Private Health Insurance reforms

What will the 2019 changes mean to you?

Widespread changes to Private Health Insurance (PHI), introduced by the Federal Government  will come into effect from 1 April. RACQ supports these changes to make private health insurance less complex and make it easier to compare policies across all providers, including RACQ Health Insurance.
 
The changes will affect Australians everywhere in a range of ways. Private Health Insurance customers will notice the name of their cover change, as all health funds will be required to include product tiers (Gold, Silver, Bronze and Basic) into their product names.
 
The changes will benefit women with breast cancer, as all medically-necessary breast surgery will be included in all Bronze tier cover, and young adults may be eligible for large discounts.
 
Australians with existing policies that include extras such as natural therapies will miss out the most, with a majority no longer covered.
 
Insurers have until 1 April 2020, to adopt all the requirements and tiers.

The tiers

The new changes are designed to make Private Health Insurance simple and affordable. Products will now be classified into four tiers of cover (Gold, Silver, Bronze and Basic) which are standardised across all health funds to make it easier to compare cover.
 
The four-tier classification system will allow Australians to know what is covered under each tier, with each product. The requirements for each tier are designed so most existing policies can be easily transferred.
 

Basic

A Basic policy covers treatment to the list below as a minimum requirement, but restrictions may apply:
  • Rehabilitation
  • Hospital psychiatric services
  • Palliative care
 

Bronze

Bronze offers the same cover as the Basic policy, plus unrestricted cover for the following:
  • Brain and nervous system
  • Eye (not cataracts)
  • Ear, nose and throat
  • Tonsils, adenoids and grommets
  • Bone, joint and muscle
  • Joint reconstruction
  • Kidney and bladder
  • Male reproductive system
  • Digestive system
  • Hernia and appendix
  • Gastrointestinal endoscopy
  • Gynaecology
  • Miscarriage and termination of pregnancy
  • Chemotherapy, radiotherapy and immunotherapy for cancer
  • Pain management
  • Skin
  • Breast surgery (medically necessary)
  • Diabetes management (excluding insulin pumps)

Silver

Silver offers the same cover as the Basic and Bronze policy, plus unrestricted cover for the following:
 
  • Heart and vascular system
  • Lung and chest
  • Blood
  • Back, neck and spine
  • Plastic and reconstructive surgery (medically necessary)
  • Dental surgery
  • Podiatric surgery (provided by an accredited podiatric surgeon)
  • Implantation of hearing devices
* Silver, Bronze and Basic policy holders may be offered additional cover for some clinical categories found in higher levels of cover. These policies are referred to as Basic plus, Bronze plus and Silver plus.

Gold

Gold offers unrestricted cover for all treatments listed in lower levels of cover and unrestricted cover for the following:
 
  • Cataracts
  • Joint replacement
  • Dialysis for chronic kidney failure
  • Pregnancy and birth
  • Assisted reproductive services
  • Weight loss surgery
  • Insulin pumps
  • Pain management with device
  • Sleep studies

Health Insurance fact box

What will no longer be covered

With the new changes, natural therapies will no longer be covered under your general treatment policy. The reforms come following a review by the former Commonwealth Chief Medical Officer, who found there was no clear evidence to support the efficacy of the listed natural therapies. The therapies no longer included are:
 
  • Alexander technique
  • Aromatherapy
  • Bowen therapy
  • Buteyko
  • Feldenkrais
  • Herbalism
  • Homeopathy
  • Iridology
  • Kinesiology
  • Naturopathy
  • Pilates
  • Reflexology
  • Rolfing
  • Shiatsu
  • Tai chi
  • Yoga
If you already have cover, your health fund will ensure you are kept informed of how the changes affect you.

How will it affect young Australians?

Young Australians will benefit from the changes, with insurers offering discounts of up to 10 percent to people aged 18-29. A 2% discount is applicable on hospital cover for each year the person is aged under 30 when they first purchase hospital insurance. Once a policy holder has an age-based discount, they will retain that discount rate until they turn 41 if they remain on the same policy. These discounts will then be gradually phased out after a policy holder turns 41.

Find out more

For more information about the reforms or to compare your existing cover, chat to an RACQ Health Insurance specialist on 1800 291 029

Conditions, limits and exclusions apply. RACQ Health Insurance is issued by MO Health Pty Ltd ABN 32 611 323 034, a registered private health insurer, trading as RACQ Health Insurance, for which RACQ Operations Pty Ltd ABN 80 009 663 414 receives commission. Please see the Product Fact Sheet for further details at racq.com/healthinsurance or contact us for a copy.