Part 1 Preliminary

1. Name of Rules

These Rules are the Private Health Insurance (Benefit Requirements) Rules 2011.

3. Definitions

In these Rules:

Act means the Private Health Insurance Act 2007.

ACT means the Australian Capital Territory.

certified Type B procedure means a Type B procedure certified in accordance with clause 10 of Schedule 1.

certified overnight Type C procedure means a Type C procedure certified in accordance with clause 11 of Schedule 1.

certified Type C procedure means a Type C procedure certified in accordance with clause 7 of Schedule 3.

continuous period of hospitalisation, for the purpose of counting days of hospital treatment, includes any two periods during which a patient was, or is, receiving hospital treatment as a patient at a hospital, whether or not the same hospital, where the periods are separated from each other by a period of not more than 7 days during which the patient was not receiving hospital treatment as a patient at any hospital.

diagnostic imaging services table means the table prescribed under subsection 4AA(1) of the Health Insurance Act 1973.

fee in the MBS means the Schedule fee as defined in subsection 8(1A) of the Health Insurance Act 1973.

general medical services table means the table prescribed under subsection 4(1) of the Health Insurance Act 1973.

insurer means a private health insurer.

item has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

MBS comprises the:

(a) general medical services table;

(b) diagnostic imaging services table; and

(c) pathology services table.

negotiated agreement means an agreement entered into between a hospital and an insurer, that includes provisions to the effect that, except to the extent (if any) provided in the agreement, the hospital agrees to accept payment by the insurer in satisfaction of any amount that would, apart from the agreement, be owed to the hospital, in relation to an episode of hospital treatment, by an insured person under a policy.

NSW means the State of New South Wales.

nursing‑home type patient has the meaning given by Schedule 4.

Note: Item 19 of Schedule 2 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 also deals with nursing‑home type patients.

outreach service means a service referred to in subsection 16(1) of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007, unless subsection 16(2) of that Act applies to the particular service.

participating midwife has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

pathology services table means the table prescribed under subsection 4A(1) of the Health Insurance Act 1973.

policy means a complying health insurance policy.

private hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a private hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

professional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

public hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a public hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

Type A procedure means:

(a) a procedure specified in clauses 3 to 9 of Schedule 1; or

(b) a certified Type B procedure; or

(c) a certified overnight Type C procedure.

Type B procedure means:

(a) a procedure specified in clauses 3 to 7 of Schedule 3 other than a certified Type B procedure; or

(b) a certified Type C procedure.

Type C procedure means a procedure specified in clause 8 of Schedule 3 other than a certified Type C procedure.

1. Name of Rules

These Rules are the Private Health Insurance (Benefit Requirements) Rules 2011.

3. Definitions

In these Rules:

Act means the Private Health Insurance Act 2007.

ACT means the Australian Capital Territory.

certified Type B procedure means a Type B procedure certified in accordance with clause 10 of Schedule 1.

certified overnight Type C procedure means a Type C procedure certified in accordance with clause 11 of Schedule 1.

certified Type C procedure means a Type C procedure certified in accordance with clause 7 of Schedule 3.

continuous period of hospitalisation, for the purpose of counting days of hospital treatment, includes any two periods during which a patient was, or is, receiving hospital treatment as a patient at a hospital, whether or not the same hospital, where the periods are separated from each other by a period of not more than 7 days during which the patient was not receiving hospital treatment as a patient at any hospital.

diagnostic imaging services table means the table prescribed under subsection 4AA(1) of the Health Insurance Act 1973.

fee in the MBS means the Schedule fee as defined in subsection 8(1A) of the Health Insurance Act 1973.

general medical services table means the table prescribed under subsection 4(1) of the Health Insurance Act 1973.

insurer means a private health insurer.

item has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

MBS comprises the:

(a) general medical services table;

(b) diagnostic imaging services table; and

(c) pathology services table.

negotiated agreement means an agreement entered into between a hospital and an insurer, that includes provisions to the effect that, except to the extent (if any) provided in the agreement, the hospital agrees to accept payment by the insurer in satisfaction of any amount that would, apart from the agreement, be owed to the hospital, in relation to an episode of hospital treatment, by an insured person under a policy.

NSW means the State of New South Wales.

nursing‑home type patient has the meaning given by Schedule 4.

Note: Item 19 of Schedule 2 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 also deals with nursing‑home type patients.

outreach service means a service referred to in subsection 16(1) of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007, unless subsection 16(2) of that Act applies to the particular service.

participating midwife has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

pathology services table means the table prescribed under subsection 4A(1) of the Health Insurance Act 1973.

policy means a complying health insurance policy.

private hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a private hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

professional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.

public hospital means a hospital in respect of which there is in force a statement under subsection 121‑5(8) of the Act that the hospital is a public hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

Type A procedure means:

(a) a procedure specified in clauses 3 to 9 of Schedule 1; or

(b) a certified Type B procedure; or

(c) a certified overnight Type C procedure.

Type B procedure means:

(a) a procedure specified in clauses 3 to 7 of Schedule 3 other than a certified Type B procedure; or

(b) a certified Type C procedure.

Type C procedure means a procedure specified in clause 8 of Schedule 3 other than a certified Type C procedure.

Part 2 Minimum benefit requirements

4. Psychiatric care, rehabilitation and palliative care

(1) For item 1 in the table in subsection 72‑1(2) of the Act, the minimum benefit for hospital treatment specified in that item 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 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.

Note: Item 1 in the table in subsection 72‑1(2) of the Act requires that each policy that covers hospital treatment must cover any part of hospital treatment that is psychiatric care, rehabilitation or palliative care if the treatment is provided in a hospital and no medicare benefit is payable for that part of the 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.

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 subsection (1), if a policy covers a type of hospital treatment, other than treatment referred to in rule 4, and the insurer for that policy has a negotiated agreement with the hospital in which the treatment is provided, the minimum benefit for that treatment is the amount specified for the treatment in the negotiated agreement.

(3) Despite subrules (1) and (2), 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.

6. Benefit not to exceed hospital fees or charges

(1) In respect of treatment referred to in rule 4 and in rule 5 other than hospital treatment for a nursing‑home type patient (as set out in Schedule 4), the amount of benefit payable by the insurer in respect of hospital treatment for a person will not exceed the fees or charges incurred in respect of that hospital treatment.

(2) In respect of treatment referred to in rule 5 of this Part, the amount of benefit payable by the insurer in respect of hospital treatment for a nursing‑home type patient (as set out in Schedule 4) will not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment less the amount of the patient contribution in relation to the patient for each day on which the patient was a patient in the hospital.

4. Psychiatric care, rehabilitation and palliative care

(1) For item 1 in the table in subsection 72‑1(2) of the Act, the minimum benefit for hospital treatment specified in that item 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 or 5 where the treatment is provided in the circumstances specified in the particular Schedule relevant to that treatment.

Note: Item 1 in the table in subsection 72‑1(2) of the Act requires that each policy that covers hospital treatment must cover any part of hospital treatment that is psychiatric care, rehabilitation or palliative care if the treatment is provided in a hospital and no medicare benefit is payable for that part of the 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.

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 subsection (1), if a policy covers a type of hospital treatment, other than treatment referred to in rule 4, and the insurer for that policy has a negotiated agreement with the hospital in which the treatment is provided, the minimum benefit for that treatment is the amount specified for the treatment in the negotiated agreement.

(3) Despite subrules (1) and (2), 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.

6. Benefit not to exceed hospital fees or charges

(1) In respect of treatment referred to in rule 4 and in rule 5 other than hospital treatment for a nursing‑home type patient (as set out in Schedule 4), the amount of benefit payable by the insurer in respect of hospital treatment for a person will not exceed the fees or charges incurred in respect of that hospital treatment.

(2) In respect of treatment referred to in rule 5 of this Part, the amount of benefit payable by the insurer in respect of hospital treatment for a nursing‑home type patient (as set out in Schedule 4) will not exceed an amount equal to the fees or charges incurred in respect of that hospital treatment less the amount of the patient contribution in relation to the patient for each day on which the patient was a patient in the hospital.

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

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.

(c) provided for the purpose of permitting the provision to the patient of hospital treatment that is:

(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.

2. 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 cellspacing="0" cellpadding="0" style="width:459pt; border-collapse:collapse"><thead><tr><td colspan="2" style="width:455pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Table 1</span><span>‑</span><span>Overnight accommodation for private patients at private hospitals in all States/Territories</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 2</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Class of patient</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Minimum benefit payable per night</span></p></td></tr></thead><tbody><tr><td style="width:223.8pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Advanced surgical patient</span></p></td><td style="width:227.2pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span>$540</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Surgical patient or obstetric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Psychiatric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 42 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> 43 – 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Rehabilitation patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 49 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> 50 </span><span>‑</span><span> 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Other patients</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:459pt; border-collapse:collapse"><thead><tr><td colspan="2" style="width:455pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Table 2</span><span>‑</span><span>Victoria</span><span>‑</span><span>overnight shared ward accommodation for private patients at public hospitals</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 1</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 2</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Class of patient</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Minimum benefit payable per night</span></p></td></tr></thead><tbody><tr><td style="width:223.8pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Advanced surgical patient</span></p></td><td style="width:227.2pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$540</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Surgical patient or obstetric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Psychiatric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 42 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 43 – 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Rehabilitation patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 49 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 50 </span><span>‑</span><span> 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Other patients</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:459pt; border-collapse:collapse"><thead><tr><td colspan="2" style="width:455pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Table 3</span><span>‑</span><span>Tasmania</span><span>‑</span><span>overnight shared ward accommodation for private patients at public hospitals</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 1</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 2</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Class of patient</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Minimum benefit payable per night</span></p></td></tr></thead><tbody><tr><td style="width:223.8pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Advanced surgical patient</span></p></td><td style="width:227.2pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$540</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Surgical patient or obstetric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Psychiatric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 42 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 43 – 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Rehabilitation patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 49 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 50 </span><span>‑</span><span> 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Other patients</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr></tbody></table>

Part 2 Type A procedures

3. Interpretation

A Type A procedure is a procedure specified in this Part provided to a patient in one of the categories of patients in clauses 4 to 9.

4. Advanced surgical patient

(1) In this Schedule, advanced surgical patient has the meaning given by this clause.

(2) A patient is taken to be an advanced surgical patient upon admission to a hospital:

(a) from and including the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3) is rendered to the patient at that hospital, unless the particular advanced surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or

(b) if a longer pre‑operative period than that referred to in paragraph (a) is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or

(c) if the advanced surgery is rendered to a patient during an admission, from the day the advanced surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).

Note: The effect of the reference in subclause (1)(a) to a professional service, being a service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.

(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS greater than $994.97:

5. Obstetric patient

(1) In this Schedule, obstetric patient has the meaning given by this clause.

(2) A patient shall be taken to be an obstetric patient during an admission to a hospital from and including:

(a) whichever is the earlier of:

(i) the day on which the patient commences labour leading to delivery in that hospital; or

(ii) the day on which a professional service with the item number 16406, 16515, 16518, 16519, 16522 (excluding caesarean), 16527, 16528, 16530, 16531, 16533 or 16534 is rendered to the patient in that hospital; or

(b) if the circumstances in paragraph (a) do not apply, the day before a professional service with the item number 16520 and 16522 (including caesarean) is rendered to the patient at that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre‑operative period; or

(c) the day on which a professional service with the item number 82118, 82120, 82123, 82125 or 82127 is rendered to a patient by a participating midwife.

(3) In this clause, the item numbers specified are the item numbers in the general medical services table.

6. Surgical patient

(1) In this Schedule, surgical patient has the meaning given by this clause.

(2) A patient shall be taken to be a surgical patient upon admission to a hospital from and including:

(a) the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3), is rendered to the patient at that hospital, unless the particular surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or

(b) if a longer pre‑operative period is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or

(c) if the surgery is rendered to a patient during an admission, from the day the surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).

Note: The effect of the reference in subclause (1)(a) to a professional service, being the service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.

(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS within the range of $296.29 to $994.97:

7. Psychiatric patient

In this Schedule, a psychiatric patient is a patient in a hospital who is admitted for the purposes of undertaking a specific psychiatric treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient’s disease, injury or condition.

Note: If a patient is receiving psychiatric treatment that is not under a specific psychiatric treatment program, the patient is taken to be in the category of 'other patient'.

8. Rehabilitation patient

In this Schedule, a rehabilitation patient is a patient in a hospital who is admitted for the purposes of undertaking a specific rehabilitation treatment program that is deemed by the insurer to be relevant and appropriate for the treatment of the patient’s disease, injury or condition.

Note: If a patient is receiving rehabilitation treatment that is not under a specific rehabilitation treatment program, the patient is taken to be in the category of 'other patient'.

9. Other patient

(1) In this Schedule, other patient is deemed to be a patient at a hospital who is receiving any treatment that involves part of an overnight stay, but who is not:

(a) an advanced surgical patient;

(b) a surgical patient;

(c) an obstetric patient;

(d) a psychiatric patient; or

(e) a rehabilitation patient.

Note: A patient receiving hospital treatment that is palliative care as described in item 1 of the table in subsection 72‑1(2) of the Act is deemed to be in the category of 'other patient'.

1. 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.

(c) provided for the purpose of permitting the provision to the patient of hospital treatment that is:

(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.

2. 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 cellspacing="0" cellpadding="0" style="width:459pt; border-collapse:collapse"><thead><tr><td colspan="2" style="width:455pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Table 1</span><span>‑</span><span>Overnight accommodation for private patients at private hospitals in all States/Territories</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Column 1</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 2</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Class of patient</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Minimum benefit payable per night</span></p></td></tr></thead><tbody><tr><td style="width:223.8pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Advanced surgical patient</span></p></td><td style="width:227.2pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span>$540</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Surgical patient or obstetric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Psychiatric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 42 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> 43 – 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Rehabilitation patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 49 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> 50 </span><span>‑</span><span> 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading"><span>Other patients</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext"><span>$376</span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:459pt; border-collapse:collapse"><thead><tr><td colspan="2" style="width:455pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Table 2</span><span>‑</span><span>Victoria</span><span>‑</span><span>overnight shared ward accommodation for private patients at public hospitals</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 1</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 2</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Class of patient</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Minimum benefit payable per night</span></p></td></tr></thead><tbody><tr><td style="width:223.8pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Advanced surgical patient</span></p></td><td style="width:227.2pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$540</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Surgical patient or obstetric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Psychiatric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 42 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 43 – 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Rehabilitation patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 49 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 50 </span><span>‑</span><span> 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Other patients</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr></tbody></table>

<table cellspacing="0" cellpadding="0" style="width:459pt; border-collapse:collapse"><thead><tr><td colspan="2" style="width:455pt; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Table 3</span><span>‑</span><span>Tasmania</span><span>‑</span><span>overnight shared ward accommodation for private patients at public hospitals</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 1</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Column 2</span></p></td></tr><tr><td style="width:223.8pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Class of patient</span></p></td><td style="width:227.2pt; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Minimum benefit payable per night</span></p></td></tr></thead><tbody><tr><td style="width:223.8pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Advanced surgical patient</span></p></td><td style="width:227.2pt; border-top:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$540</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Surgical patient or obstetric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Psychiatric patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 42 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 43 – 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Rehabilitation patient</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 49 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$501</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> 50 </span><span>‑</span><span> 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 65 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="TableHeading" style="page-break-inside:avoid"><span>Other patients</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span></span></p></td></tr><tr><td style="width:223.8pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> first 14 days</span></p></td><td style="width:227.2pt; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$435</span></p></td></tr><tr><td style="width:223.8pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>‑</span><span> over 14 days</span></p></td><td style="width:227.2pt; border-bottom:1.5pt solid #000000; padding-right:2pt; padding-left:2pt; vertical-align:top"><p class="Tabletext" style="page-break-inside:avoid; page-break-after:avoid"><span>$376</span></p></td></tr></tbody></table>

3. Interpretation

A Type A procedure is a procedure specified in this Part provided to a patient in one of the categories of patients in clauses 4 to 9.

4. Advanced surgical patient

(1) In this Schedule, advanced surgical patient has the meaning given by this clause.

(2) A patient is taken to be an advanced surgical patient upon admission to a hospital:

(a) from and including the day before a professional service of the type identified by the item number in the MBS which is specified in subclause (3) is rendered to the patient at that hospital, unless the particular advanced surgical procedure to be rendered is recognised as requiring a longer pre‑operative period; or

(b) if a longer pre‑operative period than that referred to in paragraph (a) is required, from and including the day of admission of the patient for the purpose of providing the professional service of the type mentioned in paragraph (a); or

(c) if the advanced surgery is rendered to a patient during an admission, from the day the advanced surgery involving a professional service of the type mentioned in paragraph (a) is performed (not the day before).

Note: The effect of the reference in subclause (1)(a) to a professional service, being a service for which a Medicare benefit is payable, is that a professional service must have been provided to the patient for the minimum benefit to apply.

(3) The MBS item numbers for this clause are those set out in the following table, but only where those items have a fee in the MBS greater than $994.97:

5. Obstetric patient

(1) In this Schedule, obstetric patient has the meaning given by this clause.

(2) A patient shall be taken to be an obstetric patient during an admission to a hospital from and including:

(a) whichever is the earlier of:

(i) the day on which the patient commences labour leading to delivery in that hospital; or

(ii) the day on which a professional service with the item number 16406, 16515, 16518, 16519, 16522 (excluding caesarean), 16527, 16528, 16530, 16531, 16533 or 16534 is rendered to the patient in that hospital; or

(b) if the circumstances in paragraph (a) do not apply, the day before a professional service with the item number 16520 and 16522 (including caesarean) is rendered to the patient at that hospital, unless the particular obstetric procedure to be rendered is recognised as requiring a longer pre‑operative period; or

(c) the day on which a professional service with the item number 82118, 82120, 82123, 82125 or 82127 is rendered to a patient by a participating midwife.

(3) In this clause, the item numbers specified are the item numbers in the general medical services table.