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Private Health Insurance Amendment (GP Services) Bill 2014

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2013-2014

 

 

 

THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA

 

 

 

THE SENATE

 

 

 

Private Health Insurance Amendment (GP Services) Bill 2014

 

 

 

EXPLANATORY MEMORANDUM

 

 

 

(Circulated by authority of Senator R Di Natale)



 

Private Health Insurance Amendment (GP Services) Bill 2014

OUTLINE

As a rule, private health insurance in Australia covers treatment in private hospitals and by allied health providers who do not receive a rebate from Medicare. It does not cover treatment by general practitioners in private practice, even when a co-payment is payable by the patient. The Private Health Insurance Act 2007 contains provisions that prohibit private insurers from covering services for which a Medicare benefit is payable. However, there exists some ambiguity regarding whether a private insurer may contract with a medical clinic for other services that are not specific services that are covered by Medicare (such as a consultation with a GP) but are ancillary (such as receiving preferential treatment in obtaining the appointment).

In order to safeguard the integrity and efficiency of our universal insurer - Medicare - it is necessary to clarify that such arrangements, which create a two-tiered system that favours the insured, are against the spirit and intent of the law.

This Bill amends the Private Health Insurance Act 2007 to make it clear that private health insurers may not enter into arrangements with primary care providers that provide preferential treatment to their members.

NOTES ON CLAUSES

1.       Clause 1 - Short Title

This is a formal provision specifying the short title.

2.       Clause 2 - Commencement

This clause provides for the commencement of the Act on the day after it receives the Royal Assent.

3.       Clause 3 - Schedules

This clause provides that an Act that is specified in a Schedule is amended or repealed as set out in that Schedule, and any other item in a Schedule operates according to its terms.

 

Schedule 1 - Amendments of Private Health Insurance Act 2007

Item 1

This item inserts a new Part 3-7 which includes new section 105-5 regarding GP services.

Subsection (1) prohibits insurers from entering into an agreement or arrangement for general practice services or for preferential access to GP services. Examples might include obtaining appointments sooner, access to cheaper appointments, or availability of after-hours care not available to other patients.

Paragraph (1)(a) prohibits an insurer from arranging for services to be rendered by a GP.

Paragraph (1)(b) prohibits an insurer from obtaining preferential treatment in accessing GP services.

Subsection (2) defines GP service as general treatment as defined in the Act, for which a Medicare benefit is payable.

Items 2 and 3

These items are consequential amendments.



 

Text Box: Statement of Compatibility with Human Rights
 Prepared in accordance with Part 3 of the Human Rights (Parliamentary Scrutiny) Act 2011
 
 Private Health Insurance Amendment (GP Services) Bill 2014
 
 This Bill is compatible with the human rights and freedoms recognised or declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
 
 
 Overview of the Bill
 This Bill amends the Private Health Insurance Act 2007 to clarify allowed interactions between private health insurers and general practitioners.
 
 Human rights implications
 This Bill affects the right to healthcare as expressed for instance in item 12 of the International Covenant on Economic, Social and Cultural Rights. This Bill affirms the right to equal and universal healthcare for all Australians and so is compatible with this right.
 
 Senator Di Natale