On 1 April 2019, the Government's Private Health Insurance Reforms will come into effect for all private health insurers in Australia.
To help our Emergency Services Health members understand what the Reforms will mean for them, we've put together the below overview.
Here are the key points;
- New product tiers of Gold, Silver, Bronze & Basic will define what’s covered by a hospital policy as standard across the industry. This new tiered system is linked to a standardised list of clinical categories which set the minimum standards for the hospital services to be covered under each tier. The move is designed to help make clear what is, and isn’t, covered in a particular policy.
- While some insurers will need to make significant changes to their customers’ policies to fit in with the new classification system, our existing Hospital and Combined cover for each fund fits the criteria of a Gold product - meaning it covers all 38 clinical categories. So our members can continue to expect the highest quality of cover from us, including the following hospital benefits:
- No exclusions*
- No excess or co-payments*
- No benefit restriction limits*
- All in patient procedures where Medicare pays a benefit*
- Choice of hospital, doctor or service provider*
- 100% Ambulance cover for emergency & clinically required transport or on the spot treatment*
To view the full list of all 38 clinical categories covered, click here
- We intend to continue offering just the one level of hospital cover - Gold- because it enables us to provide all our members with the best possible value for money and ultimate peace of mind – now and into the future.
- While insurers have until 2020 to adopt the Gold, Silver, Bronze & Basic tiers for all products, we’ll be embracing the new system from the get-go on 1 April 2019 because we welcome the opportunity to remove some of the complexity for consumers.
- Adoption of the new system includes renaming Lifelong Hospital and Lifelong Combined to Gold Hospital and Gold Combined respectively. These new names will become active by 1 April 2019, but rest assured, the change will effectively be in name only in that we are not moving members from their existing policy to a completely new one.
- We’re also renaming Emergency Services Health's Lifelong Extras to Rolling Extras to help highlight one of the most unique and valued elements of the cover – our Rollover Benefit – which, for the majority of our Extras categories, lets you rollover any unclaimed annual maximums from one calendar year to the next if you need it*. This benefit is exclusive to Emergency Services Health and Police Health, and is one we’re particularly proud of offering to our members.|
- In terms of changes to Extras benefits, it’s important to note that some natural therapy treatments will no longer qualify for health insurance benefits due to the Reforms. For our Extras cover in particular, there are 4 services that we have historically paid benefits towards which will be removed from 1 April 2019. They are - naturopathy (which will be removed as an extras category in its own right), as well as aromatherapy, Western herbal medicine, and homeopathy (which will be taken out of our ‘Complementary Therapies’ benefit category).
We’ll be reinvesting those benefit allocations back to members in the form of enhanced dental and optical benefits, as these are some of our most popular benefits. We’ll also be introducing a new category of benefits in relation to Counselling for Emergency Services Health.
We can also confirm that we will continue to pay benefits towards remedial massage therapy, remedial therapy, Chinese medicine and myotherapy under our ‘Complementary Therapies’ category after 1 April 2019.
We should also note that because we have never had a benefit structure for Pilates, it being named by the Government as one of the natural therapies which can no longer attract a benefit has no effect on our existing benefit structure. However under our Extras cover we do, and will continue to, provide Physiotherapy benefits to members visiting a physio who uses exercises or techniques drawn from Pilates as part of treatment - as long as the exercises or techniques are within the accepted scope of clinical practice. Benefits do not extend to instances where a physio (or any other health professional) conducts a Pilates session (either advertised or promoted as such) where the only service provided is Pilates exercises.This distinction is self-assessed by your physio, who will bill differently depending on the service provided. So if in any doubt, talk to your physio before your treatment.
- The Standard Information Statements (SIS) will take on a new format and be renamed as the Private Health Insurance Statements (PHIS) to make comparing policies easier for consumers. Insurers have until 1 April 2020 to transition to the new PHIS format, but once available we look forward to providing more meaningful comparison data to help our members understand how our cover sits against the market.
- You can also expect to see an upgrade to the www.privatehealth.gov.au website, coupled with an increase in powers and resources for The Private Health Insurance Ombudsman, to help ensure consumers are as well informed and protected as possible.
- Despite all the changes, including the changes to the names of our products, your current Membership ID Numbers and Membership Cards will remain the same and continue to function as normal.
If you have further questions, please feel free to email us at email@example.com
*Waiting periods and other conditions may apply. Hospitals, Doctors and Service Providers must be registered and recognised by us. Refer to our website for an understanding of exclusions, excesses, co-payments and restricted benefits.