Private Health Insurance Reform Rules 2018

On 13 October 2017, the Government announced a package of reforms designed to make private health insurance simpler and more affordable for all Australians.

Page last updated: 11 January 2019

The Private Health Insurance Legislation Amendment Act 2018 passed the Parliament and received Royal Assent in September 2018, making a number of reforms and establishing a framework to support the implementation of reforms through subordinate legislation.

The Private Health Insurance (Reforms) Amendment Rules 2018 (the Amendment Rules 2018) include amendments associated with the commencement of the following reforms (and related matters):

  • age-based premium discounts for hospital cover
  • improving information provisions for consumers
  • introduction of product tiers and clinical categories for hospital cover
  • the administration of second-tier default benefits arrangements for hospitals
  • removal of coverage for some natural therapies
The Amendment Rules 2018 are available on the Federal Register of Legislation website.
An Explanatory Statement has been prepared as an aid to understanding the Amendment Rules 2018. It is available for download on the Federal Register of Legislation website.

Supporting Material

Gold, Silver, Bronze and Basic – Hospital treatment product tiers (Schedule 4 to the Complying Product Rules)
Gold, Silver, Bronze and Basic – Hospital treatment product tiers (Schedule 4 to the Complying Product Rules) (PDF 163 KB)
Gold, Silver, Bronze and Basic – Hospital treatment product tiers (Schedule 4 to the Complying Product Rules) (Word 218 KB)

Clinical Categories table with MBS items (Schedule 5 to the Complying Product Rules)
Clinical Categories table with MBS items (Schedule 5 to the Complying Product Rules) (PDF 373 KB)
Clinical Categories table with MBS items (Schedule 5 to the Complying Product Rules) (Word 216 KB)

Common and Support treatments lists of MBS items (Schedules 6 & 7 to the Complying Product Rules)
Common and Support treatments lists of MBS items (Schedules 6 & 7 to the Complying Product Rules) (PDF 199 KB)
Common and Support treatments lists of MBS items (Schedules 6 & 7 to the Complying Product Rules) (Word 199 KB)

MBS items spreadsheet
MBS items spreadsheet shows the clinical category or list that each MBS item is published against for the clinical categories arrangements
MBS items spreadsheet (Excel 198 KB)
MBS items spreadsheet (PDF 2.9 MB)

Fact sheets
Fact sheets – for all 2017/18 private health insurance reforms

Frequently asked questions (FAQs)

The FAQs below provide responses to questions that arose during consultation on the exposure draft of the Amendment Rules, mainly from health insurers or clinicians.

These FAQs should be read in conjunction with the Amendment Rules 2018 and the related Explanatory Statement to gain a clear understanding of the changes for private health insurance.

More consumer-focussed information will be provided closer to the time when the changes take effect in 2019.

Frequently asked questions (FAQs) (PDF 175 KB)
Frequently asked questions (FAQs) (Word 74 KB)