Private Health Insurance Changes
Here's what you need to know

The new Gold, Silver, Bronze and Basic tiers introduced by the Australian Government require all heath funds to cover the same clinical categories (groups of hospital and medical services) under each tier. This means that existing Hospital products must be made compliant with the new legislative tiers. And, we must all use the same language across the industry, so it becomes easier for you to compare and make an informed decision.

To ensure there is still some ability for insurers to differentiate themselves and remain competitive in the market, health funds will be allowed to introduce ‘Plus’ products. A Bronze Plus product, for example, must include all of the services covered on the base Bronze product, plus other services not included in that tier.

Click here to view the details of the Government’s new base tiers, which show the services that are covered under each tier.

In addition to the new tiered system, the Government has also announced the introduction of Clinical Categories. These new groupings of hospital and medical services are designed to ensure there’s greater clarity of what is and isn’t covered under each policy to help you make informed decisions on your cover. Let’s look at the clinical category of ‘Back, Neck and Spine’ as an example. This category covers hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion. However, joint replacements, joint fusions, spinal cord conditions, back pain and chemotherapy aren’t part of this category, they’re listed under different ones.

Mental Health is one of the most complex issues in today’s society and chances are, you’ve known someone (or are someone) who has been affected by mental health issues. So, as a priority the Government launched the first of its changes to private health insurance back in April 2018. This change gives you the opportunity to upgrade your Hospital cover once in your lifetime to take advantage of a higher level of cover for mental health issues and drug and alcohol treatment when it’s needed. By upgrading for this reason, you’re exempt from serving waiting periods for these services. The waiting period exemptions will make it much easier to get the in-hospital care when it’s needed.

From 1 April 2019 health funds will have the option to offer discounts to members aged 18-29 years to encourage them to take out private hospital cover at a younger age. Insurers have the option to offer premium discounts on Hospital cover of 2% for each year that a person is aged under 30 when they first purchase hospital insurance, to a maximum of 10% for 18 to 25 year olds. This is optional and won’t be adopted by all insurers or applied to all products.

Health funds will also be allowed to pay benefits on travel and accommodation for members living in regional areas from 1 April 2019.

Private health insurers will be permitted to offer higher excess options on Hospital cover from 1 April. A higher excess reduces your premium, but it does mean that if you’re ever admitted to hospital for in-patient treatment, you’ll have to pay the excess first before HIF and Medicare can pay their amounts.

From 1 April 2019, health insurers will no longer be permitted to provide cover for some natural therapies. This change follows a recent review by the Commonwealth Chief Medical Officer, which reported there was no clear evidence demonstrating the efficacy of a number of natural therapies. For HIF members, this means that we won’t be able to pay benefits for homeopathy, naturopathy, pilates and yoga from April 1. But don't worry - you’ll still be able to claim for acupuncture, Traditional Chinese Medicine and remedial massage.