AMA Submission: Department of Health Consultation on the draft standard clinical definitions for private health insurance hospital treatment policies

The AMA has made a submission to the Private Health Ministerial Advisory Committee’s (PHMAC) latest draft of clinical definitions and MBS item mapping.

As a participant on the PHMAC, the AMA supports reform that simplifies and increases the value of private health insurance for consumers.

The submission outlines concerns that the consultation time frame was inadequate while the mapping of MBS items to the proposed Gold, Silver, Bronze and Basic product categories appears to have been done independently of key stakeholders, including relevant Department of Health Divisions including Medicare Benefits and Provider Benefits Integrity (Compliance).

The submission calls for:

  • more time to consider the mapping,
  • a more rigorous, consultative approach,  and 
  • further review of the proposed mapping to ensure that changes to private health insurance categorisation does not result in consumers experiencing an unexpected lack of coverage and out of pocket costs.

Click on the link below to access the full submission.

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