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 | Â | YES | YES | |||
Lung and chest | RCP | Â | YES | YES | |||
Blood | RCP | Â | YES | YES | |||
Back, neck and spine | RCP | Â | YES | YES | |||
Plastic and reconstructive surgery (medically necessary) | RCP | Â | YES | YES | |||
Dental surgery | RCP | Â | YES | YES | |||
Podiatric surgery (provided by a registered podiatric surgeon). Hospital Admission Paid Only | RCP | Â | YES | YES | |||
Implantation of hearing devices | RCP | Â | YES | YES | |||
Cataracts | RCP | Â | Â | YES | |||
Joint replacements | RCP | Â | Â | YES | |||
Dialysis for chronic kidney failure | RCP | Â | Â | YES | |||
Pregnancy and birth | RCP | Â | Â | YES | |||
Assisted reproductive services | RCP | Â | Â | YES | |||
Weight loss surgery | RCP | Â | Â | YES | |||
Insulin pumps | RCP | Â | Â | YES | |||
Pain management with device | RCP | Â | Â | YES | |||
Sleep studies | RCP | Â | Â | 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 ProductsComplete Ancillary and Ancillary Lite – Naturopathy and Herbalist Homeopathy Services on or after 1 April will no longer have benefits for Alexander Technique, Aromatherapy, 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. | |||||||