PRIVATE HEALTH INSURANCE REFORMS

The Australian Government’s private health insurance reforms are designed to make health cover easier to understand and more affordable. 

Some of the changes were simple and made quickly. Others won't be complete until April 2020.  

Here’s a summary of the major changes. Some will affect you, others may not, but it’s a useful snapshot of what’s changing and why. 

If a change does affect you we’ll let you know. We want to be transparent and help you understand your health cover and how you can get the most out of it. 

For more information, and the full list of reforms, visit The Department of Health. If you have any questions or want to check that you’re on the right cover for you and / or your family, call 13 13 34, visit a branch or email us.

What's changing & When  What it means 

Simpler cover categories 

(1 April 2019 – April
2020)

All hospital cover in Australia will be classified as either Gold, Silver, Bronze or Basic. The government has set out which treatments and services each category needs to include (as a minimum).

This will make it easier to compare different policies, and get the cover that's right for you.

To fit our hospital cover into the categories, there may be positive changes to your cover, and / or some negative.

We’re contacting all our members to explain what the category changes will mean. We’ll be working on this through to April 2020, so don’t worry if you don’t hear from us right away.

We’re here to help if you want to talk about your options. Just call us on 13 13 34, visit a branch or email us.

Clearer clinical definitions

(1 April 2019 – April 2020)

The government has advised that health funds need to use the same clinical definitions when referring to in-hospital treatments. 

This will make it easier for you to compare what is and isn’t covered, across products and funds.

Removal of selected natural therapies

(1 April 2019)

You’ll no longer be able to claim for certain natural therapies through extras cover. They are:

  • Alexander technique
  • aromatherapy
  • Bowen therapy
  • Buteyko
  • Feldenkrais
  • Western herbalism
  • homeopathy
  • iridology
  • kinesiology
  • naturopathy
  • Pilates
  • reflexology
  • Rolfing
  • shiatsu
  • tai chi
  • yoga.

We didn’t offer cover for everything listed above through our extras, but we’ve included the full list so you can see what’ll be excluded at every Australian health fund.

The government hasn’t excluded:

  • acupuncture
  • Chinese herbal medicine
  • remedial massage
  • myotherapy.

What you can claim for depends on your level of cover.

We’ll contact you if you’re affected by this government change.

Easier access to mental health treatment

(Completed April 2018)

If you need in-hospital mental health services, but aren’t currently covered for treatment in a private hospital, you can upgrade your hospital cover on the spot so you can claim for it straight away. There’s usually a 2 month waiting period.

You can only do this once in your lifetime.

More choice around your hospital excess

(1 April 2019)

We’ll increase our maximum excess option to $750 for singles and $1,500 for couples or families (on selected covers).

The excess is the amount you agree to contribute towards the cost of your hospital treatment. A higher excess reduces the cost of your cover. A lower excess means you’ll pay less if you make a claim, but your premium will be higher.

We don’t charge an excess for accident-related treatment, for any kids on your cover* or (on some levels of cover) for same day admissions.

* Excludes Accident Only cover

Youth discount

(2020)

The government wants to make it easier for younger people to get private health insurance, so it’s allowing health funds to discount premiums for people aged 18-29.

Although we're not offering age-based discounts, we've designed a new cover for young people. It includes treatments they're most likely to claim for and excludes those they aren't.

To help you manage your costs we’ve made it as affordable as we can.

Improved travel and accommodation benefits

(1 April 2019)

If you have hospital cover we're now able to contribute to the cost of your travel and accommodation if you need treatment at a hospital outside your area. We couldn't do this before under hospital cover. 

Health funds can choose whether to go ahead with this change or not. We’ve decided to because we want to make quality treatment more affordable and accessible for members who live in regional and rural areas. 

Lower prostheses costs 

(February
2018 – February 2020)

Some prostheses and medical devices (like replacement hip joints and pacemakers) are now cheaper. We expect more cost reductions over the next couple of years. 

This saving is helping us maintain low premium increases.

learn more

REFORMS FAQS

Get more detail on the government's health insurance reforms and how they might affect you.

WHY should i have health cover?

Wondering why you should bother? Get the facts on what it could do for you – free of hard sell.

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Why we're different from the other major funds. And how that means great value for you.

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