Effective 1 April 2019
As part of the Federal Government’s Private Health Insurance Reforms, all health funds are required to align their hospital products to new Standard Clinical Categories and Gold/Silver/Bronze/Basic product tiers.
Each Standard Clinical Category has a defined list of services that are covered. While most of your current cover has directly matched the new categories, in some cases we’ve had to add or remove services to fit the new structure.
- Where financially viable, we have increased cover for some services.
- Where premiums would be significantly impacted, we have decreased cover.
- We’re required to include the new product tier in the name. This product exceeds the minimum requirements for the ‘Basic’ tier so from now on we’ll refer to this product as StarterPak (Basic Plus).
Upgrade without waiting periods
If the services being removed are important to you, you may want to upgrade your cover.
To help make the process easier, we’re waiving all hospital waiting periods if you upgrade to Basic Hospital (Basic Plus) or Mid Hospital (Basic Plus) by 1 May 2019.
The upgrade waiver offer applies only to members who have held their current level of hospital cover for at least 12 months. If you’ve held your current level of hospital cover for less than 12 months, waiting periods may apply if you upgrade.
StarterPak Basic +
Scope of cover
Note: Restricted cover - For restricted services provided in a public hospital, we pay for accommodation in a shared room (as long as the hospital doesn’t charge more than the default rate set out by the Federal Government), and medical costs.
For a definition of each clinical category, visit the Department of Health website.
You’ll have a higher annual limit for Physio, Chiro, Osteo and Exercise Physiology
We’re increasing the combined annual limit from $300 per person to $400 per person (maximum $800 per couple / family).
We’re required to remove some Natural Therapies
Due to the Federal Government’s Private Health Insurance Reforms, health funds are no longer permitted to cover some natural therapy services from 1 April 2019.
See below for information on what will be removed and what will still be covered after 1 April 2019.
If you claim for a service that will be removed, we encourage you to make the most of your benefits while they’re available. The service must be provided by 31 March 2019, but you can submit your claim up to two years after the service date.
- Alexander technique
- Bowen therapy
- Western herbal medicine
You can still use your Natural Therapies limit to claim for:
- Remedial massage
- Chinese herbal medicine consultations
- Pilates (including Pilates classes run by a physiotherapist or exercise physiologist)
You can still use your Healthy Lifestyle limit to claim for:
- Gym membership*
- Recognised weight management programs*^
- Disease management subscriptions/memberships
- Recognised health screening services/preventative screenings (where a Medicare benefit is not payable)
*with the submission of a completed Healthy Lifestyle form.
^Recognised programs: To find out more about each program, click here.
Benefit limits, sub-limits and annual limits may apply. Limits are per calendar year unless otherwise specified.