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What do the private health insurance reforms mean for you?

20 March, 2020
PHI Reforms

Comparing hospital policies from different health insurers can be a confusing process. To make it easier, the Australian Government introduced reforms to private health insurance in April 2019.  

The changes mean that private health insurers need to classify their hospital covers into one of four tiers: Gold, Silver, Bronze or Basic. They need to do this by 1 April 2020.

Four product tiers

  1. 1. Basic

    The Basic tier must cover a minimum of three categories:

    • Rehabilitation
    • Psychiatric care
    • Palliative care
  2. 2. Bronze

    The Bronze tier must also include the following categories:

    • Joint reconstruction
    • Ear, nose, and throat
    • Gynaecology
    • Male reproductive system
    • You can find all the Bronze tier categories at the Department of Health.

  3. 3. Silver

    The Silver tier must also include the following categories:

    • Heart and vascular
    • Back, neck and spine
    • You can find all the Silver tier categories at the Department of Health.

  4. 4. Gold

    The Gold tier must also include the following categories:

    • Cataracts
    • Joint replacement
    • Pregnancy and birth
    • You can find all the Gold tier categories at the Department of Health.

What are Plus products?

Insurers can provide cover for additional services on Silver, Bronze and Basic products.  These are known as “Plus” products.  For example – Bronze Plus covers all minimum services for the Bronze tier, plus additional services selected by the insurer.

Gold products are the highest level of cover available.  Gold products must offer all services on an unrestricted basis.

Clinical categories

As part of these Reforms, the Government has also created a new list of clinical categories.  These categories make it simple to understand what you are covered for.

Health insurers must now use the Government’s categories across all products when displaying what’s covered or not covered under each hospital product.

The Clinical Definitions Working Group, established by the Private Health Ministerial Advisory Committee, has developed a list of standard clinical categories which is consumer-friendly and easy to understand.

How this might affect your cover

Each CBHS product has been categorised into Gold, Silver, Bronze or Basic.  Most CBHS products moved seamlessly into the new tiers and will cover more services than the Government’s minimum standards.  In some cases, there may be products that will have some changes to the services covered. 

More information

Sources

https://www.health.gov.au/resources/publications/private-health-insurance-reforms-gold-silver-bronze-basic-product-tiers-fact-sheet

https://www.choice.com.au/money/insurance/health/articles/health-insurance-reforms-131017

https://www1.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reforms-fact-sheet-standard-clinical-definitions

All information contained in this article is intended for general information purposes only. The information provided should not be relied upon as medical advice and does not supersede or replace a consultation with a suitably qualified Health Care Professional.

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