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Complaints drop following health insurance overhaul


Ombudsman says the new tier system could be to thank for positive change.

Australians seem to be happier with their health insurance, after a new report showed complaints dropped 11% in 2018/19, compared to the previous year.

Commonwealth Ombudsman Michael Manthorpe said the drop was partly due to the new tier system which was introduced in April 2019, bringing basic, bronze, silver and gold levels to health insurance.

Interestingly, Manthorpe also said he expected the positive trend to continue, as Australians get to grips with the new system and gain a better understanding of their health insurance.

"We anticipate that the number of complaints about benefits will reduce in future years with the implementation of private health insurance reforms in 2019–20 that standardise clinical categories and give consumers more certainty about their benefits," he said.

What is the new system?

On 1 April 2019, a new 4-tier system was introduced to give Australians clearer guidance on the quality of their health insurance. The changes will become mandatory on 1 April 2020.

  • Basic: Must cover a minimum of three treatments – rehabilitation, hospital psychiatric services and palliative care – offered on a restricted basis.
  • Bronze: All the basic benefits, plus cover for lots of other treatments including diabetes, chemotherapy, joint reconstructions and many more.
  • Silver: All the bronze benefits, plus cover for back, neck and spine treatment, the heart, lung and vascular system and medically necessary plastic surgery, among others.
  • Gold: Rehabilitation, hospital psychiatric services, and palliative care without restrictions. All the silver benefits, plus cover for cataracts, pregnancy, weight loss surgery, chronic pain and more.

Read Finder's full guide to health insurance tiers, to find out what else is included in each band, and figure out which one is right for you.

Common complaints

According to the ombudsman, two of the most common complaints were around extras benefits and unexpected hospital policy restrictions.

"Some basic and budget levels of hospital cover exclude or restrict services that many consumers assume are routine treatments," said Manthorpe.

However, Australians may be able to get a better deal by splitting their hospital and extras cover, to create a customised health insurance policy, which is better tailored to their needs.

For example, you might want a comprehensive extras policy, so you can claim your gym membership, sports massages or physiotherapy, but only need a basic hospital cover.

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Picture: GettyImages

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