Private Health Insurance Changes

In 2019 and in 2021, the Australian Government introduced new rules to help make private health insurance simpler, and make it easier for people to choose the cover that best suits them.

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The Australian Government has introduced reforms to make private health insurance simpler and help people to choose the cover that best suits them.

First wave of reforms

Gold, Silver, Bronze and Basic hospital cover

Four new tiers of hospital cover began rolling out from early 2019 and became mandatory from 1 April 2020. All hospital insurance policies are now classified as Gold, Silver, Bronze or Basic.

What is, and is not, covered in these hospital tiers are based on new minimum standard clinical categories of treatment. These clinical categories are simply groups of what hospital treatments are, and are not, covered under each policy. Each clinical category—for example, ‘bone, joint and muscle’ category, or ‘heart and vascular system’ category—sets out the hospital treatments that must be covered by your private health insurer. If a policy covers a certain category, then it must cover everything listed in it—not only some things.

Insurers can offer additional coverage above the minimum requirements in Basic Plus (+), Bronze Plus (+) and Silver Plus (+) tiers.

See Product tiers and Clinical categories for more information.

Private Health Information Statement (PHIS)

Your insurer is required to send you a statement summarising what your policy covers and does not cover at least once a year, and again each time your policy changes.

Since 2019, policy information for new Gold, Silver, Bronze or Basic hospital tiers and general treatment policies is sent to you in the form of a Private Health Information Statement (PHIS). The PHIS provides information about what is, and is not, covered based on the new tiers and clinical categories of treatment. All available policies are summarised in the PHIS documents.

You can search for and compare a standard PHIS from every insurer in Australia on this website. Insurers can also offer a customised PHIS for their members and in their emails, letters and websites, which may include further information.

See Private Health Information Statements for more information.

Mental health treatment waiting periods

Since 1 April 2018, health insurers have been providing greater access to mental health services by allowing people to upgrade their hospital cover without serving the usual two month waiting period for in-hospital psychiatric treatment. Policyholders are able to use this exemption from the usual waiting period on a once-off basis.

See Waiting periods for more information.

Natural therapies

Since 1 April 2019 private health insurers have no longer been able to offer benefits for some natural therapies as part of a health insurance policy.

The affected natural therapies are Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, western herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi, and yoga.

Discontinued policies

If an insurer plans to discontinue your policy and move you to a new policy, they must provide you with clear and transparent information about how this change will affect you.

This information will better enable you to decide whether to transfer to the alternative product chosen by your insurer, or to purchase a different product, or transfer to a different insurer.

Ability to change excess levels

Previously, hospital policy excesses were set at a maximum of $500 for singles or $1,000 for couples and families in order to avoid the Medicare Levy Surcharge.

The maximum excesses are now $750 for singles and $1,500 for couples and family policies.

See Medicare Levy Surcharge for more information.

Discounts for 18 to 29 year olds

Since 1 April 2019, insurers have had the option to offer people aged 18–29 years discounts of up to 10 per cent of their private health insurance hospital premiums. People will retain that discount until they turn 41, when it will be gradually phased out.

The allowable discount is 2 per cent for each year that a person is aged under 30, to a maximum of 10 per cent for 18 to 25 year olds.

If a policy offers age-based discounts they will be available to both new and existing policy holders.

See Age-based Discount for more information.

Travel and accommodation benefits for rural consumers

People living in regional and rural areas sometimes need to travel away from home for specialist medical and hospital treatment.

Insurers have the option to offer travel and accommodation benefits as part of hospital cover. Some insurers already offer these benefits to their members under general treatment or extras cover.

Talk to your insurer to find out more.


Second wave of reforms

Increasing the age of dependents

The Government’s proposal to increase the maximum age of dependants for private health insurance policies from 24 to 31 years and remove the age limit for dependants with a disability was passed by Parliament in June 2021.

The legislation defines a dependent as a single person aged from 18 to 31 years. However an insurer can choose to define and implement their own age range for dependents. For example, an insurer that currently has a maximum age for dependent as 24 years in their insurer rules, may increase the maximum age to 29 years rather than 31 years.

The legislation defines a person with a disability as a participant in the National Disability Insurance Scheme (NDIS) who is aged 18 years or over. They may have a partner. However, insurers will have some discretion to offer cover to people with a disability who are not participating in the NDIS. 

As it is optional for insurers to implement these policy changes, your insurer will tell you if, and how, they will apply this change. The private health insurers that are introducing these changes are in the process of developing new products to incorporate the changes. Consumers will be able to search this website for the new policies when they become available.

For more information, see the Department of Health website.

Transparency of out of pocket costs

The Australian Government Medical Costs Finder is an online tool that helps you find out more about the costs of specialist medical services.  It covers common services in and out of hospital that patients want to know more about. The tool's results are based on the most recent publicly available Government data about what people have paid for medical services. 

As part of the reforms, the Medical Costs Finder will be further enhanced to improve the transparency of out-of-pocket costs and provide patients with a better understanding of the value of private health insurance. 

For more information, visit the Department of Health website

Expanding home and community-based mental health and rehabilitation care

As part of the second wave of reforms, the Government has announced an expansion of access to home and community-based mental health and rehabilitation services under private health insurance. This measure will also expand options for insurers to fund non-MBS mental health care services under general treatment and hospital treatment policies.