Private Health Insurance Reforms 2019

Australian Government reforms to health insurance – what do they mean?

Private health insurance is a vital element of our overall health system. But it can be complex and confusing for consumers.

From 1 April 2019, hospital policies will begin to be classified in the tiers of gold, silver, bronze or basic. The aim is to improve transparency and help people understand exactly what’s covered. By April 2020 all private hospital insurance policies will sit in one of the tiers.

How do the tiers help?

The tiers set the minimum requirements for included hospital treatment. All hospital policies must meet the requirements and include ‘gold, silver, bronze or basic’ in the name. If the policy includes more than the minimum treatment, then it will be identified with ‘plus’ in its name.

That means consumers can more easily shop around for the level of cover that meets their needs. Gold has no exclusions. Silver has some exclusions  – or comes with some additional treatment categories if it’s a ‘plus’ policy. Bronze has a few more exclusions. And basic only covers a limited range of treatment.

Do I need to change my cover?

If you’re a Defence Health member, you will not need to change your cover. But it might be a good time to review your cover and make sure it includes the clinical treatment categories that meet your needs.

If you’re new to health insurance or wanting to review your cover, it should be easier to compare the levels of cover offered by different funds.

Has my cover changed?

All hospital treatments will fit within the new, consistent clinical treatment categories. For Defence Health members, all previously included treatment is still included in your cover - and Essentials Hospital, ADF Essentials Package and Value Hospital have additional clinical treatment covered from 1 April 2019. In determining the clinical categories, the government has reassigned some MBS items from a clinical category to align them with their more appropriate clinical category.

Will the changes impact my premium?

The government reform of clinical categories and product tiers will not alter premiums. Further reform of the pricing of medical devices (prostheses) and a change in the cost-shifting behaviour of public hospitals is needed to put downward pressure on premiums.

Where does my policy sit?



Level of treatment

Gold Gold is top cover, with everything (approved by Medicare) covered. This is where our ADF Total Package, Ultimate Hospital, Premier Hospital, Top Hospital, ADF Top Hospital products sitClick here for more information on included treatments in each product.
Silver Silver is mid-level cover with some exclusions (such as joint replacements or weight loss surgery). Our Advantage Hospital and Value Hospital products satisfy the ‘silver plus’ classification. Our Core Hospital meets the minimum requirements for the silver tier. Click here for more information on included treatments in each product.
Bronze Bronze is mid-level also, but with a few more exclusions. We currently offer Everyday Hospital which satisfies the 'bronze plus' classification. Click here for more information on included treatments in each product.
Basic Basic only covers a limited amount of treatments. Our ADF Essentials Package, Essentials Hospital, ADF Public Hospital and Public Hospital products satisfy the ‘basic plus’ classification. Click here for more information on included treatments in each product.


Are there other reforms?

Alternative therapies

The government is making another important and mandatory change that affects some extras policies. Because of a lack of clinical efficacy, all health funds must remove aromatherapy, homeopathy, naturopathy and herbal medicine from their benefit schedules (effective 1 April 2019).

Discount for under 30s

Health funds will have the option to give 18–29 year-olds a discount of up to 10% off the hospital premium (based on their age when they take out the cover). Defence Health offers a Youth discount on our Advantage Hospital Silver Plus, Core Hospital Silver and Everyday Hospital Bronze Plus products.

Higher hospital excess

All funds will have the option to offer hospital products that carry a higher excess – up to a maximum of $750 for singles and $1500 for a couple or family. We’re not immediately implementing a $1500 excess, but will be closely monitoring the market and member feedback. We offer a maximum $750 excess on our Advantage Hospital Silver Plus, Core Hospital Silver and Everyday Hospital Bronze Plus products.

Travel and accommodation

Funds will have the discretion to offer a benefit towards travel and accommodation costs for rural members who travel to the city for private hospital treatment. We’re examining this option and need to consider the distance thresholds and a sustainable level of benefit.