Private Health Insurance Reforms

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Reforms

A message from the CEO

Members are at the HEART of what we do.

Changes to private health insurance in 2019

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

As a result, it 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?

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

The reform package includes changes such as:

Categorising hospital insurance products as Gold/Silver/Bronze/Basic so members can better understand their level of cover.
Introducing standardised clinical categories for treatments so members know what is covered.
Reducing minimum benefits for prostheses that private health insurers must pay to place downward pressure on premium increases.
Additional support for mental health, so members with hospital cover can upgrade their cover to access mental health services without serving 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?

We notified our members of the specific changes to their cover in February 2019. Here is a quick guide on the main changes:

Updated 14 March 2019

Changes to Hospital covers
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. We’ve added a new product and made some amendments to current products.	1 April 2019	All our products will align to a Gold/Silver/Bronze/Basic tier. An overview of the changes is available here.
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	Members have been notified of changes to their products, so they are aligned to the new categories. An overview of the changes is available here.
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 have been passed onto members as part of premium calculations for 2019.
Mental health cover upgrade	Members with limited mental health cover can upgrade their cover to access in-hospital psychiatric services services without having to serve a waiting period.	1 April 2018	Members with limited mental health cover can upgrade their cover to access in-hospital psychiatric services without serving the 2-month waiting period. Members can only use this upgrade option once in a lifetime.
Changes to Extras covers
Item	Changes	Timing	What it means for members
Removal of cover for a range of natural therapies	All health funds are no longer permitted to cover a range of natural therapies from 1 April 2019 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 continue to be allowed to claim for remedial massage, myotherapy, Chinese herbal medicine consultations and acupuncture. Any savings made from the removal of these natural therapies have been redistributed into benefit improvements.