Part 1Preliminary

## 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.