Summary of the fifteenth meeting of the Private Health Ministerial Advisory Committee, 11 September 2018, Department of Health offices (Scarborough House), Canberra

This page contains information on the Private Health Ministerial Advisory Committee – Meeting Summaries

Page last updated: 17 October 2018

Summary of the fifteenth meeting of the Private Health Ministerial Advisory Committee, 11 September 2018 (PDF 135 KB)


Members and proxiesSecretariat and Other Attendees
Dr Jeffrey Harmer AO, ChairSusan Azmi, Secretariat
Ian Burgess, Medical Technology Association of AustraliaPauline Dusink, Secretariat
Dr Rachel David, Private Healthcare AustraliaDi Prosser, Secretariat
Matthew Koce, Members Health Fund AllianceJosh Shanahan, Secretariat
Jane Griffiths, Day Hospitals AustraliaDavid Whelan, Secretariat (Item 3a)
Ian Yates AM, COTACarla Roots, Secretariat (Item 3b)
Jo Root, Consumers Health Forum (proxy)Tristan Gairey, Secretariat(Item 3c)
Penny Shakespeare, ex-officioPierre Nijssen, Secretariat (Items 4 &5)
Members by teleconferenceDavid Weiss, Department of Health, Observer
Garry Richardson, Expert member
Toby Hall, St Vincent’s Health Australia
Michael Roff, Australian Private Hospitals Association
Associate Professor Julian Rait OAM,
Australian Medical Association
Philip Truskett AM, Royal Australasian College of Surgeons


Tony Lawson, Consumers Health Forum
Marcus Dripps, Allied Health Professions Australia

1. Welcome, apologies and introductions
  • The Chair noted apologies for this meeting.
2. Legislation update
a) Primary legislation
  • The Department advised members that the Private Health Insurance Legislation Amendment Bill 2018 (and related Bills) passed the Senate on 10 September 2018 and would be returned to the House of Representatives for consideration of amendments.
  • An explanation was provided about Government amendments related to the new Private Health Insurance Ombudsman’s powers, and the process and usual timing for Royal Assent.
b) Rules amendments
  • The Department updated members about the publication of exposure drafts of the Private Health Insurance (Reforms) Amendment Rules 2018 and the Private Health Insurance (Complying Product) Amendment (Terminating Products) Rules 2018 (the Rules) on 16 July 2018 for comment by 3 August 2018.
  • Members were advised that the Department is considering feedback, which has been very helpful in identifying areas that require further work. Feedback has been a combination of high level concerns about the policies being introduced and detailed comments on drafting issues.
  • Members discussed some of the matters receiving significant feedback, including the content and language describing some clinical categories and linking MBS items to clinical categories.
  • The Department updated members on the timing for making amending Rules for information to consumers about terminating products, which is to occur between passage of the Bill and Royal Assent.
  • Members discussed the Department’s intended publication on its website of answers to matters raised through the consultation process, to help stakeholders understand the approach taken on those matters.
c) Product Design
  • The Committee noted that several stakeholders had made representations to the Government about the proposed minimum requirements for the Gold/Silver/Bronze/Basic product tiers.
  • The Committee also discussed the implementation timing issues associated with the product design reforms.
3. Implementation of Reforms Update
a) Improved Models of Care Working Group
  • The Department provided an update from the third Improved Models of Care Working Group (Working Group) meeting held on 21 August 2018.
  • The Working Group’s sub-groups (Rehabilitation and Mental Health) are on track to report back to the Working Group for its fourth meeting in October 2018.
  • In the meantime, the Working Group considered some of the issues that had been considered by the sub groups, including:
    • the principles to underpin appropriate models of care;
    • the impact of private health insurance regulation on providing alternative models of care;
    • what has been learnt from successful alternatives to admitted in hospital care; and
    • the benefits of pilot projects and challenges of rolling some pilot projects into normal cover.
  • The Working Group looked at some of the options for change that the sub groups are considering, including any issues that could be expected to be raised if those options are implemented. Of particular note is that stakeholders do not find the current regulations a barrier to alternative models of care, though there is some confusion among some stakeholders about what alternative models of care can be supported under the current regulation. PHMAC reaffirmed the Working Group and sub groups’ commitment that determining the model of care should be evidence based, clinician led and provide appropriate consumer choices.
b) Ministerial Advisory Committee on Out-of-Pocket Costs
  • The Department provided an update on the Ministerial Advisory Committee on Out-of-Pocket Costs (the Out-of-Pocket Costs Committee).
  • The Out-of-Pocket Costs Committee is chaired by the Chief Medical Officer and has membership representing consumers, insurers, hospitals and a range of specialist groups. A GP representative attended the most recent meeting.
  • Doctors’ concerns are being taken into consideration. Broad consultation and feedback will be sought during the development of any option to increase transparency around specialists’
  • out-of-pocket costs.
  • Members discussed the importance of information being available about the team of people who may contribute to the final costs incurred by consumers. Members also considered that there are a number of challenges likely to face potential models for transparency (for example, around data completeness and keeping information updated and accurate).
  • The key work of the Out-of-Pocket Costs Committee is expected to be concluded this year, through a report to the Minister.
c) Second tier
  • The Department provided an update on the progress of second-tier administrative reforms.
  • The reforms are on track for implementation by 1 January 2019.
  • The Department is considering feedback from recent consultations on the Private Health Insurance (Reforms) Amendment Rules 2018 and cost recovery arrangements for administration of second-tier default benefits.
  • The Department will shortly consult on draft guidelines for second-tier arrangements and categorisation of hospitals for second-tier default benefits.
4. Premium Round
  • The Department provided an update on the 2019 premium process.
  • The 2019 premium round has commenced with the release of the premium application form on 31 August 2018. This year applications will be submitted later than usual. Insurers have until 3pm 23 November to submit their application.
  • The Department advised that industry consultation forums were held on 9 and 10 August, in Sydney and Melbourne. The forums are an annual event and an important part of the process in outlining the application form, process, and timelines.
5. Other Business