The Private Health Insurance Legislation Amendment Rules (No. 4) 2025 (the Amendment Rules) amend the:
- Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules).
- Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Rules).
The Amendment Rules were registered on the Federal Register of Legislation on 17 March 2025. Advanced notification was also emailed to stakeholders on 14 March 2025.
We administer private health insurance under the Private Health Insurance Act 2007 and associated rules.
The Amendment Rules amend the:
- Complying Product Rules to increase the daily patient contribution payable by a nursing-home type patient (NHTP) in private hospitals nationally and public hospitals in all states and territories except for the Australian Capital Territory (ACT).
- Benefit Rules to update the benefits payable by private health insurers per night for NHTPs in private hospitals nationally and public hospitals in New South Wales (NSW), Tasmania (Tas), Victoria (Vic) and Western Australia (WA). Benefits payable in the ACT, Northern Territory (NT), Queensland (Qld) and South Australia (SA) remain unchanged.
Nursing Home Type Patient (NHTP) accommodation indexation
NHTP contributions and minimum insurer benefits are indexed by the Commonwealth twice annually, on 20 March and 20 September. Jurisdictions are consulted on changes to rates in public hospitals. Some jurisdictions apply the changes from July or September, annually. Total fees and charges for privately insured NHTPs in public hospitals are determined by the state or territory in which the patient is receiving hospital treatment.
Patient contribution
The daily patient contribution rate payable by a NHTP in hospital is set out in the Complying Product Rules Part 2 – 8A(3) Benefit requirement – nursing-home type patients.
The table below shows the daily patient contribution payable by a NHTP in hospital from 20 March 2025, as described in the Amendment Rules that will be incorporated into the Complying Product Rules.
| Daily patient contribution for each day as a nursing-home type patient (NHTP) at a hospital | |
|---|---|
| Public hospitals | Patient contribution for each day a NHTP |
| Australian Capital Territory | $75.55 NO CHANGE |
| New South Wales | $78.95 |
| Northern Territory | $78.95 |
| Queensland | $78.95 |
| South Australia | $78.95 |
| Tasmania | $78.95 |
| Victoria | $78.95 |
| Western Australia | $78.95 |
| Private hospitals | Patient contribution for each day a NHTP |
| Private hospitals all states and territories | $78.95 |
Benefit payable by private health insurers for NHTP
The benefit payable per night by private health insurers for NHTP in hospitals is set out in the Benefit Rules Schedule 4 – Nursing-home type patient accommodation: hospitals in all states/territories, Part 6.
The table below shows the benefit payable by insurers for NHTP from 20 March 2025, as described in the Amendment Rules that will be incorporated into the Benefit Rules.
| Benefit payable per night by insurers for nursing home type patient accommodation | |
|---|---|
| Public hospitals | Benefit per night |
| Australian Capital Territory | $147.45 NO CHANGE |
| New South Wales | $183.40 |
| Northern Territory | $155.59 NO CHANGE |
| Queensland | $145.80 NO CHANGE |
| South Australia | $146.00 NO CHANGE |
| Tasmania | $189.50 |
| Victoria | $166.72 |
| Western Australia | $153.15 |
| Private hospitals | Benefit per night |
| Private hospitals all states and territories | $32.15 |
More information
Further details on the amendments are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation website by searching ‘Private Health Insurance Legislation Amendment Rules (No. 4) 2025’ or Register ID ‘F2025L00366.’
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