Private Health Insurance Reforms

Private Health Insurance Reforms

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Frequently Asked Questions

Changes are coming to private health insurance in 2019

The Private Health Insurance (PHI) Reforms, announced by the Federal Government in 2017, will impact all private health insurers in Australia.

This means there will be changes to some of our products from 1 April 2019.

Here you’ll find out all you need to know about the changes – what they are, what they mean for you/your family and what we’re doing to support our members.

What are the PHI Reforms?

Back in October 2017, the Minister for Health, the Hon Greg Hunt MP, announced a series of reforms to private health insurance.

The reform package included changes such as:

  • Categorising hospital insurance products as Gold/Silver/Bronze/Basic so members can better understand their level of cover.
  • Bringing in standardised clinical categories for treatments so members know what is covered.
  • Reducing minimum benefits for prostheses paid by private health insurers to reduce costs for members.
  • Requiring health insurers to allow people with hospital cover without mental health treatment to upgrade and access mental health services without a waiting period (on a once-off basis).
  • Removing coverage for a range of natural therapies.

You can view a comprehensive list of the changes at health.gov.au to see how these may affect your cover.

What are the changes?

While we’ll communicate with members directly about the changes once they’re confirmed, here is a quick guide on how the reforms will impact some policies.

Updated 8 November 2018

Item

Changes

Timing

What it means for members

Gold/Silver/Bronze/Basic hospital cover categorisation

Current products will be categorised as Gold/Silver/Bronze or Basic. New products may be added, and some current products may change.           

1 April 2019

All our products will align to a Gold/Silver/Bronze/Basic tier – we are working on ensuring that there is a minimal impact to members.

Bringing in standard clinical definitions

Health funds will need to use standard clinical or medical definitions, which means the language used will be consistent and easy to understand across all policies.

1 April 2019

We will need to make minor changes to some of our products to align to the new categories, as not all our products map directly to the new categories.

 

Reduction in minimum benefits for prostheses

The cost of prostheses (items such as joint replacements or pacemakers) have increased significantly over recent years, driving up prices for consumers. To respond to this, the government has reset the prices so insurers now pay less for prostheses.

Implemented February 2018

Any savings made from this change will be passed onto members as part of premium calculations for 2019. New premiums will come into effect on 1 April 2019 and will be announced once the Federal Government has approved the rates.

 

Mental health cover upgrade

Members with limited mental health cover can upgrade their cover to access in-hospital mental health services without having to serve a waiting period.

1 April 2018

Members with limited mental health cover can upgrade their cover to access in-patient mental health treatment in hospital without serving the 2-month waiting period. Members can use this exemption only once in a lifetime.

Removal of cover for a range of natural therapies

Health funds will no longer be able to pay benefits to members for a range of natural therapies including: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.

1 April 2019

Members with cover that includes natural therapies will be allowed to claim for remedial massage, myotherapy, Chinese herbal medicine consultations and acupuncture.

Cover will be removed for natural therapies including: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.