Health Insurance Government Reforms Show content
Introduction of clinical categories for hospital treatments Show content
A key concern for consumers was the complexity and difficulty of understanding and comparing private health insurance products.
Before the reforms, health funds usually name the hospital benefit category themselves, for example: Heart and Artery related services, Heart conditions, Cardiac Procedures, Cardiac and Cardiac related procedures. This created confusion for consumer as the scope of treatment and benefits paid varied from health fund to health fund.
This is the reason why a standard set of clinical categories has been introduced to define what different products do and do not cover, helping consumers make an informed choice about private health insurance.
From 1 April 2019, all health funds are required to use the standard clinical categories to inform customers of treatments and services included in their hospital insurance policy, making it easier to understand what different products do and do not cover.
A clinical category is defined as a group of hospital treatments/services that must be covered by a Medicare Benefit Schedule (MBS) item number. This means that if the category is covered, all health funds must cover the same treatments/services for each clinical category.
This will eliminate the confusion of the treatments covered under each product available in the market making it easier to compare and choose the cover that’s right for you.
Hospital products by tiers: Gold| Silver| Bronze| Basic Show content
Starting 1 April 2019 hospital policies will be categorised into tiers with minimum requirements of cover for each level of cover: Gold, Silver, Bronze and Basic.
Hospital products must now cover certain standard clinical categories depending on the tier it fits into. The higher the tier, the more it must cover.
If a clinical category is covered under a tier, then a health insurer must ensure that all MBS items of the category are covered. Policy names must include the tier category to easily identify the tier.
In addition, an insurer may use the word ‘Plus’ (or symbol ‘+)’ e.g. ‘Silver Plus’ to indicate that the policy covers the minimum clinical categories for a Silver tier hospital product, but it has some additional inclusions.
The new product tiers will give consumers greater certainty about the services covered by each type of hospital treatment product
Changing coverage for some Natural Therapies Show content
Following a review chaired by the former Commonwealth Chief Medical Officer, some natural therapies will be excluded from the definition of private health insurance general treatment, as there is no clear evidence demonstrating their efficacy.
From 1 April 2019 private health insurers will no longer be able to pay benefits for the excluded natural therapies services.
- Alexander technique
- Bowen therapy
- Tai chi and yoga
Not covered from 1 April 2019
CUA Health will continue to pay for those services that are still approved by the government and that are popular with our members. These include acupuncture, remedial massage and a newly introduced benefit for Chinese Herbal Medicine.
In the case where health professionals provide excluded natural therapies as an element of other treatment, health insurers may pay benefits if the services provided are within the accepted scope of clinical practice. For example, a physiotherapist providing pilates services.
For additional information on eligibility of services please visit the Department of Health.
Increase excess level on hospital covers Show content
Consumers are concerned with the premium increases and affordability. To assist with this, insurers will be able to increase the permitted excesses for private hospital insurance.
Maximum excess levels allowable by the government, will increase from $500 to $750 for singles and from $1000 to $1500 for couples/families.
CUA Health will introduce new excess levels on 4 of our hospital products whilst keeping our existing levels. Offering members the opportunity to choose a higher excess in return for lower premiums.
Age based discounts for young Australians Show content
Health insurers now have the option to offer Australians aged 18-29 years of age a discount of up to 10% on their private hospital insurance premiums.
CUA Health understands affordability is a major factor in many young Australians being able to take out private hospital cover – so we are adopting hospital health cover discounts of up to 2% for every year a member is under 30 years of age, and up to 10% for 18-25 year old.
The youth discount does not apply to extras products.
For CUA Health members, the discount will automatically apply If:
- A member chooses (or already has on 1 April 2019) a hospital product that is eligible for discounts; and
- Is of eligible age (18-29),
The rate of discounts depends upon;
- The age the person locked in their discount when they first received discount (if switching)
- The age that they joined a hospital product on CUA Health that offers a youth discount.
- The age the person on an eligible product, on the day the insurer first offered discount (E.g. 1 April For CUA health members)
|Person's age when they first purchase a hospital product offering discounts||Applicable discount|
Once a policy holder has aa youth discount they will retain that discount rate until they turn 41 if they remain on a policy that is eligible for the discount.
|If, for that period, the person is aged:||Applicable discount|
|18 or older, but under 41||Person's base percentage|
|41||Person's base percentage minus 2%|
|42||Person's base percentage minus 4%|
|43||Person's base percentage minus 6%|
|44||Person's base percentage minus 8%|
|45 or older||Zero|
When more than one adult is eligible on the policy, the average rate between the two will apply.
Changes to your cover Show content
We’ll notify all our members of their individual policy and premium changes in mid-February 2019. This will include a cover letter, a product change sheet and a Private Health Information Statement (PHIS).
This is an important opportunity for you to review your health cover, making sure you consider your personal health situation or any changing personal circumstances. This will provide a period to consider your current health insurance cover and to make any changes ahead of the 1 April 2019 effective date, if needed.
If you’d like to review or discuss your options, we would welcome the opportunity to discuss this with you. You can contact us Mon – Fri: 7.30am – 5:00pm (AEST) on 1300 499 260.
Upgrades to privatehealth.gov.au Show content
The Private Health Insurance Ombudsman (PHIO) website privatehealth.gov.au will be redeveloped to better assist consumers in comparing different health insurance products.
As a result, the current Standard Information Statement (SIS) will be replaced by a Private Health Information Statement (PHIS) as the regulated method by which insurers provide information to consumers.