PERSONAL FINANCE How health cover changes will ease the confusion
A new way of simplifying private hospital cover is a welcome change, writes
Anthony Keane
THE Olympics aren’t until 2020 but long before that Australians with private health insurance will be showered with gold, silver and bronze.
Health funds are busily preparing for big changes to the system from April next year, and fund members are being urged to check their cover early.
The introduction of gold, silver and bronze product tiers for hospital treatment is an effort to simplify a confusing system and prevent previous problems of consumers having claims rejected for treatments they thought were covered.
The CEO of health fund nib, Mark Fitzgibbon, said the new labelling system would “formalise and harmonise” different levels of hospital cover. “All the various treatments you can have are grouped into 37 clinical areas,” he said.
Gold products will cover all areas, while silver won’t include nine of them, such as pregnancy, cataracts, joint replacements and weight- loss surgery. Bronze cover excludes another seven treatment types, including implanting hearing devices and back, neck and spine treatments. The cheapest basic policies only offer restricted cover.
Mr Fitzgibbon said the current system allowed funds to cover some form of eye surgery but not others. “That was causing confusion. Now if you cover eye surgery, you have to cover all the ( categories) for eye surgery. Think about what cover you need given your family circumstances, and shop around.”
The changes are yet to be legislated after delays in the Senate, but the industry expects them to be rubber stamped.
Jessie Csaplar, an iSelect spokeswoman, said health funds and the government were busy behind the scenes.
“Systems will have to be redesigned and a lot of products will be renamed and repriced to meet the criteria of the new categorisations,” she said.
People who don’t choose gold, silver, bronze or basic cover will be put into a tier that their fund believes best suits them, so knowing your needs is important.
“We are expecting some initial confusion from customers, particularly those who currently have top cover but won’t necessarily be translated
NEW COVER EXPLAINED
GOLD The top level of private hospital cover will cover all of 37 specific clinical services, with no restrictions, including rehabilitation, hospital psychiatry services, palliative care, cancer treatments and dental surgery. SILVER Covers most of the 37 hospital services without restrictions but does not cover cataracts, joint replacements and spinal fusion, dialysis for kidney disease, pregnancy, birth and neonatal, reproductive services, weightloss surgery, insulin pumps, chronic pain and sleep studies. automatically to gold cover,” Ms Csaplar said.
The Department of Health said consumers faced difficulty comparing hospital insurance There may be restricted cover for rehabilitation, psychiatric services and palliative care. BRONZE Does not cover services not covered by silver, and also does not cover implanting hearing devices, podiatric surgery, dental surgery, medically necessary plastic surgery, back, neck and spine, blood and heart, lung and vascular system treatment. BASIC Only has to cover rehabilitation, hospital psychiatric services and palliative care, and that may be on a restricted basis.