In the February issue of VitalSigns, we unpacked the important changes arising from the private health insurance reforms. Now that the changes have been implemented on 1 April 2019, here are a few reasons why Doctors’ Health Fund is still leading the charge when it comes to quality health cover.

post reforms

New product tiers

The most significant change to come out of the new private health insurance reforms is the requirement for health funds to classify all hospital policies as; Gold, Silver, Bronze or Basic, depending on the clinical categories the policy covers.

Gold is the highest tier and covers all 38 of the new clinical categories, while Basic policies are only required to include three categories: rehabilitation, psychiatric services and palliative care.

The new product tiers aim to improve transparency for consumers by standardising terminology and making comparisons between policies easier.

Doctors’ Health Fund does not have a Basic policy because we don’t believe the Basic tier provides adequate health cover.  Our entry-level hospital cover is classified as Bronze ‘Plus’ because it covers more clinical categories than the new Bronze tier. We also have two Gold-level hospital covers, Prime Cover Gold and Top Cover Gold.

More information about the clinical categories can be found at

Out-of-pocket costs

Remember, the new classification system establishes the range of services required in each tier; it does not necessarily denote the quality of that coverage. The quality of the coverage will also be influenced by the medical benefits paid by the fund and the range of private hospitals with which the fund chooses to contract.

Where the medical schedule offered by the fund is not adhered to by your treating doctor, a gap may arise; even in Gold products. Similarly, if a patient decides to be admitted to an uncontracted private hospital, a gap may be charged by that hospital. 

At Doctors’ Health Fund, we advocate for quality medical coverage on all our products, including our market-leading Top Cover that pays medical benefits up to the AMA list of services and fees. Similarly, we strive to contract with as many private hospitals as feasible, and currently have more than 550 contracts across Australia; including both overnight and same-day facilities.

New excess options

Doctors’ Health Fund now offers a higher excess option of $750 per year on Prime Choice Gold and Smart Starter Bronze Plus hospital policies (limited to $1,500 for couples and family policies).

It’s important to note that while a higher excess might sound like a good idea, you should always consider the savings in the context of the higher excess that you need to pay should you need to go to hospital.

We have also capped the excess payment to one payment for each person on the policy per year, meaning the same person will not pay more than one excess per year for hospital admission.

New youth discount

We now offer a Youth Discount of up to 10% off the hospital premium to members aged 18 to 29.

This discount is a voluntary scheme which came off the back of the reforms. While not all health funds have chosen to adopt it, we support this initiative because we believe it is good policy to incentivise more young Australians to take up private health insurance.

The discount will range between 2% and 10% per annum; depending on the age of the person at the time of joining Doctors’ Health Fund. If you are already a member of Doctors’ Health Fund, your discount is determined by your age on 1 April 2019, and for new members; it’s your age when you take out cover for the first time after 1 April 2019. For more information on the youth discount, visit

New travel and accommodation benefits

We now offer members an expanded travel and accommodation benefit as part of their hospital policy. The benefit covers travel and accommodation costs pre and post a hospital admission. It is now available to both patients and carers living in regional and rural areas who need to travel to urban centres or capital cities to receive specialist medical and hospital treatments that are not available in their local town.

This is another reform that is not a mandatory requirement, but worthy of our support as it will improve the value of private health insurance for our members in regional and rural Australia.

If you have any further questions about the latest changes, please call 1800 226 126 or email