9ASpecialist psychiatric treatment—portability requirements

9A Specialist psychiatric treatment—portability requirements

(1) For the purposes of subsection 78‑1(6) of the Act, subrules (4) to (8) of this rule modify the requirements of section 78‑1 of the Act in relation to:

(a) an insurance policy (the new policy) to which a person transfers from another policy (the old policy), if:

(i) the transfer is an upgrade in relation to psychiatric treatment; and

(ii) the person chooses under rule 9B to have the upgrade treated in accordance with those subrules; and

(b) a benefit (the higher benefit) under the new policy for specialist psychiatric treatment provided to the person.

(2) The transfer is an upgrade, in relation to psychiatric treatment, if the benefit for psychiatric treatment under the new policy is higher than the benefit for psychiatric treatment under the old policy.

(3) For the purposes of subrule (2), disregard any co‑payment or excess that is required to be paid under the old policy or the new policy in respect of psychiatric treatment.

Waiting periods

(4) The new policy must not:

(a) if the length of the person’s period of pre‑upgrade hospital cover was 2 months or longer—apply to the person a waiting period for the higher benefit; or

(b) otherwise—apply to the person a waiting period for the higher benefit that is longer than 2 months reduced by the length of the person’s period of pre‑upgrade hospital cover.

(5) The person’s period of pre‑upgrade hospital cover is the longest period:

(a) that ended immediately before the upgrade; and

(b) at all times during which the person had hospital cover.

Retrospective cover

(6) Subrules (7) and (8) apply if the upgrade occurs:

(a) on or after the day (the admission day) the person became an admitted patient of a hospital in relation to the specialist psychiatric treatment mentioned in paragraph (1)(b); and

(b) on or before the fifth business day to occur on or after the admission day.

(7) The new policy’s coverage of specialist psychiatric treatment must start no later than the admission day.

Example: A person is admitted to hospital for specialist psychiatric treatment. The person’s insurance policy provides minimum benefits for psychiatric treatment. 3 business days later, the person upgrades to a new policy and chooses to have the upgrade treated in accordance with subrules (4) to (8). The higher benefits under the new policy for specialist psychiatric treatment must apply from the day of the admission.

(8) Subrule (7) does not prevent the new policy from applying a waiting period in accordance with subrule (4). The reference in paragraph (5)(a) to the upgrade is taken to be a reference to the start of the new policy’s coverage of specialist psychiatric treatment.