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We’ll begin to use ‘standard clinical definitions’ across our website and whenever you hear from us. We want health cover to be easier to understand so there can be greater transparency about what’s included and what’s not.

What does the introduction of ‘standard clinical definitions’ mean?

By April 2020, all health funds will be required to define the clinical categories of hospital services in the same way, which will help customers to understand and compare health insurance policies. For example, the hospital services which form part of the category 'heart and vascular system’ will be exactly the same across all funds.

All hospital treatments and services will be divided into 38 separate clinical categories, with specified Medicare Benefit Schedule (MBS) items (medical services subsidised by the Government) within each category. The standardisation of clinical categories and MBS items means that there may be a change to the individual MBS items currently included under your policy.  

How will health insurance be categorised as part of the changes?

A new classification system will be introduced from April 2019 to make it easier to understand and compare health insurance products. By April 2020, all hospital products will be classified and named as ‘Basic’, ‘Bronze’, ‘Silver’ or ‘Gold’.Each product classification must include a minimum number of hospital treatments as set out by the Government. For example, a ‘Gold’ product must include all 38 clinical categories of treatments. Health funds can also choose to include more than the minimum number of clinical categories in each product. In this case, the product would become a ‘plus’ classification—for example, ‘Bronze Plus’.

We’ll be in touch soon to let you know if your product name is changing, and if we will be adding or removing treatments and services from your existing product to fit into the new Basic, Bronze, Silver and Gold classifications.

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