Clinical Categories Review

Private health insurance hospital policies use standard definitions of hospital services so people can more easily compare policies from different insurers. This review will see how effective these clinical categories are for the average Australian.

Why we’re having this review

The clinical categories are standard definitions of hospital services covered under private health insurance. These were introduced as part of our private insurance health reforms. The purpose of the clinical categories is to:

  • simplify hospital insurance products
  • make these products more transparent
  • form the minimum requirements for the different tiers of services.

This review will:

  • see how effective the clinical categories are in helping consumers better understand hospital insurance policies
  • consider how the industry has incorporated these new regulations into operating processes.

What we’re reviewing

The committee will evaluate the categories and provide advice to Health about:

  • the current scope of cover and MBS mapping of the clinical categories
  • identified and potential interpretation issues
  • stakeholder feedback
  • the legislative framework for the clinical categories
  • regulatory and management frameworks for amending the clinical categories.

Clinical Categories Review Advisory Committee

We have set up the Clinical Categories Review Advisory Committee to conduct the review. This independent committee includes key stakeholders with experience in private health insurance, clinical practice, and health service management.

Contact

Clinical Categories Review Advisory Committee secretariat

Contact the secretariat for the Clinical Categories Review Advisory Committee for further information on the review.
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