New tiered private health cover reforms reveal exactly what your policy covers

THE much-awaited private health cover reforms will be unveiled today giving the 1.3 million Australians with health insurance exact information on what their policies cover.

EXPECTANT mothers and people suffering from chronic pain will have to fork out hundreds of dollars more in premiums for “gold” private health cover under the new tiered private health care reforms.

After months of consultations, Health Minister Greg Hunt will today unveil the minimum hospital treatments covered by the new policy bands — Gold, Silver, Bronze and Basic — due to come in from April 1, 2019.

The changes are designed to help the 13 million Australians with private health insurance compare more than 70,000 insurance policies, which all offer different levels of cover.

Under the proposed bands, cataract surgery, IVF, joint replacements, kidney dialysis, insulin pumps and sleep studies will all be excluded from silver and bronze policies meaning patients will require top-level gold cover.

Ciara Houlihan, 35, with daughter Emily, 18 months, and Jenny Bourke, 34, with daughter Poppy, 1 say it is unfair women have to pre-plan health cover when it comes to having a family. Picture: David Swift

Silver policies will cover 27 hospital treatments — only seven more than bronze policies — including foot surgery, medical plastic surgery procedures, heart treatments and dental surgery.

The Government has recommended that 20 basic hospital treatments including appendix surgeries, vasectomies, melanoma treatment, chemotherapy and tonsil removal be covered by all bronze policies.

In a win for female patients, women’s health services such as breast reconstruction, gynaecological services, and ovarian and breast cancer treatments will also be included in all bronze policies.

Health Minister Greg Hunt said the change would “empower consumers” by explaining exactly what is covered and what is not. “This will support thousands of Australian women through cancer diagnosis, treatment and recuperation,” he said.

But women who want private obstetrics included in their private health insurance policies will need to take out the highest tier cover which also covers treatments such as weight loss surgery and chronic pain.

Treatments for issues such as melanoma treatment and will be covered by all bronze policies.

Sydney mums yesterday hit out at insurers forcing them to pre-plan health cover to specifically include childbirth to qualify for private hospital care.

Waterloo mum Ciara Houlihan, 35, said there should be blanket obstetrics cover so women can have a child when they’re ready, instead of shilling out as soon as they consider conceiving.

“Once you decide to have a baby you need to take out top-level cover, even though it could take between a few months or a few years,” Ms Houlihan said.

Bondi mum Jenny Bourke, 34, was relieved choosing the right private health cover for her young family would become simpler but urged insurers to make obstetric cover standard.

“Private health care is extremely expensive and I don’t think we get value for money, especially because it’s difficult to understand exactly what you’re covered for,” she said.

Federal Health Minister Greg Hunt Picture: Mick Tsikas

Ms Bourke hopes she won’t need to spend hours combing through the fine print of insurance policies under the simpler system where cover is ranked as gold, silver, bronze and basic.

Mother-of-one Liz Barry, 34, argued including obstetrics in the most basic plan was an important step to cover unplanned pregnancies.

“It’s not fair that unplanned pregnancies aren’t covered because obstetrics hasn’t been added to the insurance cover a whole year earlier,” she said.

Ms Barry added the government should step in to stop insurers charging expectant mothers thousands of dollars over and above gold-plated insurance to see specialists.

Australian Medical Association president Dr Tony Bartone welcomed the introduction of the tiered system but said pregnancy should be included in all three tiers because it had a “significant unplanned component”.

“It needs to be part of all three” Dr Bartone said.

He also criticised the Government the Government for including a “basic” or “junk policy” category, despite former minister Sussan Ley and Labor having called for “junk policies” to be banned. “Some of those policies are only used as tax deduction, they aren’t providing any value,” he said.