Prescribed List
The Private Health Insurance (Medical Devices and Human Tissue Products) Rules is a legislative instrument made under the Private Health Insurance Act 2007. The Schedule to the Rules is known as the Prescribed List of Medical Devices and Human Tissue Products (the Prescribed List).
The law requires private health insurers to pay a benefit for a medical device or human tissue product if:
- a Medicare benefit is payable for a service associated with the use of the device or product
- the device or product is on the Prescribed List
- the device or product has been used for or implanted into you as part of hospital treatment or hospital substitute treatment
- you have appropriate health insurance to cover for the treatment.
The Prescribed List shows the minimum benefits insurers are required to pay for listed devices or products.
What devices or products are listed
Devices and products currently listed on the Prescribed List include surgically implanted medical devices, devices designed and essential for implantation or for maintaining the implant, human tissue products and other specified devices.
There are more than 11,000 devices or products listed on the Prescribed List, including:
- hip, knee or shoulder joint replacement devices
- cardiac implantable electronic devices, like pacemakers and implantable cardioverter defibrillators
- vascular and cardiac stents
- human tissue items like bone or bone fragments, vascular grafts, corneas and heart valves
- insulin infusion pumps
- cardiac ablation catheters
- cardiac remote monitoring systems.
What devices or products are not included
Devices or products not eligible to be listed on the Prescribed List include:
- external devices, like prosthetic limbs or external breast prostheses
- surgically implanted devices, not purposely designed for replacing an anatomical body part, or combat a pathological or modulate a physiological process, such as some cosmetic implants
- devices intended to be used for diagnostic purposes.
Out of pocket costs
If you have an appropriate cover, and the device or product listed on the Prescribed List was provided to you, or used during procedure, or implanted into your body as part of your hospital treatment, you should not have any out of pocket costs.
But if the minimum benefit set up on the Prescribed List is less than the cost of the product, you might have to pay the difference.
Before you have your treatment, discuss the cost and your cover with:
- your health insurer
- your treating doctor
- the hospital you will be treated at.
Read more about out of pocket costs.
The Prescribed List for insurers
Private hospitals and health insurers use the Prescribed List to keep their claims and payments systems up to date.
For updates on Prescribed List changes and other matters related to private health insurance see our private health insurance circulars.
Prescribed List reforms
Learn more about the Prescribed List reviews and reforms.
How to list a device or product on the Prescribed List
Learn more about listing devices products on the Prescribed List.