Gold, silver bronze: making health insurance easier to navigate

For consumers who already have health insurance and for those contemplating a policy, it is important they assure themselves they are getting the most out of their health insurance arrangements. 

The significant changes to private health insurance beginning today are a timely prompt for consumers to spend time studying what’s available if they want to get the best value out of their health cover.

Poring over health insurance policy detail may seem the last thing most people would want to do, but there is merit in familiarising yourself with the new tiers system for hospital cover in assessing your current and future health needs and potential care costs. 

The Gold, Silver, Bronze and Basic categories introduced from today will present the existing range of health insurance policies and any new ones mapped against four new product tiers delineating the levels of policies and indicating relative costs of policies. They are one of a set of reforms designed to make health insurance simpler and more certain. 

Requiring all health funds to classify their private hospital cover into minimum grouping of clinical categories, should make it easier to compare different policies.   

Recognising that people have different needs depending on their lifestage and circumstances, there is room for flexibility and choice.  Insurers can offer additional cover above the minimum requirements in the form of Basic Plus, Bronze Plus and Silver Plus products. For instance, a Silver Plus policy may offer cover for pregnancy and birth, a category that is a mandatory part of Gold cover, but not other services covered in Gold, such as cataract surgery and joint replacements. 

Below this article are some links which should help guide you to a decision on your health insurance.

Many of us ‘set and forget’ our insurance arrangements: this applies as much to health insurance as it does to other forms of insurance. So why should familiarising yourself with the new health insurance changes be something you should do now rather than delay?

It is always a good thing to ‘shop around’. Comprehending the choices for cover, and the relative value that different levels of treatment represent, helps in understanding the relatively higher cost of some categories of treatment as the tiers move up from Basic to Gold.

The tiers also demonstrate the expanding range of many medical procedures whose cost to the health insurance system generates premiums beyond the reach of many people. 

If we are the ones who may benefit, we are the ones who must pay. So, it makes sense that we should also understand the relative values of our health care.

The tiers system has followed months of exhaustive discussions in an advisory committee involving health funds, medical and hospital representatives and a single consumer representative from the Consumers Health Forum.

The need for change in the way policies are presented by the health funds has come in the wake of increasing complaints and frustration from consumers about the uncertainty and complexity of health insurance.

With the cost of premiums rising each year, often accompanied by a shrinking in cover, the need for clarity and transparency had become ever more pressing.

Gone are the hospital insurance policies of years ago which were largely based on whether you had cover for a private room and with little or no breakdown of what procedures you might be covered for.

When it comes to modern medical treatment there is much more on offer, from multiple cancer treatments to open heart surgery and from products like insulin pumps to pain relief implants.

And all of these are coming under accelerating demand with the ageing of the population.

More transparency in health care costs, including the proposed development of a website showing individual specialists’ fees, should play their part in bringing more scrutiny to the cost benefits of health care.

The choices in health care are mushrooming and will continue to do so.  Yet with so many healthy lifestyle options to reduce the risk of or need for expensive treatment, with so many new and emerging technologies and with a system comprises of a mix of private and public providers and payers, consumers will need to be evermore engaged in their health decisions.

The new product tiers, in their own way, contribute to the gradual, welcome growth of transparency in health services. 

To get a quick summary of the four tiers of  hospital cover changes, and a helpful chart showing what treatments are covered by each tier, go to https://beta.health.gov.au/resources/publications/private-health-insurance-reforms-gold-silver-bronze-basic-product-tiers-fact-sheet

Having got an explanation of how the changes work and wanting to select the cover that suits you and your pocket, you will find an authoritative and consumer-friendly aide on the site of the Private Health Insurance Ombudsman, at https://www.privatehealth.gov.au/dynamic/search 

Where to see the details of what treatments are covered by each clinical category:  https://beta.health.gov.au/health-topics/private-health-insurance/private-health-insurance-reforms/clinical-categories-for-hospital-cover

For an explainer of the other private health insurance reforms, go to  https://beta.health.gov.au/resources/collections/private-health-insurance-reforms-fact-sheets

 

 

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Consumers Health Forum