Your guide to Private Health Insurance Reforms

It is important to us that our members understand the various elements of private health insurance and have clarity about any changes.

We have created two graphic demonstrations below as an easy reference for our members to explain the Private Health Insurance Reforms and our approach.

On 13 October 2017, Federal Health Minister Greg Hunt announced a wide package of reforms for the Private Health Insurance industry. These reforms are designed to make things easier for consumers and create more transparency across the industry.

In line with these reforms, we have made changes to ensure compliance with the government and to help improve transparency and understanding of our products. Importantly, we also want to ensure that our members understand the value of their cover.

Some of the key reforms that may affect Westfund members are outlined below:

Summary of Private Health Insurance reforms for Westfund Members
What How When Why
Gold/Silver/Bronze/Basic product tiers Product tiers will be introduced to make the range of products easier to understand for consumers. The tiers are:

Hospital products – Gold, Silver, Bronze and Basic

Extras products – Product tiers for Extras is yet to occur, however changes to legislation on the naming of products has required Westfund to make name changes to our current Extras products.


From 1 April 2019

(all funds must have implemented by 1 April 2020)

We’re working to ensure our products fit within the government’s tier structure to ensure transparency and ease of understanding.

This may mean changes to certain products and we will inform affected members as soon as possible.

Increase to maximum excess levels The government will increase permitted excess levels on hospital policies from $500 to $750 for singles and from $1000 to $1500 for couples/families. This will allow consumers to choose products with higher excesses in return for lower premiums. Voluntary from 1 April 2019 We are changing the maximum excess available on most policies in line with the government’s decision to allow increased excess levels.
Natural Therapies Health funds will no longer be able to provide benefits on the following natural therapies on complying health insurance products from 1 April 2019: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, western herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi, and yoga. Compulsory from 1 April 2019


In line with the government’s decision to remove certain natural therapies, as of 1 April 2019 we will no longer include a benefit for the specified therapies on any of our health insurance products.
Clinical Categories Health funds will be required to use standard clinical categories for hospital treatments across all documentation and all platforms. From 1 April 2019

(all funds must have implemented by 1 April 2020)

We will adopt these clinical categories to assist our members’ understanding of what they are and aren’t covered for under their hospital cover.
Improved access to travel and accommodation benefits for regional and rural areas Health funds will be able to offer travel and accommodation benefits under hospital cover instead of only under extras policies Voluntary from 1 April 2019 We’re pleased to already offer travel and accommodation benefits to our members and will continue to assess how we can improve these.
Discounts for 18 – 29 year olds Health funds will be able to offer 18 to 29 year olds a discount on their premium of up to 10 per cent. Legislation currently prevents insurers from offering premium discounts to people based on their age. Voluntary from 1 April 2019 We are assessing our approach to this change and will inform all affected members as necessary.
Prostheses pricing reform Reductions in costs for prostheses paid by private health insurers commenced in 2018, with further reductions to costs for some devices planned for 2019 and 2020. Compulsory from February 2018 Savings generated by reducing costs associated with prostheses have already been passed on to members in the form of reduced premium increases in 2018.

We will continue to assess this in coming years in line with the government’s continuing reform in this area.

Supporting mental health Patients with limited mental health cover can upgrade their cover to access in-hospital mental health services without serving a waiting period. Patients can use this exemption from the existing two month waiting period only once. Compulsory from 1 April 2018 We welcome the government’s commitment to supporting better options for mental health care. This change came into effect on 1 April 2018.

When will I know if these changes affect me?

The changes will be implemented over an extended period of time to ensure the smoothest transition for private health insurance policyholders. Given the scope of these changes, we have completed a comprehensive analysis of what is best for our members and what the reforms mean for them as individuals. Plans are well underway to inform individual members of any changes relevant to their individual policies, with direct communication and general member education developing for distribution early in 2019.

How will you inform me of any changes to my cover?

We will use your chosen communication preference – either by email or post. To update or check your preference, call us on 1300 937 838 or head to Members Online.

I have questions/concerns about these changes. What can I do?

We’re here to help and welcome any feedback from our members. If you need assistance with a query or concern, simply email or call us on 1300 937 838 from 8am – 6pm AEDT, Monday to Friday (excluding Public Holidays).


Why do health insurers increase premiums?

Health insurers review premiums and policies on an annual basis in a consultative process with the government. As a result of this process, there may be some changes to the cost of your premium as of 1 April 2019. For more information on these changes, please read our frequently asked questions.