Private Health Insurance Changes

Back to all news 14 December 2018

Private health insurance continues to be in the spotlight as policy makers, health providers and insurers seek ways to ease the financial pressure on consumers and make it easier for consumers to understand.

We support reducing the cost of health care, providing consumers with transparency and minimising waste in the health system. A number of government reforms have already been implemented and more will roll out in 2019.

2019 changes

Standard clinical definitions and product tiers

Covers affected: All hospital covers.

The government is implementing standard definitions of procedures and therapies for all hospital insurance policies. These will be divided into 37 clinical categories that use simple language rather than medical jargon.

Policies will be 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 category it can have ‘plus’ added to its name (e.g. silver+ or bronze+).

Generally, the minimum requirements for each category are:

Gold

No restrictions or exclusions on any medically necessary hospital treatment.

Silver

Allows for exclusions on a number of high cost services such as pregnancy, dialysis, cataract surgery and weight loss surgery, but must cover cardiac, spinal surgery and dental surgery, among others.

Bronze

More exclusions while still covering many common procedures including chemotherapy, endoscopy, general surgeries (such as appendix, tonsils and hernia) and joint reconstructions.

Basic

Only covers rehabilitation, hospital psychiatric services and palliative care which can be on a restricted basis only (meaning high out-of-pocket costs for patients).

To fit our current policies into the appropriate tier, restrictions may be removed from some services, and some that are partially covered may be excluded. We expect there to be some wins and losses for our members and have tried to minimise the impact of these wherever possible. Any changes to individual covers will be advised to members during our annual premium change communication due to go to members by the end of February.

Natural therapies changes

The new government legislation will prevent private health funds from covering some natural therapies including Bowen therapy, naturopathy and yoga.

Pilates will be excluded, however, we are waiting for clarification from the Department of Health on how this type of treatment conducted by a physiotherapist will be impacted.

Acupuncture and remedial massage will still be covered.

New excess levels

Private health insurers will be able to offer products with higher excesses from 1 April 2019. Members will be 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 are looking at introducing 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.

Prostheses reforms

If you’re having surgery you may have a prosthesis implanted or inserted. Prostheses can include manufactured body parts, human tissue items and other medical devices.

We pay your private hospital a benefit for surgically implanted prostheses if:

  • you are covered for the treatment; and
  • the product is on the government’s Prostheses List.

The Prostheses List includes over 10,000 items and shows the amount private health insurers must pay for each item. Private prostheses costs are generally higher than the equivalent product used in the public sector and reforms have commenced to redress the balance.

More information

To find out more about all the Private Health Insurance reforms, see the government fact sheets.