What are the Major Changes of the Health Insurance Reforms?

In early September, the Government passed an amendment to the private health insurance legislation. The goal is to make health cover simpler and more affordable for Australians. The changes as a result of this amendment will be rolled out on 1 April 2019. So what are some of the major health reform changes and how might they affect you?

A simplified tiered system

To make it easier for everyday Australians to identify, compare, research and take out health insurance, a tiered system for hospital cover will be mandatory for all insurers. Consumers will be able to choose from Gold, Silver, Bronze or Basic Hospital Cover. The easily identifiable tiers are designed to make policies more understandable and comparable.

What’s in and what’s out in each policy

The Government has clearly defined treatments and services, known as clinical categories, which must be included at each product tier level. This means that there are a number of treatments which must be included in each tier but the insurer also has the ability to add further treatments should they wish. It also means that all insurers must use the same language for hospital procedures to minimise confusion by everyone.

Some natural therapies are being removed

A number of natural therapies will no longer be covered on any Extras policy. Chinese medicine and remedial massage will continue to be allowed to be covered.

There are some non-compulsory items too

  • Age-based discounts for 18-29 year olds may be offered to encourage younger Australians to take out health insurance.
  • Hospital policies are now allowed to offer travel and accommodation benefits for those living in regional areas.
  • The excess that you choose when signing up for your policy is now allowed to be increased.

Mental health access

Those on low-tier policies who have limited access to mental health cover are being given the option of having their waiting periods waived if they want to upgrade their policy to access mental health services. This reform came into effect on 1 April 2018 and aims to allow people to get access to in-hospital mental health services when they need it. However, the two-month waiting period can only be waived once.

Changes to Prosthesis List benefits

The government has recently lowered the minimum benefit repayable for most of the items named on the Prosthesis List (e.g. surgically implanted prostheses, human tissue items and other medical devices).

If you’re interested in learning more, you can always read the full Department of Health document - Private health insurance 2017 reforms

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