Health fund rebate reforms explained

After the private health funds reforms kicked in in April this year, affecting almost half of Australian population using private health care, many were left unsure what treatments can be claimed and which of them were cut out of the eligible list.

In this article, we will break it down and explain what it means to you, how health funds work and how the reforms affect you.

What’s this private health fund all about?

Let’s start from the beginning..

In Australia, the public health system Medicare covers most Australian residents for health care. However, Medicare does not cover everything and you can choose to take out private health insurance to give yourself a wider range of health care options and more comprehensive cover.

There are two types of private health insurance: hospital & general treatment. (1)

Hospital policies cover you when you go to the hospital, while general treatment policies (sometimes known as ancillary or extras) cover you for ancillary (additional) treatments.

There are about 30+ different private health care providers. For full list of registered health insurers click here: (2)

Most health funds offer combined policies that provide a packaged cover for both hospital and general treatment services, or you can buy the separate hospital and general treatment policies to ‘mix and match’. (3).

There are also different levels of coverage that you may opt in to and most of the time you can decide what treatments you’ll have covered by your health fund and to what extent.

Remedial massage and recent rebate claim reforms

Remedial massage and myotherapy are included in the ‘extras cover’ of the majority of health funds¹. Both modalities fall under the natural therapy category alongside with physiotherapy and chiropractic.

It is the exact category that has just undercome a major reform limiting the types of treatments eligible for rebates.

The changes were a long time coming as the announcement of excluded modalities was made back in April 2017 (4). Nevertheless, it was still bad news for all private health fund members when the insurance industry made this drastic cut taking a lot of natural therapies of the rebates eligible list.

From 1 April 2019 private health insurers will no longer be able to offer benefits for some natural therapies as part of a health insurance policy.

The affected natural therapies are:

Alexander technique	naturopathy
aromatherapy	Pilates
Bowen therapy	reflexology
Buteyko	Rolfing
Feldenkrais	shiatsu
western herbalism	tai chi
homoeopathy	kinesiology
yoga

The reform followed a review of natural therapies by the former Commonwealth Chief Medical Officer. The reason for those changes is that there is no clear, scientific evidence that these natural therapies are effective. (4)

Luckily for all our Tonic family, those changes do not apply to remedial massage and myotherapy which are still included in the rebate eligible list.

Tonic patients with Australian private health fund and with appropriate extras cover will continue to be able to claim on relevant services provided by our massage therapists.

So it’s business as usual for our Tonic remedial massage therapists and myotherapists.. what are you waiting for – book your message with us today!

One more thing you should know..

Every private health fund policy has an expiry date. Your insurer will renew your policy to ensure you’re covered at all times. But what happens if you haven’t used all the benefits that you were eligible for? Unfortunately, the unused credits won’t roll over to your new policy, they will be lost.

To make the most of your private health insurance, make sure that you use all benefits before your policy expires. After all, you paid for them by buying your health fund policy.

Depending on your policy, your deadline to use all credits is either at the end of the financial year (SOON! 31st June!!!) or at the end of the calendar year (31^st December). Less often the insurance policy will last for 12 months from the day you join your health fund.

Whichever option you choose it’s good to mark that date in bold in your calendar and plan your treatments ahead so that you don’t miss out.

Book your appointment with Tonic now to use your remaining remedial massage or myotherapy credits before they run out!

¹ we recommend that you check with your insurer as to the extent of your policy and rebate coverage to be certain

References:

1. https://www.privatehealth.gov.au/health_insurance/index.htm
2. https://www.privatehealth.gov.au/dynamic/insurer
3. https://www.health.gov.au/internet/main/publishing.nsf/Content/health-privatehealth-whatisPHI
4. https://www.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reforms-fact-sheet-removing-coverage-for-some-natural-therapies