10Benefits for listed items provided as part of hospital treatment

10 Benefits for listed items provided as part of hospital treatment

(1) This section is made for the purposes of paragraph (a) of the column headed “The amount of the benefit must be …” in item 4 of the table in subsection 72‑1(2) of the Act and sets out the amount (or method for working out the amount) that is the minimum benefit for a listed item provided as part of hospital treatment. Listed items (other than specified listed items)—private hospitals (2) For a listed item (other than a specified listed item) provided as part of an episode of hospital treatment in a private hospital, the minimum benefit for the listed item is the amount specified in the column headed “Minimum benefit” of the table in Schedule 1 for the listed item. Specified listed items—private hospitals (3) For a specified listed item provided as part of an episode of hospital treatment in a private hospital, the minimum benefit for the specified listed item is the amount for the specified listed item worked out in accordance with subsection (6). Listed items (other than specified listed items)—public hospitals (4) For a listed item (other than a specified listed item) provided as part of an episode of hospital treatment in a public hospital, the minimum benefit for the listed item is the lesser of the following amounts: (a) the amount for the listed item specified in the column headed “Minimum benefit” of the table in Schedule 1; (b) the amount of the insured person’s liability to the public hospital for the listed item. Specified listed items—public hospitals (5) For a specified listed item provided as part of an episode of hospital treatment in a public hospital, the minimum benefit for the specified listed item is the lesser of the following amounts: (a) the amount for the specified listed item worked out in accordance with subsection (6); (b) the amount of the insured person’s liability to the public hospital for the specified listed item. Minimum benefits for specified listed items—private and public hospitals (6) The amount for a specified listed item worked out in accordance with this subsection is: (a) if the sum of default minimum benefits for the treatment in which the specified listed item was used is $6,399 or less—the default minimum benefit for the specified listed item; or (b) if the sum of default minimum benefits for the treatment in which the specified listed item was used is more than $6,399—the amount worked out by dividing the default minimum benefit for the specified listed item by the sum of the default minimum benefits for the treatment in which the specified listed item was used and multiplying the result by $6,399.

Note: Example: If an irrigated cardiac ablation catheter, a mapping catheter for cardiac ablation and a patch for cardiac ablation are each listed in Schedule 1 and are used in a relevant treatment in accordance with any conditions, and if:

(a) the default minimum benefit of the irrigated cardiac ablation catheter is X; and
(b) the default minimum benefit of the mapping catheter for cardiac ablation is Y; and
(c) the default minimum benefit of the patch for cardiac ablation is Z;

Note: then the sum of the default minimum benefits for the treatment is (X+Y+Z). If the sum of the default minimum benefits for the treatment (X+Y+Z) is more than $6,399, then the minimum benefit for the irrigated cardiac ablation catheter is worked out by taking X, dividing it by (X+Y+Z), then multiplying the result by $6,399.

(7) For the purposes of this section:

default minimum benefit for a listed item is the amount specified in the column headed “Minimum benefit” of the table in Schedule 1 for the listed item.

sum of default minimum benefits for a treatment is the sum of the default minimum benefits for each specified listed item used in the treatment.