5. Other hospital treatments

(1) For item 5 in the table in subsection 72-1 (2) of the Act, for a policy that covers any type of hospital treatment provided in a hospital, other than treatment referred to in rule 4, the minimum benefit for that treatment is the amount set out, or worked out using the method for working out the minimum benefit, for that treatment in Schedules 1, 2, 3, 4 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.

(2) Despite subrule (1), the minimum benefit for the treatment may be reduced by the amount of any co-payment or excess that is required to be paid under the insured person's policy in respect of that treatment.

Schedule 1―Overnight accommodation: private hospitals in all States/Territories and shared ward accommodation at public hospitals in Victoria and Tasmania

Part 1―General

Circumstances

For rules 4 and 5 of Part 2 of these Rules, the circumstances specified for hospital treatment to which this Schedule applies are that the treatment is:

(a) provided to a patient who is not a nursing-home type patient; and

(b) provided to a patient:

(i) at a private hospital; or

(ii) as shared ward accommodation at a public hospital in Victoria or Tasmania; and

Note: The definition of hospital treatment in section 121-5 of the Act includes that the treatment is provided either at the hospital or provided or arranged with the direct involvement of a hospital. This Schedule sets out benefit requirements only for treatment provided at the relevant hospital ― see paragraph 121-5 (1) (c) of the Act.

(i) a Type A procedure; and

(ii) for a period that includes part of an overnight stay.

Note: A Type A procedure is defined to include a certified Type B procedure and a certified overnight Type C procedure―see the definitions of those terms in rule 3 of Part 1 of these Rules.

Minimum benefit

(1) The minimum benefit for hospital treatment provided in the circumstances specified in this Schedule is the amount set out in the tables in this Schedule for that hospital treatment.

(2) When counting the days referred to in the tables in this Schedule to determine the minimum benefit in respect of any particular patient, days forming part of a continuous period of hospitalisation are to be counted.

Table 1―Accommodation at private hospitals in all States/Territories

Class of patient	Minimum benefit payable per night
Advanced surgical patient
- first 14 days	$347
- over 14 days	$241
Surgical patient or obstetric patient
- first 14 days	$321
- over 14 days	$241
Psychiatric patient
- first 42 days	$321
- 43 – 65 days	$279
- over 65 days	$241
Rehabilitation patient
- first 49 days	$321
- 50 - 65 days	$279
- over 65 days	$241
Other patients
- first 14 days	$279
- over 14 days	$241

Table 2― Victoria: shared ward accommodation at a public hospital

Class of patient	Minimum benefit payable per night
Advanced surgical patient
- first 14 days	$347
- over 14 days	$241
Surgical patient or obstetric patient
- first 14 days	$321
- over 14 days	$241
Psychiatric
- first 42 days	$321
- 43 – 65 days	$280
- over 65 days	$241
Rehabilitation patient
- first 49 days	$321
- 50 – 65 days	$280
- over 65 days	$241
Other patients
- first 14 days	$280
- over 14 days	$241

Table 3―Tasmania: shared ward accommodation at a public hospital

Class of patient	Minimum benefit payable per night
Advanced surgical patient
- first 14 days	$347
- over 14 days	$241
Surgical patient or obstetric patient
- first 14 days	$321
- over 14 days	$241
Psychiatric patient
- first 42 days	$321
- 43 – 65 days	$279
- over 65 days	$241
Rehabilitation patient
- first 49 days	$321
- 50 – 65 days	$279
- over 65 days	$241
Other patients
- first 14 days	$279
- over 14 days	$241

5. Other hospital treatments

Get a plain-English read of 5. Other hospital treatments

5. Other hospital treatments