Australian Government private health insurance reforms

From 1 April, 2019 premiums on most covers will change. Click here to find out why.

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 will come into effect from 1 April 2019.

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 38 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 tier it can have ‘plus’ added to its name (e.g. Silver+ or Bronze+). TUH is committed to providing members with high quality cover and will not offer a Basic level cover. Our Silver and Bronze covers offer more than the minimum requirements and will earn 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 current product and what will change from 1 April 2019. You can click on the name to open the detailed product guide.

Download fact sheet

Removal of some natural therapies

Covers affected: all extras covers

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

Acupuncture and massage will still be 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.

Visit Department of Health for details

New excess levels

Covers affected: Silver+ Family Hospital, Silver+ No Pregnancy Hospital and Bronze+ Hospital.

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 will introduce 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.