{"id":"F2005L01878","name":"National Health Act 1953 - Determination pursuant to subsection 5D(1) (PSO 6/2005)","slug":"national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005","collection":"legislative_instrument","jurisdiction":"commonwealth","status":"repealed","isInForce":false,"actNumber":null,"makingDate":null,"administeringDepartment":null,"currentVersion":{"id":36073,"registerId":"commonwealth-F2005L01878-current","compilationNumber":null,"startDate":"2026-04-01","status":"Repealed","reasons":null,"registeredAt":null},"sections":[{"sectionNumber":"Notes","sectionType":"part","heading":"Notes","content":"# Notes\n\nNote 1: Health funds can pay benefits under an applicable benefits arrangement (sometimes referred to as a “hospital cover policy”) for any service specified in this Determination if, and only if, the service is provided to a patient as a direct substitute for hospital treatment that would otherwise be provided in a hospital or day hospital facility (see the definition of \"outreach service\" in subsection 4(1) of the National Health Act 1953 (the Act) as well as sections 5A, 5C and 5D of the Act).\n\nNote 2: Health funds can also pay benefits for professional services that are rendered to a patient by a medical practitioner while the services specified in this Determination are being provided, so long as those services are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. Under section 5C of the Act outreach services (defined in subsection 4(1) of the Act) are deemed to be a form of \"hospital treatment\". Under section 5A of the Act health funds can provide benefits under an applicable benefits arrangement for hospital treatment and any professional services rendered to a patient by a medical practitioner while the hospital treatment is being provided. The Determination in effect allows health funds to provide benefits under an applicable benefits arrangement for those out-of-hospital professional services that are provided while services that are specified in this Determination are being provided as a direct substitute for treatment that would ordinarily be provided in a hospital or day hospital facility. However, the Determination does not permit health funds to provide benefits for professional services provided out-of-hospital in any other situation.","sortOrder":0}],"analysis":{"kimi_summary":{"_metrics":{"model":"kimi-k2.5","source":"moonshot-batch","completionTokens":2490},"content_quality":"ok","complexity_score":3,"scope_assessment":{"changed":false,"description":"This instrument (PSO 6/2005) appears to maintain its original scope of specifying which hospital-substitute services qualify for private health insurance benefits. The explanatory notes clarify the legislative framework without indicating expansion beyond the initial purpose of section 5D determinations."},"complexity_factors":["Cross-references to four separate provisions of the National Health Act 1953 (subsection 4(1) and sections 5A, 5C, and 5D)","Conditional logic requiring services to be 'direct substitutes' for hospital treatment to trigger coverage","Distinction between the outreach services themselves and separately rendered professional services","Use of defined statutory terms including 'applicable benefits arrangement' and 'outreach service'"],"plain_english_summary":"This Determination lets private hospital insurance cover certain listed “outreach services” provided at home or in the community when they directly substitute for care you would otherwise get as an admitted or day‑patient in hospital. It affects privately insured patients who can safely receive hospital‑level treatment outside hospital, and also treats doctor care during the same outreach visit as hospital benefit—but it does not make routine home GP visits automatically covered."}},"importantCases":[],"_links":{"self":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005","history":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005/history","analysis":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005/analysis","conflicts":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005/conflicts","importantCases":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005/important-cases","documents":"/api/acts/national-health-act-1953-determination-pursuant-to-subsection-5d-1-pso-6-2005/documents"}}