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BCNA News 01 Apr 2019

Private health insurance changes start from today

About half the Australian population has private health insurance, but many people don’t fully understand what they are getting for their money and what they are covered for.

Women and men with breast cancer have confirmed this sentiment in the stories they have told Breast Cancer Network Australia (BCNA) over the years. We have heard from numerous people who believed they had ‘top cover’ only to discover they were significantly out-of-pocket after having treatment for breast cancer.

BCNA welcomes Australia’s private health insurance reforms, which will start to roll out from today. The changes include the following:

  • Private hospital cover will be classified in four easy to understand tiers – Gold, Silver, Bronze and Basic.
  • Private health insurers will be able to offer discounts for young people aged between 18 and 29.
  • High excesses in exchange for lower premiums will be available.
  • Travel and accommodation benefits for people who need to travel for treatment.
  • Improved access to mental health treatment by allowing people to upgrade their hospital cover without serving a new waiting period.
  • Insurers will no longer be able to offer benefits for some natural therapies, including yoga, tai chi, aromatherapy and naturopathy, as part of ‘extras’ policies.
  • The Private Health Insurance Ombudsman will have new powers to investigate complaints and other issues.

Many insurers will implement the new Gold, Silver, Bronze and Basic tiers of hospital cover by the middle of 2019, and all insurers have until 1 April 2020 to introduce the new tiers for all hospital policies.

What this will mean is the higher the tier, the more categories it covers – making it easier to understand your policy and compare it to others.

It also means that if your health insurer covers a category – for example, ‘bone, joint and muscle’ or ‘heart and vascular system’ – they must cover all of the treatments in that category.

Under the new changes women will benefit from guaranteed cover in Bronze tier policies and above for:

  • Breast cancer treatment
  • Ovarian cancer treatment
  • Breast reconstruction after breast cancer surgery
  • Gynaecological services

It is important to note that although radiotherapy as part of cancer treatment is covered in the Bronze, Silver and Gold tiers, this cover is only for radiotherapy given as an in-patient procedure (i.e. when you have been admitted to hospital). Most radiotherapy treatment for breast cancer, especially early breast cancer, is given as an out-patient procedure, and so is not covered by private health insurance.  Radiotherapy is available free of charge through the public health system.

If you already have private health insurance, your insurer will send specific information about your policy.

You can find out more about the changes to private health insurance on the Australian Department of Health website and can download a fact sheet here.