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Private health insurance reforms

We have made changes to private health insurance to make it simpler and easier for you to choose the cover that best suits you and your family.

Cover image for YouTube video Private health insurance made simpler
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Choosing the right private health insurance can be confusing.

That’s why the Australian Government is introducing reforms to make the choice easier for everyone.

Now private health insurers must group all private hospital cover into four tiers: Gold, Silver, Bronze and Basic, each with minimum inclusions.

Making it easier to choose the right insurance for you.

To find out more about the reforms, visit health.gov.au

Private Health Insurance made simpler.

Authorised by the Australian Government, Canberra.

View all campaign materials.

What is included in the reforms?

The reforms include the following:

If you already have private health insurance, your insurer will send specific information about your policy.

Read an overview of the reforms.

Why are the reforms needed?

More than half the Australian population — about 13.6 million people — have private health insurance, but many people don’t fully understand what they are getting for their money and what they are covered for.

Australians have told us they find private health insurance complex and hard to understand what different policies cover and what they do not.

We want to make private health insurance simpler and easier for you to choose the cover that best suits you and your family.

When will the reforms begin?

All of the reforms have now started.

Many insurers are now using the new Gold, Silver, Bronze and Basic tiers of hospital cover. Insurers have until 1 April 2020 to introduce the new tiers for all hospital policies.

How will the different levels of hospital cover work?

What is, and is not, covered in these tiers will be based on new minimum standard clinical categories. Clinical categories are types of hospital treatments described in a standard way.

The higher the tier, the more categories it covers.

If your health insurer covers a category — for example, ‘bone, joint and muscle’ or ‘heart and vascular system’ — they must cover all of the treatments in that category.

This makes policies easier to compare.

Health insurers will still be able to offer more than the minimum requirements. Policies which cover more than the minimum categories will use either the word 'plus' or a '+' sign in the policy name.

Who is affected?

The reforms may affect you if you have private health insurance. Some groups may be particularly interested in the reforms.

Young people

If you are between 18 and 29, your health insurer may offer you a discount on your hospital premium. The discount will gradually reduce after you turn 41.

The allowed discounts vary and generally depend on how old you are when you purchase a policy that offers discounts, or your age when your insurer introduces the discounts to your existing policy. Your insurer can choose to offer discounts as follows:

  • 18 to 25 years — 10%
  • 26 years — 8%
  • 27 years — 6%
  • 28 years — 4%
  • 29 years — 2%

Read more about discounts for young people.

People travelling long distances for hospital treatment

Insurers will be able to offer travel and accommodation benefits as part of hospital cover to people who need to travel long distances to access specialised hospital treatment. This will be particularly beneficial for people living in rural and regional areas.

Read more about travel and accommodation benefits.

People accessing mental health treatment in hospital

Since 1 April 2018, patients with limited cover for mental health treatment have been able to upgrade their hospital cover to access higher benefits for these services without serving a waiting period. Policy holders are able to use this exemption from the usual waiting period on a one off basis.

Read more about access to mental health treatment in hospital.

Women

Women will benefit from guaranteed cover in Bronze tiers and above for:

  • gynaecological services
  • ovarian and breast cancer treatment
  • breast reconstruction

Pregnancy and assisted reproductive services — such as IVF — are only minimum requirements for the Gold tier.

Natural therapies

Since 1 April 2019 health insurers have not been able to offer benefits for some natural therapies. The decision to remove those natural therapies from private health insurance cover was made following a 2015 review chaired by the then Chief Medical Officer.

Learn about why the change was made, the therapies affected and the progress of the Natural Therapies Review 2019-20.

Your options

If you already have private hospital cover, your insurer will tell you which tier your policy is in.

You can then check if the cover is right for your needs.

Compare policies online

The Private Health Insurance Ombudsman has released a simple comparison tool to help you compare health insurance products. You can select specific hospital services or general treatments that are most important to you for more tailored results.

Access the comparison tool.

Consumer resources

Private health insurance reforms – consumer resources

These resources contain information for the general public on reforms to private health insurance. Resources include fact sheets, an infographic and a video about the product tiers.

Private health insurance reforms campaign

A consumer information campaign, first launched on Sunday 17 February 2019, is helping Australians better understand the Government’s reforms to make private health insurance simpler.
 
Campaign materials are available below. Many of these are also available in five other languages.

Private health insurance reforms – campaign materials

These campaign materials outline the Government’s reforms to private health insurance.

Several resources are available in English and 5 other languages, including Simplified Chinese, Traditional Chinese, Arabic, Vietnamese and Korean.

Australian Government Coat of Arms

Authorised by the Australian Government, Canberra

Last updated: 
18 October 2019

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