4 Definitions
In these Rules:
Act means the Private Health Insurance Act 2007.
addiction medicine specialist means a specialist (within the meaning of the Health Insurance Act 1973) in relation to addiction medicine.
basic policy means an insurance policy that:
(a) covers hospital treatment; and
(b) covers at least the treatments in all of the clinical categories indicated for a basic policy in Schedule 4; and
(c) is not a gold, silver or bronze policy.
bronze policy means an insurance policy that:
(a) covers hospital treatment; and
(b) covers at least the treatments in all of the clinical categories indicated for a bronze policy in Schedule 4; and
(c) is not a gold or silver policy.
certified Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.
certified overnight Type C procedure has the same meaning as in rule 3 of the Private Health Insurance (Benefit Requirements) Rules.
clinical category, for hospital treatment, means a clinical category that is set out in Schedule 5.
consultant physician has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.
consultant psychiatrist means a specialist (within the meaning of the Health Insurance Act 1973) in relation to psychiatry.
general medical services table has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.
gold policy means an insurance policy that:
(a) covers hospital treatment; and
(b) covers the treatments in all of the clinical categories indicated for a gold policy in Schedule 4.
implantable cardiac event recorder includes a component of an implantable cardiac event recorder.
insulin infusion pump includes a component of an insulin infusion pump.
insurer means a private health insurer.
MBS item means an item that is in, or which from time to time a determination under section 3C of the Health Insurance Act 1973 deems to be in, any of the following:
(a) the general medical services table, made under section 4 of the Health Insurance Act 1973, as in force from time to time;
(b) the diagnostic imaging services table, made under section 4AA of that Act, as in force from time to time;
(c) the pathology services table, made under section 4A of that Act, as in force from time to time.
National Disability Insurance Scheme has the same meaning as in section 9 of the National Disability Insurance Scheme Act 2013.
National Disability Insurance Scheme launch has the same meaning as in section 9 of the National Disability Insurance Scheme Act 2013.
National Law means:
(a) for a State or Territory other than Western Australia — the Health Practitioner Regulation National Law set out in the Schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) as it applies (with or without modification) as law of the State or Territory; or
(b) for Western Australia — the legislation enacted by the Health Practitioner Regulation National Law (WA) Act 2010 that corresponds to the Health Practitioner Regulation National Law.
Note: The Intergovernmental Agreement for a National Registration and Accreditation Scheme for the Health Professions that was made on 26 March 2008 provides for the enactment of the State and Territory legislation mentioned in this definition.
participant has the same meaning as in section 9 of the National Disability Insurance Scheme Act 2013.
period of pre‑upgrade hospital cover has the meaning given by subrule 9A(5).
person with a disability means a participant in the National Disability Insurance Scheme or the National Disability Insurance Scheme launch.
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.
product tier means:
(a) for a gold policy—“gold”; and
(b) for a silver policy—“silver”; and
(c) for a bronze policy—“bronze”; and
(d) for a basic policy—“basic”.
professional attendance has the same meaning as in clause 1.2.3 of the general medical services table.
professional service has the same meaning as in subsection 3(1) of the Health Insurance Act 1973.
psychiatric treatment means hospital treatment, or hospital‑substitute treatment, that is psychiatric care.
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.
registered podiatric surgeon means a podiatric surgeon who holds specialist registration in the specialty of podiatric surgery under the National Law.
Note: The registration requirements for a registered podiatric surgeon for the purpose of these Rules are the same registration requirements for podiatric surgeons as set out in rule 8 of the Private Health Insurance (Accreditation) Rules as made from time to time.
silver policy means an insurance policy that:
(a) covers hospital treatment; and
(b) covers at least the treatments in all of the clinical categories indicated for a silver policy in Schedule 4; and
(c) is not a gold policy.
specialist psychiatric treatment means psychiatric treatment provided to a person who is:
(a) an admitted patient of a hospital; and
(b) under the care of an addiction medicine specialist or consult psychiatrist.
State, when used in Schedule 1, Schedule 2 or Schedule 3, means a risk equalisation jurisdiction.
Note: The risk equalisation jurisdictions are set out in the Private Health Insurance (Health Benefits Fund Policy) Rules 2015. Under those rules, the area specified in each of the following paragraphs is a risk equalisation jurisdiction:
Note: (a) Australian Capital Territory, Norfolk Island and New South Wales;
Note: (b) Northern Territory;
Note: (c) Queensland;
Note: (d) South Australia;
Note: (e) Tasmania;
Note: (f) Victoria;
Note: (g) Western Australia and the Territory of Christmas Island and the Territory of Cocos (Keeling) Islands.
upgrade, in relation to psychiatric treatment, has the meaning given by subrules 9A(2) and (3).
Note: Unless the contrary intention appears, terms used in these Rules have the same meaning as in the Act― see section 13 of the Legislative Instruments Act 2003. These terms include:
adult
applicable benefits arrangement
complying health insurance policy
complying health insurance product
cover
dependent non‑student
dependent person
dependent person with a disability
dependent student
general treatment
hospital cover
hospital‑substitute treatment
hospital treatment
medical practitioner
medicare benefit
policy holder
private health information statement
private health insurer
product
product subgroup
risk equalisation jurisdiction
rules [of an insurer]
transfer
waiting period