Important changes to private health insurance

In 2017, the Federal Government announced some big changes to private health insurance that will help with affordability and transparency, and provide better access to mental health services.

What’s changed so far

Prosthesis Reform

From 1 February 2018 the minimum benefits payable for almost all medical devices listed on the Prostheses List (e.g. for surgically implanted prostheses, human tissue items and other medical devices) have been reduced. This is estimated to deliver around $188 million in savings for members across the private health insurance industry this year.

Mental Health Reform

From 1 April 2018 the Mental Health Waiver (Waiver) will allow a person with hospital cover to access in-hospital Psychiatric Services without serving the usual 2 month Waiting Period. To access the Waiver you need to have:
  • private hospital cover, and
  • served your 2 month Waiting Period on Restricted in-hospital Psychiatric Services, and
  • upgraded to a hospital cover that has Included in-hospital Psychiatric Services
If you’re a new ahm member, you’ll need to have had a gap of less than 30 days since you last held private hospital cover.
The Waiver can be used once per person in a lifetime. To access the Waiver, you’ll need to call us on 134 236 or live chat with us.

What's in store next year

Here's a quick look at the changes coming on 1 April 2019. We'll give you more info about what these changes mean for you closer to the time (as some of the nitty gritty detail is still being worked on by the Government).
What does it mean?
New product categories
There will be 4 categories of hospital products – Gold, Silver, Bronze and Basic - and 3 categories of general treatment (extras) products - Gold, Silver and Bronze. This will make it easier to compare cover types.
Discounts on premiums for people aged 18 to 29
Insurers will be able to offer discounted private hospital cover to people aged 18 to 29. Legislation currently stops insurers from offering premium discounts to people based on their age.
Increase of maximum excess amounts so members can choose a higher excess with lower premiums
The permitted excess amount will increase to $750. This will allow people to choose products with a higher excess in return for lower premiums, while also meeting the requirements for Medicare Levy Surcharge exemptions.
Removal of rebates for a range of natural therapies
Cover for the following natural therapies will be removed from all private health insurance products: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi, and yoga.
Improved access to travel and accommodation benefits for regional and rural areas
Insurers will be able to offer travel and accommodation benefits under hospital cover instead of only under general treatment policies.
Standard clinical definitions
Insurers will be required to use standard clinical definitions across all of their documentation and across all platforms.
To find out more, The Department of Health has the full list of reforms, as well as a handy fact sheet overview.