2019 Private Health Insurance Reforms

Introduction Of Hospital Product Tiers Gold, Silver, Bronze and Basic

These product tiers will take effect from 1 April and will give members greater certainty about the services covered by each type of hospital treatment product. The changes will make it easier to compare different hospital treatment products to find one that meets their individual needs.

Changes To Our Product Names:

CURRENT PRODUCT NAME

NEW PRODUCT NAME

PRODUCT CHANGES

Deluxe Hospital

Gold Deluxe Hospital

Name Change Only

Private Hospital

Gold Private Hospital

Name Change Only

Bare Essentials Hospital

Bronze Essentials Hospital

Alignment with Bronze Clinical Category

Increased Excess

Name Change

Basic Hospital

Basic Hospital

No Changes

Please refer to the Table below for the list of categories in each tier.

The Bare Essentials Hospital product will change to meet the requirements of the Bronze classification.

Product Tiers and Clinical Categories

The following table sets out the clinical categories that are indicated for policies of each product tier.

Clinical Category

Basic

Bronze

Silver

Gold

Rehabilitation

YES/R

YES/R

YES/R

YES

Hospital psychiatric services

YES/R

YES/R

YES/R

YES

Palliative care

YES/R

YES/R

YES/R

YES

Brain and nervous system

RCP

YES

YES

YES

Eye (not cataracts)

RCP

YES

YES

YES

Ear, nose and throat

RCP

YES

YES

YES

Tonsils, adenoids and grommets

RCP

YES

YES

YES

Bone, joint and muscle

RCP

YES

YES

YES

Joint reconstructions

RCP

YES

YES

YES

Kidney and bladder

RCP

YES

YES

YES

Male reproductive system

RCP

YES

YES

YES

Digestive system

RCP

YES

YES

YES

Hernia and appendix

RCP

YES

YES

YES

Gastrointestinal endoscopy

RCP

YES

YES

YES

Gynaecology

RCP

YES

YES

YES

Miscarriage and termination of pregnancy

RCP

YES

YES

YES

Chemotherapy, radiotherapy and immunotherapy for cancer

RCP

YES

YES

YES

Pain management

RCP

YES

YES

YES

Skin

RCP

YES

YES

YES

Breast surgery (medically necessary)

RCP

YES

YES

YES

Diabetes management (excluding insulin pumps)

RCP

YES

YES

YES

Heart and vascular system

RCP

 

YES

YES

Lung and chest

RCP

 

YES

YES

Blood

RCP

 

YES

YES

Back, neck and spine

RCP

 

YES

YES

Plastic and reconstructive surgery (medically necessary)

RCP

 

YES

YES

Dental surgery

RCP

 

YES

YES

Podiatric surgery (provided by a registered podiatric surgeon). Hospital Admission Paid Only

RCP

 

YES

YES

Implantation of hearing devices

RCP

 

YES

YES

Cataracts

RCP

 

 

YES

Joint replacements

RCP

 

 

YES

Dialysis for chronic kidney failure

RCP

 

 

YES

Pregnancy and birth

RCP

 

 

YES

Assisted reproductive services

RCP

 

 

YES

Weight loss surgery

RCP

 

 

YES

Insulin pumps

RCP

 

 

YES

Pain management with device

RCP

 

 

YES

Sleep studies

RCP

 

 

YES

 

YES

Indicates the clinical category is a minimum requirement of the product tier. The clinical category must be covered on an unrestricted basis.

YES/R

Indicates the clinical category is a minimum requirement of the product tier. The clinical category may be offered on a restricted cover basis in Basic, Bronze and Silver product tiers only.

RCP

Restricted cover permitted: indicates the clinical category is not a minimum requirement of the product tier. Insurers may choose to offer these as additional clinical categories on a restricted or unrestricted basis.

 

A blank cell indicates that the clinical category is not a minimum requirement of the product tier. Insurers may choose to offer these as additional clinical categories; however it must be on an unrestricted basis.

 

Removal of Selected Natural Therapy Services from Extras Products

Complete Ancillary and Ancillary Lite – Naturopathy and Herbalist Homeopathy Services on or after 1 April will no longer have benefits for Alexander Technique, Aromatherapy,
Bowen Therapy, Buteyko, Feldenkrais, Herbalism, Homeopathy, Iridology, Kinesiology, Naturopathy, Pilates, Reflexology, Rolfing, Shiatsu, Tai Chi, and Yoga.

Members who have these products have received a letter enclosed explaining the changes in detail.

Maximum Policy Excess

Premiums are lower for those members who choose a higher excess product. ACA Health’s Bare Essentials Hospital policy has an excess per adult on the policy. Effective 1 April this excess will now increase from $500 to $750 per adult per calendar year.

Standard Clinical Definitions

Private Health Insurance will adopt standard clinical definitions in products and other documentation. These changes will make it easier for members to understand the parameters of their insurance cover.

Strengthening The Private Health Insurance Ombudsman

The Government will boost additional powers and funding to the Private Health Insurance Ombudsman to ensure consumer complaints are resolved clearly and quickly and to improve their website privatehealth.gov.au to make it easier to compare insurance products, and allow insurers to provide personalised information to consumers on products.

Posted: February 13 2019