Australian private health insurance changes – Acupuncture and Chinese Medicine

Private health insurance changes took effect on 1st April 2019. There is still confusion as to what these changes mean for the consumer, especially in relation to coverage for acupuncture.

The intention is to make things more streamlined and easier to understand by creating standardised tiers of Gold, Silver, Bronze and Basic for hospital covers. Each tier offers the same interventions across health funds and can be viewed here.

In order to help counter the ever-increasing cost of private health insurance, consumers will be able to pay a higher excess (the amount you must contribute if you need to use your insurance) in order to reduce their premiums (the amount you pay every year).

For private hospital cover, the excess can now be set as high as $750 for singles (up from $500) and $1500 for couples and families (up from $1000).

Many natural therapies will no longer have rebates offered by health funds, due to legislative changes. This removed government support in the form of rebates for the health insurers and redefined them to no longer fall under general treatment.

Acupuncture, Chinese Medicine and remedial massage (including Tuina) are not affected by this and your health fund will still offer rebates for the use of these services.

A review was conducted by the National Health and Medical Research Council (NHMRC), which aimed to evaluate the effectiveness, safety and cost-effectiveness of 17 natural therapies. This resulted in a list of natural therapies which they determined they would no longer support private health insurance for. The following therapies will no longer receive rebates from private health insurance:

There has been debate regarding the authenticity of the findings of NHMRC, in particular regarding the methodology and benchmarks used to determine effectiveness. There are petitions circulating to demand a reassessment of these changes to reinstate natural therapies such as this one here.

The following from the government fact sheet is of particular note though: “Insurers can offer incentives to purchasers of private health insurance as long as the incentives meet the requirements of the Private Health Insurance (Complying Product) Rules. These incentives could include services provided by a natural therapist. It will be up to each insurer to decide whether to offer this type of incentive.”

So whilst the government has removed support for the offering of these therapies by health funds, they have also left the door open for the health funds to offer some form of ‘incentive’. Ultimately the ball is still in the court of the health funds as to whether they choose to offer it.  

It is worth noting that these therapies are not banned, they are still available – just not with health fund rebates. The individual financial effect of this is dependant on the level of cover held, with the amount having been rebated varying dramatically between different covers and health funds.

Whilst this may lead to a higher cost per treatment – please remember that the longer view is of preventative healthcare. These therapies help address the root causes of imbalance to your health and thus lowered long term costs of healthcare.  

With the ever-increasing costs of private health insurance and a dwindling list of supported therapies, many are now reconsidering the cost-benefit equation of having private health insurance. This is a pertinent time to re-evaluate your personal cover to ensure you are getting the best investment for your health.  

As an example of health funds that will offer coverage for acupuncture, the chart below lists funds that offer on the spot rebates through Hicaps claiming system – such as that used at Dantian Health.

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