A prosthesis is a surgically implanted device that replaces a damaged body part. Prostheses include complex and sophisticated devices such as hip and knee replacements, cardiac stents, pacemakers, as well as more common items such as intraocular lenses.
Under the Private Health Insurance Act 2007, private health insurance funds are required to pay benefits for a range of prostheses that are provided as part of an episode of hospital treatment or hospital substitute treatment for which a patient has cover and for which a Medicare benefit is payable for the associated professional service.
The Australian Government Department of Health and Ageing produces the Prostheses List which contains the prostheses and human tissue products that attract health funds benefits and the number of benefits to be paid.
MTAA provides non-aligned medical technology industry representatives on government committees involved in the prostheses listing processes. Please follow the link for a list of members of the Prostheses List Advisory Committee (PLAC).
The Prostheses List is approved by the Minister for Health and Ageing or her delegate by means of a parliamentary disallowable instrument. Once listed, surgeons and their patients can access over 9,000 prostheses the majority of which are available without a gap or patient co-payment.
The latest Prostheses List is available on the Department of Health and Ageing's website.
The Private Health Insurance (PHI) circulars are distributed by the Department of Health and Ageing and contain information about the operation of private health insurance and the licensing of new private hospitals and day hospital facilities in Australia.
The Prostheses List Advisory Committee (PLAC) Bulletins provide information about the current and future Prostheses List cycles.