Private health insurance changes explained

Aside from an average increase of 3.25 per cent to health insurance premiums, a number of government reforms will come into effect on April 1.

Composite image private health insurance cards

There will be a raft of changes to Private Health Insurance in Australia on April 1 Source: SBS

There will be a number of changes to Private Health Insurance in Australia from April 1. The most notable of these is a rise in insurance premiums by 3.25 per cent on average. 

But there are also other reforms being rolled out across the industry. 

Four new tiers of hospital cover will be introduced this year and become mandatory from April 1, 2020.

All hospital insurance policies will be classified as Gold, Silver, Bronze or Basic.

What is, and isn't, covered in each category will be based on new minimum standards.

For example, if heart and vascular system is covered in the category then it must cover everything listed in that category.

Private Hospital cover will be classified under a new system of four tiers.
Source: AAP


Basic Plus, Bronze Plus and Silver Plus policies will cover at least one service more than what's offered in the normal categories.

For example a Silver Plus policy could include cover for cataract surgery which would otherwise only be covered under a Gold policy. Each insurer will vary in what extra they include on the plus package.

The reforms do not apply to extras cover.

Insurers will be also allowed to offer young adults aged 18-29 years discounts of up to 10 per cent on their private health insurance hospital premiums.

They will be able to retain that discount until they turn 41 if they stay on the same policy. The allowable discount will be two per cent for each year a person is aged under 30.

Customers can also choose to increase their excess in exchange for a lower premium. The maximum excesses have been raised to $750 for singles (from $500) and $1500 for couples and family policies (from $1000).

People living in regional and rural areas can receive travel and accommodation benefits by insurers if they need to travel for special medical or hospital treatment.

A range of natural therapies now cannot be covered by insurers and will be removed, including homeopathy, naturopathy, Pilates, yoga aromatherapy and Bowen therapy.


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Published 25 March 2019 at 6:04am, updated 25 March 2019 at 11:11am