Private Health Insurance Act 2007

CHAPTER 4 - HEALTH INSURANCE BUSINESS, HEALTH BENEFITS FUNDS AND MISCELLANEOUS OBLIGATIONS OF PRIVATE HEALTH INSURERS  

PART 4-2 - HEALTH INSURANCE BUSINESS  

Division 121 - What is health insurance business?  

SECTION 121-5   MEANING OF HOSPITAL TREATMENT  

121-5(1)    
Hospital treatment is treatment (including the provision of goods and services) that:

(a)    is intended to manage a disease, injury or condition; and

(b)    is provided to a person:

(i) by a person who is authorised by a ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital to provide the treatment; or

(ii) under the management or control of such a person; and

(c)    either:

(i) is provided at a hospital; or

(ii) is provided, or arranged, with the direct involvement of a hospital.

121-5(2)    
Without limiting subsection (1) , hospital treatment includes any other treatment, or treatment included in a class of treatments, specified in the Private Health Insurance (Health Insurance Business) Rules for the purposes of this subsection.

121-5(2A)    
Without limiting subsection (1) or (2) , hospital treatment also includes benefits for travel or accommodation relating to treatment covered by subsection (1) or (2) .

121-5(3)    
Without limiting subsection (1) or (2) , the reference to treatment in those subsections includes a reference to any of, or any combination of, accommodation, nursing, medical, surgical, podiatric surgical, diagnostic, therapeutic, prosthetic, pharmacological, pathology or other services or goods intended to manage a disease, injury or condition.

121-5(4)    
Despite subsections (1) , (2) and (2A) , treatment is not ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital treatment if it is specified in, or is included in a class of treatments specified in, the Private Health Insurance (Health Insurance Business) Rules for the purposes of this subsection.

121-5(5)    
A hospital is a facility for which a declaration under subsection (6) is in force.

121-5(6)    
The Minister may, in writing:

(a)    declare that a facility is a ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital; or

(b)    revoke such a declaration.

Note:

Refusals to make declarations, and revocations of declarations are reviewable under Part 6-9 .

121-5(7)    
In deciding whether to declare that a facility is a ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital, or to revoke such a declaration, the Minister must have regard to:

(a)    the nature of the facility; and

(b)    the range and scope of the services provided, or proposed to be provided, under the management or control of the facility and at or on behalf of the facility; and

(c)    whether the necessary approvals by a State or Territory, or by an authority of a State or Territory, have been obtained in relation to the facility; and

(d)    whether the accreditation requirements of an appropriate accrediting body have been met; and

(e)    whether undertakings have been made, or have been complied with, relating to providing to private health insurers information, of the kind specified in the Private Health Insurance (Health Insurance Business) Rules, relating to treatment of persons insured under ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

complying health insurance products that are ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

referable to ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

health benefits funds; and

(ea)    if the Minister is deciding whether to revoke such a declaration - any contravention of conditions to which the declaration is subject; and

(f)    any other matters specified in the Private Health Insurance (Health Insurance Business) Rules.

121-5(8)    
A declaration under subsection (6) that a facility is a ^[*]

To find definitions of asterisked terms, see the Dictionary in Schedule 1 .

hospital must include either a statement that the hospital is a public hospital or a statement that the hospital is a private hospital.