The next round of the Australian Government’s Private Health Insurance reforms will begin to come into effect from 1 April 2019, and we have provided a summary of the changes here. You can also find all the key information about these upcoming changes here. 

Hospital Product Classification
Hospital policies will be classified as Gold, Silver, Bronze or Basic. The Government has developed 38 Standard Clinical Categories which will define the level of cover based on what the policy includes. Gold requires all clinical categories to be included while at the other extreme, Basic requires only three clinical categories to be covered.

Underlying MBS codes have been mapped into the 38 Standard Clinical Categories. The mapping of the MBS codes to those categories can be found here.

Top Cover & Prime Choice – these hospital policies are classified as Gold meaning they offer the most comprehensive levels of cover available and cover all clinical categories. Top Cover has the added feature of paying medical benefits up to the AMA list of services and fees.

Smart StarterThis hospital policy is classified as Bronze Plus, indicating it includes the clinical categories required in Bronze, plus some additional clinical categories. This is the only policy that involved some changes for us. We have excluded some previously covered services while including some new services.

All our Smart Starter members were notified of these changes in late January, and we have included these changes here on our website. Our aim with Smart Starter is to offer a policy that is more affordable for those starting out in adult life; who are generally young and healthy. 

Extras coverThe removal of 16 natural therapies from Health Funds has not impacted Doctors’ Health Fund, as we have never provided cover for these services, with the exception of Pilates services delivered by a physiotherapist. Physiotherapy that includes exercises drawn from Pilates is still covered, but no benefits will be paid where the classes consist solely of Pilates. 

The one change our members with Basic Extras will see, which is not related to the reforms, is the change in the optical cover to $300 over a two year period.

Discounts for 18 to 29-Year-Olds
On 1 April 2019, the new youth discounting provisions come into effect. Although these are optional, Doctors’ Health Fund believes they are good policy and so will be implementing these provisions. The applicable discount is dependent on your age on 1 April 2019 (or future commencement date) as per the table below. 

youth discount table

The discount remains with you, while you retain your cover until turning 40, at which time it reduces by 2% per annum.

We will notify all impacted members of their discount allowance in early April.

New $750 Hospital Excess Policies 
From 1 April 2019, Prime Choice and Smart Starter will be offered with a higher excess amount of $750 per hospital admission. The maximum excess for Couples and Family policies is $1,500. Our $500 excess will also still be available.

We have also changed the excess applied to Couples and Family policies. The excess is now capped at one excess per person every year. So if the same person on the cover requires two hospital admissions in the same calendar year, they will only have to pay the excess once.

Members interested in these products should consider the higher cost they will incur when being admitted to hospital.

New Travel & Accommodation Benefits
Members living in regional and rural areas that need to travel to urban centres or capital cities to receive specialist hospital treatment, not available in their local town, can claim on travel and accommodation costs. This benefit is available for both the patient and a carer.

While this is not a mandatory requirement, we believe it is a positive initiative, which will improve the value of private health insurance for consumers in regional and rural Australia. We are pleased to support this new initiative and will be providing these benefits to our members. More information will be provided on our website.