What are the new clinical categories under Hospital Cover?

A new list of clinical categories for hospital treatment was introduced from April 2019.

To make it easier for everyday Australians to understand, a new list of clinical categories for hospital cover is now mandatory for all insurers. 

What does this mean?

Private health insurers are required to use standard clinical categories across all documentation and across all platforms. These clinical categories have been introduced from 1 April 2019. 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, easy to understand and designed to cover all services. Consumer testing has been done to ensure that the list of clinical categories is appropriate for use by consumers.

Details of the clinical categories are in the Private Health Insurance (Reforms) Amendment Rules 2018 and are in the table attached below.

Why is this important?

The Government’s private health insurance consultations revealed that a key concern for consumers was complexity and ease of understanding of private health insurance products. Therefore, introducing a standardised set of clinical categories which define inclusions and exclusions will help consumers make an informed choice about private health insurance and what different products do, and do not, cover.

Who will benefit?

The clinical categories will assist Members to understand their own products and allow them to compare and understand different health insurance policies.

Clinical Categories - your need-to-know guide.

View all the clinical categories, including definitions and included services.

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