patient is admitted to a second‑tier eligible hospital between 1 January 2019 and 31 August 2019:

            (a) an insurer may instead work out the average charge on the basis of the repealed provisions; and
            (b) if the insurer does so, comparable has the same meaning as in the repealed provisions.

      (2) For subclause (1), the repealed provisions are the provisions of this Schedule as in force immediately before the commencement of Schedule 4 to the Private Health Insurance (Reforms) Amendment Rules 2018.

          Note: For the purpose of determining which category the second‑tier eligible hospital to which the patient was admitted is placed in, an insurer must use the Department's determination in respect of that hospital under subclause 1A(1), (2), (3) or (4).

Endnotes

Endnote 1—About the endnotes
The endnotes provide information about this compilation and the compiled law.

The following endnotes are included in every compilation:

Endnote 1—About the endnotes
Endnote 2—Abbreviation key
Endnote 3—Legislation history
Endnote 4—Amendment history

Abbreviation key—Endnote 2
The abbreviation key sets out abbreviations that may be used in the endnotes.

Legislation history and amendment history—Endnotes 3 and 4
Amending laws are annotated in the legislation history and amendment history.

The legislation history in endnote 3 provides information about each law that has amended (or will amend) the compiled law. The information includes commencement details for amending laws and details of any application, saving or transitional provisions that are