PHI Reforms FAQs

The Private Health Insurance (PHI) industry is in the midst of significant Government initiated reforms. Navy Health supports these changes as they provide transparency and PHI easier for you to understand.

Below is a table which outlines the reform and the action Navy Health has taken.

Why has the government decided on these reforms for Private Health Insurance?

These reforms have been decided on for numerous factor outlined below:

1. Affordability: Feedback from consumers has been consistent in that PHI is becoming unaffordable. Some to the reforms that have been announced i.e. prosthesis savings and the removal of natural therapies are designed to cost Navy Health less. Navy Health is committed to passing these savings onto our members, in full.
2. Transparency: Having standard clinical definition and product categories will assist PHI consumers in understanding what they are covered for by making comparison simpler.

Why is Navy Health making changes to my products?

Navy Health is making the changes in response to the government imposed reforms that were announced in October 2017. Navy Health is required to make these changes to ensure our products are compliant with legislation and they support our member’s needs.

Will the cost of my policy increase?

The cost of your policy will be considered later this year as part of the annual premium review process, and may be adjusted from 1 April 2020. Navy Health will communicate to you separately should your premium be changed.

The Government has implemented reforms to assist in making Private Health Insurance affordable – where are my savings?

1. In February 2018, the Government announced they had entered into an agreement with the Medical Technology Association of Australia to lower the price of SOME implanted prosthesis. The savings that have been estimated have been taken into consideration in our premium calculations and is estimated to be approx. $20 per membership for Navy Health members.
2. When Navy Health is no longer able to pay a benefit on some Natural Therapies (as detailed in the table above) –these savings will be passed onto our members.
3. The reform allowing for the increase in the maximum level of excess may also assist in making Private Health Insurance more affordable. Navy Health is conducting an assessment to understand how this will benefit our members.

Where can I get more information on the reforms?

More information on the reforms can be found at www.health.gov.au

Saver Hospital

Saver Hospital & Saver Plus 

Is Saver Bronze+ Hospital 500 and/or Saver Bronze+ Hospital 500 & Extras 65 different from my current Saver Hospital or Saver Plus?

• Yes, you will now be covered for more services than you previously were on the Saver product. The below table explains the differences to the services you will now be covered for and what is now excluded

I have Saver Hospital and am booked into hospital after 13/01/2019, for a service that is no longer covered (Heart & Vascular, Pregnancy & Birth & Sleep studies)?

• Navy Health will honour any previously booked admissions, if the procedure was booked in November at the time Navy Health sent the communication to you. Benefits will be paid at the previous level of cover for these admissions.

Will I be subject to re serving my waiting periods?

• You will not be required to serve any waiting periods for any waiting periods you have already served. If you choose a product with higher benefits, you will be subject to the applicable upgrade waits.

Is my policy cost increasing?

• There are no immediate changes to the cost of your policy, however, please note, your policy may be impacted by the yearly Private Health Insurance rate rise effective 1 April 2020. Navy Health will communicate to you separately should you be affected.

Core Hospital

Core Hospital 

Is Core Silver+ Hospital 500 different from my current Core Hospital?

• Yes, you will now be covered for more services than you previously were on the Core product, The below table explains the differences to the services you will now be covered for and what is now excluded

I have Core Hospital 200 and am booked into hospital after 13/01/2019, what excess will I pay?

• As a transitional measure, any treatments and services where you are admitted to hospital prior to 13/01/2019 will be covered as normal under your current Core Hospital 200 policy and you will pay a $200 excess. Any services booked into hospital after 13/01/2019 will have a $500 excess applied.

Will I be subject to re serving my waiting periods?

• You will not be required to serve any waiting periods for any waiting periods you have already served. If you choose a product with higher benefits, you will be subject to the applicable upgrade waits.
• If you automatically transfer from Core Hospital 500 to Core Silver+ Hospital 500 (or choose a lower level of cover), provided you have satisfied your inital waiting periods, no additional waiting periods apply.

Is my policy cost increasing?

There are no immediate changes to the cost of your policy, however, please note, your policy may be impacted by the yearly Private Health Insurance rate rise effective 1 April 2020. Navy Health will communicate to you separately should you be affected. For members on Core 200 , as you have been transferred to a higher excess product the cost of you policy will decrease.