8Complying products―coverage requirements

8 Complying products―coverage requirements

(1) For subsection 69‑1 (2) of the Act, a policy of a kind specified in the following table must also cover any treatment as specified in the table.

<table cellspacing="0" cellpadding="0" style="width:100%; border-collapse:collapse"><thead><tr><td colspan="3" style="border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Coverage requirements</span></p></td></tr><tr><td style="width:10.08%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Item</span></p></td><td style="width:44.4%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Kind of policy</span></p></td><td style="width:45.52%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt; font-weight:bold">Treatments the policy must cover</span></p></td></tr></thead><tbody><tr><td style="width:10.08%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">1</span></p></td><td style="width:44.4%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">A policy that includes cover for hospital</span><span style="font-size:10pt">‑</span><span style="font-size:10pt">substitute treatment.</span></p></td><td style="width:45.52%; border-top:1.5pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">Hospital treatment for the same types of treatment covered by the policy for hospital</span><span style="font-size:10pt">‑</span><span style="font-size:10pt">substitute treatment.</span></p></td></tr><tr><td style="width:10.08%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">2</span></p></td><td style="width:44.4%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">A policy under which a person is covered, wholly or partly, for hospital treatment where:</span></p><p class="Tablea"><span>(a) the treatment includes the provision of a kind of medical device or human tissue product that is listed in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules, made under the Act, as in force from time to time; and</span></p><p style="margin-top:3pt; margin-left:13.95pt; text-indent:-13.95pt; line-height:12pt"><span style="font-size:10pt">(b)</span><span style="width:2.29pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">either:</span></p><p style="margin-top:3pt; margin-left:27.9pt; text-indent:-13.95pt; line-height:12pt"><span style="font-size:10pt">(i)</span><span style="width:4.51pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">a medicare benefit is payable in respect of the professional service associated with the provision of the medical device or human tissue product; or</span></p><p style="margin-top:3pt; margin-left:27.9pt; text-indent:-13.95pt; line-height:12pt"><span style="font-size:10pt">(ii)</span><span style="width:1.73pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">the provision of the medical device or human tissue product is associated with podiatric treatment by a registered podiatric surgeon; or</span></p><p style="margin-top:3pt; margin-left:27.9pt; text-indent:-13.95pt; line-height:12pt"><span style="font-size:10pt">(iii) for a medical device or human tissue product that is an insulin infusion pump:</span></p><p style="margin-top:3pt; margin-left:43.95pt; text-indent:-18pt; line-height:12pt"><span style="font-size:10pt">(A) the insulin infusion pump is provided during a professional service for which a medicare benefit is payable; and</span></p><p style="margin-top:3pt; margin-left:43.95pt; text-indent:-18pt; line-height:12pt"><span style="font-size:10pt">(B) the professional service is a professional attendance by a consultant physician in the practice of his or her specialty; and</span></p><p style="margin-top:3pt; margin-left:43.95pt; text-indent:-18pt; line-height:12pt"><span style="font-size:10pt">(C) the professional service is provided as a certified Type C procedure or certified overnight Type C procedure; and</span></p><p style="margin-top:3pt; margin-left:43.95pt; text-indent:-18pt; line-height:12pt"><span style="font-size:10pt">(D) the insulin infusion pump is provided for the purpose of administering insulin.</span></p></td><td style="width:45.52%; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">The provision of the medical device or human tissue product.</span></p></td></tr><tr><td style="width:10.08%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; line-height:12pt"><span style="font-size:10pt">3</span></p></td><td style="width:44.4%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt">A policy under which a person is covered, wholly or partly, for hospital</span><span style="font-size:10pt">‑</span><span style="font-size:10pt">substitute treatment where:</span></p><p class="Tablea"><span>(a) the treatment includes the provision of a medical device or human tissue product of a kind listed in the Private Health Insurance (Medical Devices and Human Tissue Products) Rules, made under the Act, as in force from time to time; and</span></p><p style="margin-top:3pt; margin-left:13.95pt; text-indent:-13.95pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt">(b)</span><span style="width:2.29pt; text-indent:0pt; font-size:10pt; display:inline-block"> </span><span style="font-size:10pt">a medicare benefit is payable in respect of the professional service associated with the provision of the medical device or human tissue product.</span></p></td><td style="width:45.52%; border-top:0.75pt solid #000000; border-bottom:1.5pt solid #000000; padding-right:5.4pt; padding-left:5.4pt; vertical-align:top"><p style="margin-top:3pt; page-break-inside:avoid; page-break-after:avoid; line-height:12pt"><span style="font-size:10pt">The provision of the medical device or human tissue product.</span></p></td></tr></tbody></table>