Private Health Insurance is changing - what the reforms mean to members

Last year the Australian Government announced a wide-ranging package of reforms to private health insurance, which aim to make it simpler and more affordable for all Australians.

These reforms are being introduced across the private health insurance industry and there are a number of mandatory changes which will affect all health funds. Some of the reforms have already been implemented, but there are a range of changes that will be introduced from 1 April 2019.

For GMHBA members, there may be some changes to your health insurance policy as a result of the reforms.

These changes could mean new inclusions or exclusions, a change to the name of your policy and/or a change to your excess amount.

If any of these changes are going to affect your cover, we will communicate with you directly via email or letter in early 2019.

Why the need for reform?

The reforms are designed to address the affordability of private health cover in Australia and make private health insurance easier to choose and use.

Keeping costs down

At GMHBA, we are doing everything possible to keep costs down for our members.

We are seeing healthcare costs rise year on year. The Australian population is ageing, and there are more instances of chronic disease. Medical technologies are more costly. Treatments are increasingly complex.

From April 2019, these reforms will enable us to:

  • offer discounts for 18–29 year olds on selected products
  • increase excess options for members to improve value and affordability of their cover
  • offer regional travel and accommodation benefits on GMHBA Gold & Silver + hospital products

Easier to understand

We know health insurance is a complex product. These changes will ultimately empower consumers to choose the health insurance product that is right for them and make it easier to for our members to use their health insurance in a way that gives them the most value from their cover.

The implementation of Gold, Silver, Bronze & Basic hospital product categorisation will improve simplicity and transparency for our members.

The main comparison website, privatehealth.gov.au will also be upgraded to make comparisons easier. 

Further information:

For further information about the changes that are happening and what they mean, see the guide below. We will contact you in early 2019 with information specific to your policy.

You can also read the Department of Health’s individual fact sheets available here.

Reforms:

What does it mean for our members?

There will be four categories across all funds for hospital products – Gold, Silver, Bronze and Basic, making it easier for members to know what they are covered for.
Health funds will not be able to use the terms Gold, Silver or Bronze in the naming of their extras products

Which members are affected?

The majority of members will see a change in their product name

When will/has it come into effect?

1 April 2019

What does it mean for our members?

Private health insurers will be required to use standard clinical categories across all services, including references to inclusions and exclusions. This helps members compare coverage and make informed decisions about their level of cover.

For further information on the standard clinical categories and to understand how they fit into the product categories refer to the Australian Government Private Health Insurance Reforms

Which members are affected?

All members with a hospital policy

When will/has it come into effect?

1 April 2019

Why are you making this change?

A review by the Department of Health found there is not enough evidence to demonstrate the effectiveness of a number of natural therapies. Removing benefits for selected Natural Therapies is a requirement of the Australian Governments Private Health Insurance Reforms

Which natural therapies will I be able to use after 1 April 2019?

On eligible products, you can claim benefits towards Remedial Massage, Myotherapy, Acupuncture and other included extras services such as Dental, Physiotherapy, Chiropractic. Annual limits and waiting periods apply.

What does it mean for our members?

Naturopathy, Homeopathy and Pilates classes run by a physiotherapist will be removed from GMHBA extras covers. If your product includes benefits for Natural therapies services which are being removed, you will be able to claim for any service received before 1 April 2019 for up to 2 years after the date of service.  Any service provided after 1 April 2019 will not be payable. Annual limits and waiting periods apply.

Which members are affected?

All covers that previously included benefits for these services

When will/has it come into effect?

1 April 2019

What does it mean for our members?

The discount you receive depends on your age when you first take out an eligible hospital cover. If you take out an eligible hospital cover at 25, the discount is 10% versus 2% at 29 years old.

The discount is ongoing until you are 41 years old, if you keep your eligible hospital cover. From this age, the discount will reduce by 2% per year until it reaches zero.

Which members are affected?

Members between 18-29 years of age on selected hospital products

I've just turned 30, am I eligible for a youth discount?

We are only permitted to apply a discount to members who are aged between 18 – 29 as at 1 April 2019

When will/has it come into effect?

1 April 2019

What discount would I receive?

Age when you first purchase an eligible hospital
product offering an age-based discount
% discount that a health insurer can offer
18-25 years old 10%
26 years old 8%
27 years old 6%
28 years old 4%
29 years old 2%
30 years old 0%

Where can I find out more?

Visit Age-based discount.

What does it mean for our members?

A new higher excess level is available from 1 April on selected hospital covers. An excess is only payable if you’re admitted to hospital. If your product includes an excess this is a fixed amount you agree to pay towards your hospital admission.

Choosing a higher excess could help to reduce the cost of your premium. Hospital excesses will be lifted to $750 for an overnight stay in hospital as a private patient. Other policies will include a new maximum excess level.

To review your current excess level login to your member area. You will be able to review and change your excess online however the new $750 or $1500 excess option will not be available until April 2019.

If you are on selected family covers, you may not need to pay an excess if one of your child dependents up to 21 years of age goes to hospital. Contact us to find out whether this applies to your product.

Which members are affected?

Selected policies

When will/has it come into effect?

1 April 2019

What does it mean for our members?

Private health insurers will now be able to offer travel and accommodation benefits relating to hospital treatments covered by the policy

Which members are affected?

Rural and regional members on selected GMHBA Gold & Silver + hospital products

When will/has it come into effect?

1 April 2019

What does it mean for our members?

Members who have held limited cover for at least two months will be able to upgrade their cover to access in-hospital mental health services, and waive the waiting period. This enables members to seek help when they most need it

Which members are affected?

Members who have held a hospital policy with GMHBA for at least two months

When will/has it come into effect?

1 April 2018

What does it mean for our members?

Minimum benefits payable for almost all medical devices listed on the Prostheses List have been reduced. Total estimated savings to private health insurers over the next four premium years (2018 to 2021) are estimated to be $1.1 billion dollars.*
Savings will be passed on directly to members by reduced premium increases

Which members are affected?

All

When will/has it come into effect?

1 February 2018

*Department of Health

What does it mean for our members?

You will only need to re-serve waiting periods for services not previously included under your cover or for increased benefits or annual limits.