Criteria for Type C Banding

In accordance with the Private Health Insurance Act 2007 and Private Health Insurance (Benefit Requirements) Rules 2011, Type C procedures do not normally require hospital treatment. However, under certain situations minimum private health insurance benefits are payable for patients admitted to hospital to receive a certified Type C procedure. For benefits to be payable, the medical practitioner providing the procedure must certify in writing that it would be contrary to accepted medical practice to provide the procedure unless the patient is given hospital treatment because of 1) the patient’s medical condition or 2) other special circumstances.

To assist medical practitioners to complete Type C Banding Certification for private health insurance claims, the following criteria for Type C Banding Certification Form (the Form) have been developed and endorsed by the Australian Society of Plastic Surgeons, the Australasian College of Dermatologists, General Surgeons Australia and the Australian Medical Association.

For full details please read here.