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Reform changes – a re-cap

The Federal Government’s Private Health Insurance Reforms came into effect from 1st April 2019 – one of the biggest shake-ups in health insurance in recent times.

As with everything we do, our members were at the heart of our process to implement the reforms – it was our priority to help you understand the changes. We communicated with each and every one of you directly about the reforms – what they are and what they mean for you and your family, including any required changes to some of our products.

Now that we’ve put all the reform changes in place, here’s a quick round-up of the biggest changes and what they mean, plus some of the highlights from our 2019 benefits review.

Reform change


What it means for members


Hospital cover

Gold/Silver/Bronze/Basic hospital categorisation





Noticed a change in the name of your Hospital cover? As part of the reforms, all health funds had to align their Hospital products to a standard categorisation system. So all our Hospital products now align to a tier: Gold, Silver, Bronze or Basic.

Got the word ‘Plus’ in your cover name (like Mid Classic (Silver Plus))? That means our cover includes more benefits than the minimum required for that tier.

The government deadline for the categorisation changes is April 2020 but, to make it easier for our members, we’ve implemented all the reform changes from April 2019.

Hospital cover

Bringing in standard clinical definitions




With the reforms, all health funds must use standard clinical or medical definitions (so the language will be consistent across all funds – good news).

This change makes it easier to compare products and understand what’s covered (or not) on a membership policy. Before the reforms not all of our products aligned directly to these definitions, so we’ve had to make minor changes to some of our products to achieve this. Don’t worry, if this change affected you – we’ve been in touch.

Hospital cover

Mental health cover upgrade 





Mental wellbeing is so valuable and access to mental health services if and when you need them is vital.

As part of the reforms, health funds are now providing greater access to mental health services in hospital for members. But what does this mean exactly?

In addition to the psychology benefits available under our Top Extras and Essential Extras covers, members on a Hospital product with limited mental health cover can now upgrade their cover to access in-hospital mental health services without having to serve an additional waiting period. Members simply need to have served the original two-month waiting period for psychiatric services to access the waiver and the upgrade can only be accessed by a person once in their lifetime.

Extras cover

Removal of cover for some natural therapies




As part of the reforms, the government has determined which natural therapies can receive benefits and excluded others from being covered. This means health funds can no longer pay benefits for some natural therapies previously covered. We still pay benefits for those allowed services (acupuncture, Chinese herbal medicine, myotherapy and remedial massage).

Private Health Information Statements (PHIS)






Thinking of reviewing your cover options? We know that health insurance can be confusing and sometimes you might feel like you’re comparing apples to oranges.

To help with this, the government has introduced the ‘Private Health Information Statement’ (or PHIS) – a standardised statement summarising your policy cover – that’s used across the industry, making it easier to understand what you’re covered for and compare covers.

We’ll be sending members a PHIS for their membership this month, so keep an eye out. (Some funds will use the older ‘Standard Information Statement’ (or SIS) until April 2020, but we’ve already made the change).


Extras benefits - could you be claiming more?

Again, we’ve communicated with members about any changes to our Extras benefits that impact you directly. But here are some of the highlights from our annual benefits review.


Top Extras

Essential Extras


StarterPak (Basic Plus) (our combined Hospital and Extras option)

Orthodontia: now you can claim benefits after 12 months of cover, down from 24 months.

Chiro, Osteo, Physio and Exercise physiology: you can now get more back for your first visit ($45).

Chiro and Osteo: we’ve increased our annual limit to $480 per person.


Psychology: we’ve introduced a new benefit. So (after the 2-month waiting period) you’ll have an annual limit of $250 per person.

Optical: we’ve increased our annual benefit limit to $200 per person (up from $165).


Chiro, Osteo, Physio and Exercise Physiology: we’ve increased our combined annual limit for these services to $400 per person (to a maximum of $800 per couple/family) – that’s a $100 increase!


We all know that private health Insurance provides peace of mind for the unexpected. But it can also help you to manage your health and wellbeing – and we want you to get the most out of it.

So why not remind yourself what you’re covered for (and what else you could be claiming!) by logging on to online member services here. Haven’t used OMS before? Just click Register and follow the instructions. If you want to review or change your cover, you can do that online too.