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Important Government Changes to Private Health Insurance

You’ve heard a lot of talk about the private health insurance reforms for 2019/2020. Some of these changes have already come into effect, while others like the gold, silver and bronze health insurance tiers only has to be implemented by 1 April 2020.
Fact Checked

Updated: 24 May 2024

Don’t get overwhelmed by all the hype. We’ve summarised the most significant government changes to private health insurance for you below.

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Private health insurance reforms summary

Some of the private health insurance reforms for 2019 include standardisation of all clinical definitions to help customers make sense of what they’re covered for. By April 2020 all health funds must adopt the 4-tier Gold, Silver, Bronze and Basic health insurance classification system, and provide at least partial coverage for mental health services, even on the lowest plan.

However, there has also been a reduction in the minimum benefits payable for devices listed on the prostheses list and many of the natural therapies are no longer available on Extras cover.

Key health insurance changes for April 1

Health insurance reform
How the reforms affect you
Effective date
Properly informed about out-of-pocket costs
Ensuring consumers are adequately informed about the potential out of pocket costs.
2 Jan 2018
Changes to the Prosthesis list benefits
Reduced expenditures on prostheses under an agreement with the Medical Technology Association of Australia.
1 Apr 2018
Provides primary care, eye care, dental care, and allied health services in Victoria.
Easier for people without full cover to upgrade and access mental health services and drug & alcohol treatment.
Before 1 April 2020
More support for mental health services
The Government introduces gold, silver, bronze, and basic categories to enable standardised definitions for treatment, so there are “no nasty surprises”.
1 Apr 2019
Standard clinical definitions