CTHIn ForceLegislation
Private Health Insurance (Benefit Requirements) Rules 2011
1. Circumstances1. Circumstances
Start here
Get a plain-English read of 1. Circumstances
Turn the raw legal text into a practical explanation grounded in Private Health Insurance (Benefit Requirements) Rules 2011.
### 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.