Changes to Private Health Insurance Policies (2019)


Changes to your PRIVATE HEALTH INSURANCE Policy – New classifications are coming into effect in 2019 – Gold, Silver, Bronze and Basic.  What this means to YOU.


Private Health Insurance policy changes being implemented in Australia – effective in 2019 – could impact what IS or ISN’T covered by a Private Health Fund for Plastic Surgery procedures.

  • Many changes in health fund policies are being implemented in Australia in 2019 after governmental review.
  • This page has additional information on new 2019 Gold, Silver, Bronze and Silver Health Insurance classification systems for Private Health Cover in Australia.

Why are health insurance funds changing to different policy categories?

+-Australian Health Fund Changes occurring in 2019 including BUPA and other funds

+-Overview of NEW Policy Classifications for Private Health Funds

Quick Overview of Changes to Health Fund Policy Classifications & Coverage

  • There are over 70,000 DIFFERENT health fund policies in Australia – an overwhelming number that means confusion to patients AND insurance teams alike.
  • Due to high complaints about insurance fund policy exclusions, the Australian Government is simplifying WHAT Policy Coverage actually means – across ALL insurers.
  • This should help private health fund policy holders KNOW exactly what they’re buying – and covered for – meaning they can shop around with better information.
  • “Junk policies” are being targeted for being phased out.

+-What does the TERM 'Junk Policy' mean in terms of health insurance?

  • “Junk policy” is a TERM used to describe a low cost, low coverage health insurance policy classification that appears to be of LITTLE or NO value to most consumers.

Great Health Insurance Company transparency and Health Fund policy coverage clarity are the primary aims of these changes to health fund policy classifications and rankings.

+-When do NEW Policy Classifications go into effect for Private Health Funds?

NEW Policy Classifications going into effect for BUPA and other Private Health Funds

  • These changes go into effect during 2019.

+-What do new insurance policy classifications mean in view of PLASTIC SURGERY COST coverage?

  • Changes to your POLICY WILL impact your PHI Coverage for hospitalisation and surgical fees for Plastic Surgery procedures.
  • Additionally, MBS changes and new medicare criteria for plastic surgery have changed.
  • Your procedure may be subjected to stricter rebate limitations or fail to meet requirements and criteria for a Medicare rebate/MBS Item Code.

TIP: If you’re counting on using your Health Fund cover to help pay for your reconstructive or corrective plastic surgery procedure, such as a Breast Reduction or Rhinoplasty, you may want to ask your Insurance company what changes these new ranking systems will have on your existing policy.

Suggestion: Read our other blogs related to surgery and rebates, Medicare and Super Withdrawal:

What does fully covered really mean in terms of private health insurance policies and surgery expenses

Super and Plastic Surgery: Changes to the Application Process for Early Withdrawal of Super for Surgery based on compassionate grounds“?

Read the BLOG on Super for Surgery.

Phone us on 1300 264 811 for information on how this might impact your future surgery.

+-What are the new classifications going to be for health insurance policy coverage?

Australia Health Minister Greg Hunt’s initiative to reclassify Health Fund Policies into Gold, Silver, Bronze & Basic Categories starting in 2019.

Excerpt from the changes according to Australian Health Minister Greg Hunt’s media release:

For the first time I am proud to mandate vital support for women under the Silver and Bronze categories, which will include gynaecological services, ovarian and breast cancer treatment and breast reconstruction.

This will support thousands of Australian women through cancer diagnosis, treatment and recuperation.

Consumers should expect to see new insurance policies categorised under this new system by early 2019 from insurance companies.

  • These 2019 Health Insurance Classification changes to Gold, Silver, Bronze and Basic, AIM to help consumers more easily understand what’s covered by private health funds.

Understanding Private Health Insurance Hospital Cover and related policy inclusions and exclusions can be very confusing, and the pending changes proposed by the Health Minister, coming into effect in early 2019, could greatly impact what Plastic Surgery procedures are eligible for cover.

What this means to patients:

The only way to assess your actual coverage is to have a Quote from your Surgeon with details of the surgery procedure code (if applicable).  Then phone your Insurance Company, such as BUPA, Medibank, AAMI or Australian Unity, for actual clarification.

** Please note that this information is general in nature, and is a synopsis of selected information available from news outlets and insurance firms.

More INFO:  Health Fund Coverage Complaints for Hospitalisation Exclusions, New Classifications in 2019

health insurance cover plastic surgery - criteria, waiting periods, exclusions

+-What should I know about complaining to a Health Insurance Fund?

Excerpted from an SBS article, Record rise in private health complaints

  • Complaints about private health insurance increased by 30 per cent in the last financial year, the worst rise in a decade.
  • The Private Health Insurance Ombudsman received 5750 complaints in 2016/17, up from 4416 in 2015/16.
  • “This is an increase of over 1300 complaints within one year, which is the largest rise we have experienced over the past 10 years,” the ombudsman’s latest State of the Health Funds report said.

+-How do I know if I'll be covered for plastic surgery?

What you’ll NEED to do BEFORE you can assess whether rebates for your surgery by your Specialist Plastic Surgeon will be applicable:

  • Read Part 1 – what the health fund term “fully covered” or “rebate” really mean in terms of plastic surgery costs to patients and then continue with the one you’re reading now.
  • Read and understand your Health Insurance Policy including exclusions, pre-existing conditions and waiting periods
  • GET your documents in order (your Policy, your notes about the surgery including the Medicare ITEM Number that your Surgeon has told you applies to your condition, your original referral from your GP, any accompanying documentation, scans, or images you have, along with your Surgeon’s notes and Estimates/Quote).
  • Other paperwork may also be required so be patient, and be prepared.
  • Find a comfortable spot to be on the phone for some time (and allow adequate time – don’t try to squish in a call to your health fund during a 30 minute office break)!
  • Contact your health fund directly, by phone, with all of your documents in order.

+-What waiting periods and exclusion might apply? How do I check?

Health Insurance Terms, Waiting Periods, and Exclusion Criteria – ‘it’s complicated’

Is it possible the coverage and exclusion terms are so complex, not even the health fund employees always fully understand them?

So we can’t answer that question. Just recognise there IS a strong push by the Government to INSIST on Health Insurers, such as BUPA, AIH and others, to use plain-language and clear coverage and exclusion statements in their health fund policy materials – especially in view of the increase in Ombudsman level complaints.

+-BEST TIPS for Contacting your Health Insurance Company

What to DO first, and what to HAVE in front of you, before you phone your private health fund to see what coverage you have in relation to your plastic surgery procedure.

  • Grab a coffee or snack and a fully charged phone
  • Allow at least an hour for the conversation (don’t try to squeeze it in on a short break from the office)
  • Put your feet up and plan to spend some time on hold (or maybe get out the nail polish while you wait)
  • Consider the possibility you may be given different or inaccurate information each time you call.
  • Ask for a reference number or name of person you speak to.

Some patients found it helpful to telephone their health insurance company on two separate occasions, to check what they’ve been told is covered, with different representatives, JUST to verify the information they’ve been given was correct.

This blog, originally published in early 2018 and updated last 28 November 2018.


Visit our Downloadable Guides pages

For more information about Cosmetic and Plastic Surgery options and research in Australia.

Plastic Surgery Patient Information Guide

Further Reading about Plastic & Cosmetic Surgery

Last updated: 05/05/2022
Author profile image
Michelle Staughton
Michelle Staughton - Patient Liaison Manager at Coco Ruby Plastic Surgery in Melbourne, Victoria, Australia. As a past patient, Michelle has insider knowledge of the journey our patients embark on. A busy mother of 3, and independent business owner, Michelle appreciates the organisation required to get things done in today’s hectic life. Her role as Patient Experience Manager Michelle is a great guide for your plastic surgery journey.

Coco Ruby’s Specialist Plastic and ENT Surgeons

With a wealth of experience and training, our Specialist Plastic Surgeons are dedicated to best practice patient care and education, customising Breast Enlargement Surgery for each and every patient to best meet their needs and desired surgical outcomes.

coco ruby specialist plastic surgeons 

What to do next?

Our Patient Liaison Team can assist with any questions you may have when considering a procedure. You can send in an enquiry form below or call our Melbourne Clinic between 9 am – 5 pm Monday to Friday.

Phone 1300 264 811, Email us: or Book a FREE 15-minute Phone Chat with our Patient Liaison Manager or a Virtual Consultation with a Surgeon.

Disclaimer: Results depend on individual patient circumstances and can vary significantly. Results may also be impacted by a variety of factors including your lifestyle, weight, nutritional intake and overall health. Consult your Specialist Plastic Surgeon for details. This information is general in nature and is not intended to be medical advice nor does it constitute a doctor-patient relationship. Surgery risks and complications will be covered in detail during a consultation with your Surgeon.