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 have revised our products to ensure they fit within the government’s tier structure, ensuring transparency and ease of understanding.

We’re empowering our members to select the cover that suits their needs with Your Cover, Your Choice – Hospital and Extras covers combined to provide what you want most from your insurance/policy

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 have changed 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, we 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 have adopted 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 From 1 July 2019, we will implement Age Based Discounts for eligible members.
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 reforms 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. Communication around these reforms, as well as any change in premium, was sent to members in February 2019. This communication contained detailed information specific to our members’ individual circumstances.

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

We have sent this communication using 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 has my premium changed?

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.

Reforms in detail

I am an existing Westfund member who is being merged across to a new product as of 1 April 2019. Do I need to serve waits on additional benefits on my new policy?

No. Where members are merged onto new products they will not have to serve any waiting periods on new products. If a member chooses to transfer to a new cover prior to 1 April 2019, or onto a product that has not been chosen as the logical transition from the previous cover, the usual waiting period conditions will apply.

What are clinical categories? Why have they been implemented?

Clinical categories are exactly that – categories or types of hospital treatments. For example, if your policy covers ‘joint replacements’, you are covered for any hospital service that is included in that category. The creation of clinical categories will allow people to compare similar policies across insurers and give greater certainty about the services that are covered by their policy.
A full list of clinical categories, including the scope of cover within the categories, is available from the Department of Health.

What are standard clinical definitions?

Clinical definitions refer to the separate treatments within a category. For example, ‘knee replacement’ is within the clinical category of ‘joint replacements’.
By April 2020 all funds must use the same standard clinical definitions. The terminology, descriptions and definitions used to explain treatments or services will be the same regardless of fund, making it easier for you to understand and compare policies.

Why are you removing benefits for some natural therapies from my policy?

During the reform process, the government commissioned a review of a number of natural therapies. This review concluded that there was insufficient evidence that certain therapies are effective. Therefore, as per the government’s directive, health funds Australia-wide will no longer be able to pay benefits on certain natural therapies.
These natural therapies are: Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, Western herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, Shiatsu, Tai chi and yoga.

Why have excess options increased?

Increased excess options allow you to have more control over the cost of your cover. One of the primary reasons for federal government reform of private health insurance was to address affordability, and being able to manage the cost of cover empowers members to make the choice that is right for them.
If you choose a higher excess option, this will mean that your premium will be lower. The maximum excess option is $750 per single policy/$1500 for families.
Remember, with Westfund you won’t pay an excess on any claim for day surgery, kids or hospitalisation resulting from an accident*
(*may apply within 12 months of transferring from another fund)

How does the government initiative travel and accommodation benefit differ from my current benefit with Westfund?

As per Westfund’s current travel and accommodation benefit, members can receive up to $600 per calendar year per policy which includes:

  • up to $150 per night for accommodation expenses incurred in relation to a hospital admission
  • up to $70 per round trip (minimum 150km) towards travel expenses for inpatient and outpatient medical specialist services when referred by a Medicare Registered Practitioner.

This benefit is available to members after one year of continuous membership, on certain Westfund policies*.
In line with the government initiative around travel and accommodation benefit, Westfund have chosen to extend our current travel benefit to include travel for in-patient services, not just out-patient services.

*The above amounts reflect the level of travel and accommodation benefits available on Westfund’s Gold Hospital policy. See policy details for specific amounts for other levels of cover.

I still have questions about the reforms. Where can I find out more?

For further information on the federal government’s private health insurance reforms, including detailed explanation on all changes, visit the Department of Health’s dedicated reforms page.