PHI 09/19 - March 2019 Prostheses List – Benefit Changes

Page last updated: 20 February 2019

PHI 09/19 - March 2019 Prostheses List – Benefit Changes (PDF 114 KB)

1 February 2019

This circular informs Prostheses List users about changes to benefits that will appear in the March 2019 Prostheses List.

Private Health Insurance Circular 47/18 (Prostheses List Benefit Reduction Rounding Issue – August 2018) informed users that a rounding issue had been identified with the implementation of the Prostheses List Benefit Reductions that took effect from 1 August 2019. The circular stated that this issue would be addressed in the March 2019 Prostheses List.

The spreadsheet at Attachment A provides the current and revised benefits for the 464 groupings of prostheses impacted by the rounding issue.

Under the Government Agreement with the Medical Technology Association of Australia (MTAA), the remaining benefit premium for devices listed in the Hip and Knee categories with the SCP suffix for “superior clinical performance” was to be removed with effect from 1 February 2019. As the Prostheses List is now made three times per year, it is not practicable to do this. Instead, these changes will be made in the Prostheses List to take effect from 1 March 2019. The benefits for these devices will be reduced to the group benefits for devices in the same groupings but without the SCP suffix.

The spreadsheet at Attachment B provides the current and revised benefits for the 34 groupings of prostheses impacted by the removal of the benefit premium for SCP.

These benefit changes were not reflected in the draft Prostheses List circulated to sponsors with prostheses listed on the Prostheses List on Thursday 24 January 2019.

The March Prostheses List is now being revised now to apply the benefit reductions as appropriate.

If you have any queries or concerns about this matter, please email to the Prostheses Section at Prostheses@health.gov.au with “March 2019 Benefits Changes” in the Subject field.

Attachment A (PDF 262 KB)
Attachment A (Excel 206 KB)

Attachment B (PDF 75KB)
Attachment B (Excel 14 KB)