Australian Government private health insurance reforms
We fully support reducing the cost of health care, providing consumers with transparency and minimising waste in the health system. The government has introduced a number of reforms to private health insurance with these goals in mind. These changes came into effect from 1 April 2019.
Standard clinical definitions and product tiers
Covers affected: All hospital covers.
The government implemented standard definitions of procedures and therapies for all hospital insurance policies. These are divided into 37 clinical categories that use simple language rather than medical jargon.
Policies are classified as Gold, Silver, Bronze and Basic, depending on how many of the clinical categories they cover. If a product covers more than the minimum requirements for its tier it can have ‘plus’ added to its name (e.g. Silver+ or Bronze+). Our Silver and Bronze covers offer more than the minimum requirements and earned the ‘plus’ rating.
Below are the minimum criteria the government has set for each tier. Please refer to the information in your rate change notice for any product changes that may be relevant to your level of cover.
Gold - no restrictions or exclusions on any medically necessary hospital treatment.
Silver - allows for exclusions while still covering many high cost services such as heart and vascular system, back, neck and spine and implantation of hearing devices, among others.
Bronze - has more exclusions while still covering many common procedures including chemotherapy, endoscopy, general surgeries (such as appendix, tonsils and hernia) and joint reconstructions.
Basic - must cover rehabilitation, hospital psychiatric services and palliative care on at least a restricted basis, and may cover other services on a restricted basis.
Here’s a side-by-side comparison of all of our hospital covers so you can compare your old product and what has changed from 1 April 2019. You can click on the name to open the detailed product guide.
The new government legislation prevents private health funds from covering some natural therapies including Pilates, Bowen therapy, naturopathy and yoga.
Acupuncture and massage are still covered.
More on Pilates
Pilates-informed exercises prescribed and provided by a registered physiotherapist or exercise physiologist as part of your treatment to manage or prevent a specific disease, injury or condition are covered.
Covers affected: Silver+ Family Hospital, Silver+ No Pregnancy Hospital and Bronze+ Hospital.
Private health insurers are able to offer products with higher excesses from 1 April 2019. Members are able to choose to remain on their existing policy or transfer to more affordable cover with a higher excess without impacting their quality of cover.
We have introduced new policies with a $750 excess option to sit alongside some of our existing products. As with all TUH policies, the excess does not apply to dependant children. Adult policy holders only pay the excess once in a calendar year even if they have multiple hospital admissions.
If you would like to discuss moving from your existing cover to a higher excess policy, please contact us.