1 A Risk sharing in the Australian private health insurance market 04 Research Paper 4 June 2015
2 1 About PHIAC The Private Health Insurance Administration Council (PHIAC) is an independent statutory authority that regulates the private health insurance industry. Private health insurance policy is set down by the Australian Government via the Department of Health (DoH). PHIAC s statutory objectives are described in the Private Health Insurance Act 2007 (PHI Act). Section of the PHI Act instructs PHIAC in performing its role, to take all reasonable steps to strike an appropriate balance between the three objectives of: a. fostering an efficient and competitive health insurance industry; b. protecting the interests of consumers; and c. ensuring the prudential safety of individual private health insurers. In order to promote these objectives, PHIAC has undertaken research on competition and other issues within the Australian private health insurance industry. The aim of this research is to support an improved understanding of the Australian private health insurance industry. It is important to stress that PHIAC is not a policy body. As noted above, policy responsibility for private health insurance is reposed within the DoH as principal adviser to the Minister for Health and the Government. Accordingly, PHIAC does not seek to propose, nor to advance, any particular policy prescription or solution to the matters it examines. It does, however, aspire to provide the factual and contextual basis for a much improved discussion about the important issues that affect private health insurance in Australia. It should not be implied that any view expressed in this research paper is necessarily that of the Minister for Health or the Government. The Government announced in the Budget that PHIAC will be closed with effect from 1 July PHIAC s operations will be merged into, predominantly, the Australian Prudential Regulation Authority, with the remainder of its functions reverting to other agencies. i
3 2 Preface Private health insurance is a vital product for many Australians. Around 47 per cent of Australians or 11.3 million people hold a health insurance policy which covers them for hospital treatment, while around 56 per cent of the population or 13.2 million people are covered for general treatment. In addition, around 12 per cent of the value of all health services provided in this country is paid for by the private health insurance industry. Risk sharing between the consumer and the insurer is an important element in any insurance market. Consumers seek to maximise the transfer of risk to the insurer at minimal cost, while insurers seek to ensure the risk they are taking on is appropriately priced. The process of striking a balance between risk transfer and pricing is central to a competitive insurance market. The private health insurance market has this characteristic but is different to other insurance markets in one fundamental respect private health insurers are required to community rate their products. This means that the premium charged for cover cannot vary by specific risk characteristics, such as the health status or age (except to the extent allowed under Lifetime Healthcare Cover), of an individual policyholder. Notwithstanding community rating, there is a wide range of hospital products on the market. The more expensive products are likely to provide more comprehensive coverage, with the health insurer bearing more of the risk relating to the financial costs of treatment. The premiums become cheaper as the consumer accepts a higher level of risk by including one or more features such as an excess, co-payments, exclusions and restrictions, which results in the consumer facing higher out-of-pocket costs for their care. These additional costs may provide consumers with an incentive to constrain their utilisation of services. This paper explores the regulatory approach, recent industry trends and policy issues relating to the various features embedded in health insurance policies which spread the risk of the financial costs of treatment between the insurer and the consumer in respect of hospital cover. The paper focuses on hospital products because this is where policy makers have imposed greater regulatory constraints, and because hospital products represent about three-quarters of the industry by benefits paid. While the issue of risk sharing also arises in the general treatment products, policy makers have chosen to have less intervention in this market in terms of how general treatment products are designed. The paper also focuses on features involving cost sharing (such as an excess and co-payments) and coverage (such as exclusions and restrictions). However, this paper does not address the risk that consumers may be required to pay an additional cost (out-of-pocket or gap payment) arising from the difference in the fees charged by the hospital and medical provider and the benefit paid by the insurer for a particular treatment. While the extent to which these gap payments are covered in a health insurance policy represents another form of risk sharing between the insurer and the policyholder, this issue is not related to product design which is the focus of this paper. There is very little published material examining the spreading of risk between insurers and consumers in the private health insurance industry. However, the paper draws on submissions received by PHIAC in response to its Discussion Paper No. 1, Competition in the Australian Private Health Insurance Market, released by PHIAC in November PHIAC also acknowledges helpful discussions with the Private Health Insurance Ombudsman. 2 1 See Not all submissions received by PHIAC were publicly release. PHIAC has preserved confidentiality where it was sought both in this report and on its website. 2 The functions of the Private Health Insurance Ombudsman have transferred to the Commonwealth Ombudsman with effect from 1 July ii
4 Preface 3 Use of this Paper While PHIAC endeavours to ensure the quality of this publication, it does not accept any responsibility for the accuracy, completeness or currency of the material included in this publication and will not be liable for any loss or damage arising out of any use of, or reliance on, this publication. This publication is available for your use under a Creative Commons Attribution 3.0 Australia licence, with the exception of the Commonwealth Coat of Arms, photographs, images, signatures and where otherwise stated. The full licence terms are available from au/legalcode. Use of PHIAC material under a Creative Commons Attribution 3.0 Australia licence requires you to attribute the work (but not in a way that suggests that PHIAC endorses you or your use of the work). PHIAC material used as supplied Provided you have not modified or transformed PHIAC material in any way including, for example, by changing the text; calculating percentage changes; graphing or charting data; or deriving new statistics from published PHIAC statistics then the PHIAC prefers the following attribution: Source: Private Health Insurance Administration Council Derivative work If you have modified or transformed PHIAC material, or derived new material from those of PHIAC in any way, then PHIAC prefers the following attribution: Based on Private Health Insurance Administration Council data Use of the Coat of Arms The terms under which the Coat of Arms can be used are set out on the It s an Honour website (see Disclaimer The purpose of this paper is to stimulate discussion. It is not a position paper and the information canvassed in it does not constitute recommendations or legal advice. While PHIAC endeavours to ensure the quality of this paper, it does not accept any responsibility for the accuracy, completeness or currency of the material included in this paper, and will not be liable for any loss arising out of any use of, or reliance on, this paper. PHIAC encourages readers to seek independent advice and to exercise care in relation to any material contained in this paper.
5 4 Table of Contents About PHIAC 1 Preface 2 1. Risk transfer through cost sharing Introduction Regulatory approach 5 Excesses 5 Co-payments 6 Fixed percentage amount Trends in excesses Trends in excess, co-payments and fixed percentage amounts Matters for discussion 8 Excesses 8 Co-payments and fixed percentage amounts 9 2. Risk sharing through coverage adjustment Introduction Regulatory approach Trends in exclusions and restrictions Products containing exclusions, benefit limitation periods, restrictions, and caps on hospital treatment 12 Exclusions 12 Benefit limitation periods 13 Restricted products 13 Caps on hospital treatment Trends in full cover policies Difference between the top and bottom of the market Matters for discussion 14 Competition 14 Other consumer issues 15 Community rating 16 Regulation of premium changes 16 Government incentives 16 Other issues 17 References 18
6 5 1. Risk transfer through cost sharing 1.1 Introduction Health insurers share the risks relating to the financial costs of treatment between themselves and policyholders by including various features in insurance policies. This chapter examines the regulatory approach, recent trends and policy issues relating to the use of an excess and a co-payment (including a fixed percentage of cost) as a means of sharing the financial risk of treatment between the insurer and the consumer. 1.2 Regulatory approach Excesses An excess is the fixed amount a policyholder agrees to pay for hospital treatment before a private health insurance benefit is payable. For example, if a policy has an excess of $200 per hospital admission, the insured person is required to pay the first $200 of the hospital costs if they go to hospital as a private patient. The excess may be capped per hospital admission and on an annual basis, or on an annual basis only. In April 2015, 31 of the 34 3 insurers offered for purchase at least one hospital product 4 for purchase with an excess. 5 The 3 insurers who do not currently offer for purchase a hospital product with an excess are small 3 There is one small health insurer (Queensland Teachers Union Health Fund) that does not offer health insurance products in NSW. 4 The presentation of statistical information relating hospital products throughout this paper refers to non-corporate hospital products. 5 This statistic, and other comparable statistics in this paper, is based on non-corporate hospital products currently on the market for purchase in NSW as reported on The results would be very similar in other jurisdictions as health insures tend to offer the same product nationally. restricted insurers. Relative to April 2013, there has been an increasing use of an excess in hospital products. In particular, 69 per cent of hospital products available for purchase in the NSW market in April 2015 include an excess compared with 59 cent April Private health insurers can set any level of excess they wish on hospital products. However, the level of excess for hospital treatment is regulated for Medicare Levy Surcharge (MLS) purposes. 6 Policyholders who are above the income thresholds 7 are exempt from the MLS provided that: they hold a complying health insurance product 8 that covers hospital treatment; and any excess payable in respect of benefits under the policy is no more than: $500 in any 12 month period in relation to a policy under which only one person is insured; and $1,000 in any 12 month period in relation to any other policy. 9 6 The level of the excess for hospital treatment is not regulated for the purposes of the Private Health Insurance Rebate. A person is eligible for this rebate provided they hold a complying health insurance product and earn less than the income test thresholds. 7 For the income tax year, the income thresholds for MLS purposes start at $90,000 for a single person with no dependents, and $180,000 for a family with one dependent child, with the threshold rising $1,500 per dependent child. 8 The term complying health insurance product is defined in Division 63 of the Private Health Insurance Act Sub-sections 3(5) and 3(7) of the Medicare Levy Act
7 1. Risk transfer through cost sharing 6 This policy approach means that those wishing to avoid the MLS must purchase a hospital cover product where the excess is no greater than the above limits. It also means that effectively the market for policies with an excess greater than the above limits is confined to consumers with incomes below the MLS income thresholds. 10 Another implication of this policy approach is in the setting of the size of the excess. The most common excess is $250 (half the maximum) or $500 per annum (the maximum amount) for a product covering a single person, and $500 (half the maximum) or $1,000 per annum (the maximum amount) for a product covering more than one person. Some insurers offer a wider range of excess choices, with the excess set side of the $250 amount (say, $200 or $300) or below the $500 amount (say, $400) for a product covering a single person, and a similar approach for policies covering more than one person. One health insurer offers a family product where each adult would pay an excess on hospital admission set at a maximum of $500 per adult per year while dependent children would not pay an excess. 11 This may be a sign that the market is operating in a competitive way with insurers seeking to differentiate themselves in the market place and providing consumers with choice. Co-payments A co-payment is where the policyholder agrees to pay an agreed amount each time a service is provided. For example, a policy may have a copayment clause that requires payment of the first $50 for each day s hospital accommodation. In this case, if the insured person is in hospital for three days, they would be required to pay the first $150 of hospital accommodation costs. It is noted that a policy may have no excess or co-payment requirement, either an excess or co-payment requirement, or both an excess and co-payment requirement. 10 In April 2015, only two small health insurers offered a hospital product with an excess greater than the MLS limits, with the excess on each product set at $750 or $1,000 for a single person policy and $1,500 or $2,000 for other policies. Further, there are only 3 of these products available for purchase in the NSW market out of a total of 251 products. 11 This means that the maximum excess per year is $1,000 (that is, two times $500), and hence the product is exempt for MLS purposes. The co-payment is typically set as an amount per day of a hospital stay, and is usually capped per hospital stay or per annum, or both per hospital stay and per annum. An example of a potentially low co-payment product on the market in NSW is one which requires the consumer to pay $40 per day for a private or shared room capped at $280 per hospital stay and $30 per day for day surgery, but with no cap on the annual amount of co-payments. An example of a high co-payment product on the market in NSW is one which requires the consumer to pay $100 per day for a private or shared room capped at $500 per hospital stay and $150 per day for day surgery. The total co-payment is capped at $1,000 per year. Co-payments are not subject to any regulation. Consequently, a policy can require any level of copayment without affecting the MLS, the Private Health Insurance Rebate or the Lifetime Health Cover (LHC) 12 status of the consumer. This has resulted in a wide range of co-payment options available in the market providing consumers with considerable choice, again perhaps signalling that the market is operating in a competitive way. Health insurers offer more hospital products with an excess than with a co-payment. In April 2015: 8 out of the 34 insurers offered for purchase at least one hospital product with a co-payment in the NSW market 13 compared with 31 insurers which offered at least one hospital product with an excess; 8 per cent of hospital products providing family cover on the market in NSW have a co-payment compared with around 69 per cent with an excess; 14 and 12 The LHC means that if the consumer does not have hospital cover on the 1st of July following their 31st birthday and then decides to take out hospital cover later on, the consumer pays a 2 per cent loading on top of their premium for every year the consumer is aged over 30. For example, if the consumer takes out hospital cover at age 40, they pay 20 per cent more than someone who first took out hospital cover at age 30. The maximum loading is 70 per cent. Once the consumer has paid a LHC loading on their private hospital insurance for 10 continuous years, the loading is removed as long as the consumer retains their hospital cover. 13 A further two insurers offered co-payment products in the past and who no longer offer such products for purchase. 14 Family (two adults with dependants) hospital products currently offered in NSW have been used in this paper are as representative for the products available for purchase in the Australian market. In fact, insurers generally offer the same product in each jurisdiction with only the price varying between jurisdictions.
8 1. Risk transfer through cost sharing 7 38 per cent of hospital products available on the market in NSW providing family cover with a copayment also include an excess. 15 These comprised only 3 per cent of the total number of hospital products providing family cover in that market. 16 Relative to April 2013, there has been a movement away from including a co-payment in hospital products. In particular, in April 2015 only 8 insurers offered one or more hospital products including a copayment for purchase in the NSW market compared with 10 insurers in April The low usage of co-payments in hospital products may reflect concerns around the consumer facing uncertain out-of-pocket expenses whereas an excess provides certainty to the consumer on they much they have to pay. Fixed percentage amount Some hospital cover policies set the benefit at a fixed percentage of the hospital accommodation costs of a private hospital episode, perhaps combined with a cap on the amount to be paid by the policyholder. In effect, the fixed percentage has the same impact as an excess or a co-payment. There is no regulation of the fixed percentage amount or the magnitude of the cap. In April 2015 (as was the case in April 2013), only one small insurer offered three hospital products of this kind That is, 8 products with an excess and a co-payment compared with 21 products with a co-payment on the market. 16 That is, 8 products with an excess and a co-payment compared with 251 hospital products on the market. 17 There are only 17 products of this kind available for purchase in April 2015 compared with 52 in April This large drop is due to one insurer who had a large number of hospital products with a co-payment available for purchase in NSW in April 2013 whereas this insurer offered no such products in April Hospital products with a fixed percentage of hospital accommodation costs on the market at April 2015 are 65 per cent, 75 per cent and 90 per cent. An example of the cap on out-ofpocket costs in the case of the 90 per cent fixed percentage product is $500 per adult for each calendar year for hospital admission (not payable by dependent children). 1.3 Trends in excesses There has been a moderate increase in the proportion of policies with an excess and/or a co-payment 19 over the past decade. This is summarised in Figure 1. The key observations are as follows: The most notable change is the decline in hospital cover policies with an excess greater than the $500 (single)/$1,000 (more than one person) maximum amounts for MLS purposes and/ or a co-payment, from 23.2 per cent of total policyholders with hospital cover in March 2003 to 0.7 per cent in March This decline could represent a delayed response to the policy change in July 2000 when the maximum amounts for MLS purposes were set. It may also indicate the low level of interest consumers with incomes below the MLS thresholds have in taking out health insurance with an excess greater than the maximum allowable for MLS purposes. 21 More than offsetting this decline has been the growth in policyholders with an excess equal to or less than the $500/$1,000 maximum limits and/ or a co-payment. The small upward movement between March 2013 and March 2015 (76.8 per cent to 79.4 per cent) is consistent with the upward movement in the number of product with an excess on the market (see above). Overall, the proportion of policyholders with an excess and/or co-payment has been steadily increasing, from 69.6 per cent in March 2007 to 80.1 per cent in March Over the period 1989 to 2003, the percentage of hospital cover policies with a front-end deductible (currently known as an excess) has been continuously increasing, from around 6 per cent in June 1989 to 20 per cent in June 1995, 50 per cent in June 2000 and 59 per cent in June The average annual growth rate in policies with an excess was 19 per cent over the period June 1989 to June While this data is not strictly comparable to the data in Figure 1, 22 the large shift towards policies including an excess since 1989 represents a significant structural change. 19 This means that the PHIAC data captures policies with an excess and no co-payment, no excess and a co-payment, and both an excess and a co-payment. 20 March 2015 is the lowest point in this series. 21 In support of this, see footnote The methodology used to collect the statistics was changed in September As an illustration, as at June 2003, data on frontend deductibles (old data series) is 59 per cent of hospital cover policies compared with 73 per cent of hospital cover policies with an excess (new data series). That is, there is a 14 percentage point gap between the new and the old series.
9 1. Risk transfer through cost sharing 8 1. Hospital cover policies with an excess and/or co-payment Percent of total hospital policies Policies with an excess and/or a co-payment Policies with an excess < $500/$1,000 and/or a co-payment Policies with an excess > $500/$1,000 and/or a co-payment Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar 15 Note: Data on the percentage of persons insured with hospital cover and subject to an excess relative to the total number of insured persons and the percentage of hospital cover policies with an excess relative to the total number of hospital cover policies is very similar. Data on the split of insured persons with an excess less than, or greater than, $500/$1,000 is not available. Source: PHIAC 1.4 Trends in excess, co-payments and fixed percentage amounts PHIAC currently does not collect quarterly data on hospital cover policies which include an excess or a co-payment and insured persons subject to an excess or a co-payment (ie, separately), nor on the number of policies which pay a fixed percentage amount of hospital accommodation costs and insured persons subject to a fixed percentage amount. 1.5 Matters for discussion to avoid the MLS with no intention of using the private health care system. 23 Over time, the real value of the maximum excess has been eroded by inflation, as illustrated in Table 2. Another way to look at this issue is to compare the excess with average yearly earnings. Over the period since 2000, the excess as a proportion of average yearly earnings has approximately halved, from 1.2 per cent and 2.4 per cent based on the $500 and $1,000 excess respectively in 2000 to 0.6 per cent and 1.2 per cent respectively in This erosion in the value of the excess means that it is acting as less of a constraint on consumers utilising hospital services. Excesses The maximum excess of $500 for policies covering a single person and $1,000 for any other policy for MLS purposes commenced on 1 July Prior to this, the maximum excess was $1,000 for a single person and $2,000 for any other policy. It was considered at the time that an excess of this magnitude was designed to make health insurance products so inexpensive and tokentistic to appeal to high income earners seeking 23 Supplementary Explanatory Memorandum, Taxation Laws Amendment Bill (no 6) 2000, page 8 and 9, available at
10 1. Risk transfer through cost sharing 9 2. Real value of maximum excess Amount set in July 2000 Real value in March 2015 based on movements in the Consumer Price Index Real value in March 2015 based on movements in the health component of the Consumer Price Index $500 $341 (or 32 per cent decline) $249 (or 50 per cent decline) $1,000 $683 (or 32 per cent decline) $555 (or 50 per cent decline) Source: PHIAC Medibank Private submits 24 that this erosion in the real value of the maximum excess has the following implications: It places upward pressure on premiums because the effect of maintaining the nominal value of the excess is to transfer risk to the insurer over time. If the real value of the maximum excess was maintained, it is estimated that premiums could be up to $300 per annum lower. Consequently, the budget cost of the Private Health Insurance Rebate is higher than otherwise. Apart from an excess, there are many other features available to health insurers which involve the policyholder carrying some of the risk of the cost of hospital care such as co-payments, exclusions and restrictions. Because these features are not regulated, health insurers may adjust them so that the risk borne by policyholders is not eroded over time and in effect compensate insurers for the declining real value of the maximum excess. The ability of consumers to select an optimal amount of risk is reduced as the real value of the maximum allowable excess declines. From the consumer s point of view, this could be considered to be a sub-optimal outcome. 25 Notwithstanding these arguments, there is clearly a limit to how much the maximum excess can be increased as there is a point where the size of the excess will lead to consumers buying the product to avoid the MLS with little likelihood of utilising the private hospital system. Furthermore, the attendant consequences for product design and associated impacts on community rating might need to be fully assessed before increasing the minimum excess amount. Co-payments and fixed percentage amounts As mentioned, co-payments and fixed percentage amounts are not regulated for MLS purposes. This opens the possibility that co-payments could be set at an amount so as to enable annual premiums to be below the cost of the MLS. Similarly, the fixed percentage amount could be set so low as to enable annual premiums to be set below the cost of the MLS. As with a high excess, products with a high copayment or a low fixed percentage amount may be attractive to consumers wishing to avoid the MLS with little intention of utilising their cover when hospital treatment is required. This provides an argument to regulate the maximum amount of a co-payment and the minimum percentage amount. However, at present, there does not appear to be evidence of insurers offering products with co-payments and fixed percentage amounts designed to enable premium levels to be set to achieve this outcome. 26 This is not to say such products may not emerge in the future. 24 Medibank Private s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page In this respect, there is some evidence that consumers are increasingly choosing private hospital cover with the maximum excess. For example, Medibank Private indicates that the number of policyholders choosing the maximum excess has doubled over the last three years. Medibank Private s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page The highest co-payment in the NSW market, where the co-payment is capped, is currently $1,000 per annum, and the lowest fixed percentage amount of hospital accommodation costs currently in the market is 65 per cent combined with a $1,000 cap per hospital admission (not payable by dependent children and no annual maximum).
11 10 2. Risk sharing through coverage adjustment 2.1 Introduction Insurers provide hospital products that exclude or restrict benefits for some treatments, impose benefit limitation periods and/or restrict the coverage to being treated as a private patient in a public hospital, in return for lower premiums. Exclusionary products are those which do not cover a particular treatment as a private patient in a public or private hospital. Common treatments excluded include expensive treatments such as cardiac services, assisted reproductive services (infertility services), hip and knee replacements and/or treatments typically not required by the age group the product is targeting. 27 Restrictions are where the policy covers certain treatments, but only to a limited extent. For example, a policy may cover the cost of a hip replacement, but only as a private patient in a public hospital. Consequently, the policyholder is not covered for this treatment at a private hospital. Another example is that the benefit for a particular treatment performed in a private hospital may be limited to the minimum default amount for hospital accommodation costs set out in the Private Health Insurance (Benefit Requirements) Amendment Rules This is likely to result in the insured person incurring significant out-of-pocket expenses for hospital accommodation costs if treated in a private hospital, but there is likely to be no (or minimal) outof-pocket expenses if treated as a private patient in a shared ward of a public hospital. Hospital treatment benefits, including accommodation as a private patient in a private or public hospital, may be capped to a particular number of days, say 100 days per year. Benefit limitation periods are where the policyholder only receives minimum default benefits for hospital accommodation costs for an initial period (usually two years) after purchasing the policy (provided the person is not switching from another insurer). 28 This chapter outlines the regulatory approach, recent trends and policy issues relating to the use of exclusions, restrictions, caps on hospital treatment and benefit limitation periods as a means of sharing the financial risk of treatment between the insurer and the consumer A product which is effectively the same as an exclusionary product is an inclusionary product. The difference is that inclusionary products start from the assumption that all treatments (other than the minimum mandated rehabilitation, psychiatric and palliative care services) are excluded. Particular treatments are then included in the policy to make up the product the consumer buys. 28 Under Division 78 of the PHI Act, insurers are prohibited from imposing benefit limitation periods for persons transferring to a new policy, either within the one insurer or between insurers.
12 2. Risk sharing through coverage adjustment Trends in exclusions and restrictions Percent of total hospital policies Exclusions and/or restrictions (a) Restrictions (b) Exclusions (c) Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar 15 Note: The significant increase in exclusionary products in March 2011 relative to March 2010 is partly due to a re-classification of policies between exclusions and restrictions by some insurers. Furthermore, there is a break in the excess and co-payment data in June 2007 due to a change in the definition used. While the data on exclusionary products pre and post March 2011 and the data on excess and payments pre and post June 2007 is not strictly comparable, the data over the entire period can be taken as a proxy for the overall trend. (a) This includes hospital policies with exclusions and restrictions, with exclusions but no restrictions, and with restrictions but no exclusions. (b) This includes hospital policies with restrictions with or without exclusions. (c) This includes hospital policies with exclusions with or without restrictions. Source: PHIAC 2.2 Regulatory approach Regulation of the content of health insurance products could be described as light touch. The only regulatory requirement is that hospital products must cover psychiatric, rehabilitative and palliative care, at least at the default rate. 29 Beyond this minimum requirement, there is no limit on how many treatments can be excluded from a policy, or on the use of restrictions or benefit limitation periods. Furthermore, there are no additional regulatory requirements in respect of hospital products providing cover for being treated only as a private patient in a public hospital. There are also no limits on these features for MLS or private health insurance rebate purposes. 29 Sub-section 72(2), item 1 of the PHI Act. The default rate is the minimum benefit level set the Private Health Insurance (Benefit Requirements) Amendment Rules This light touch approach to product regulation has been in place since Prior to 1995, insurers could only exclude treatments in a private hospital and the insurer still had to pay benefits for all treatments in a public hospital. 2.3 Trends in exclusions and restrictions Figure 3 shows the proportion of hospital cover policies with: (i) an exclusion, (ii) a restriction, and (iii) an exclusion and/or a restriction. It is important to note that the data on exclusionary products does not capture products which exclude items that are not covered by Medicare (such as ambulance and most cosmetic surgery). It is also noted that the data on restrictions captures products with at least one treatment subject to a benefit limitation period exceeding 12 months and products which only cover treatment in a public hospital.
13 2. Risk sharing through coverage adjustment 12 Over the period since 2003, the proportion of hospital cover policies with one or more exclusions has increased significantly (see Figure 3). However, this data needs to be interpreted with caution because a large part of the increase in March 2011 (from 16.2 per cent in March 2010 to 26.5 per cent in March 2011) can be attributed to a reclassification of policies by some insurers. Further, the fall in exclusions in March 2013 and the rise in restrictions is also largely due to reclassifications by some insurers. Given the deficiencies in the data, it is reasonable to conclude that the proportion of hospital cover policies with an exclusion has more likely doubled since June 2003 rather than quadrupling as shown in Figure 3. In contrast, the proportion of hospital cover policies containing a restriction has remained broadly flat over the period March 2003 to March 2012, but has since risen from 34.4 per cent in March 2012 to 44.8 per cent in March In aggregate, the proportion of hospital cover policies containing at least one exclusion and/or restriction has risen from 36.4 per cent in March 2003 to 53.0 per cent in March Observations made by industry stakeholders explaining the growth in exclusionary products include the following: Products with exclusions provide the opportunity for consumers to buy cheaper health insurance products as premiums increase at a faster rate than average incomes. In particular, they are attractive for low health risk (young) consumers. 30 In this respect, some insurers are actively marketing products to attract younger age groups. 31 Comparatively cheap health insurance products are also attractive for those consumers seeking to avoid the MLS. The concern is that consumers who are price sensitive are making their decision to select a low priced product when buying health insurance for the first time or to downgrade their coverage based on price considerations rather than on health risk considerations. Affordability of private health insurance products could be becoming a more important issue over time. 32 As a guide, the cost of top hospital cover (before the Private Health Insurance Rebate) has risen from around 4.4 per cent of average weekly earnings in 2002 to around 6.3 per cent in This reflects that health inflation is about twice the rate of inflation in the broader economy. If affordability is an issue, the availability of exclusionary products provides the opportunity for existing consumers to downgrade their cover and pay a lower premium, and for new consumers to enter the health insurance market at a lower than otherwise pricing point. The growth in exclusionary products could, in part, be a response by health insurers to the constraining of premium increases by the Government. 34 Consequently, health insurers may wish to add exclusions to products in order to maintain profitability. 2.4 Products containing exclusions, benefit limitation periods, restrictions, and caps on hospital treatment Exclusions The use of exclusions in hospital products has increased since April In particular, the number of insurers offering one or more products with one or more exclusions (excluding ambulance) has increased from 17 in April 2013 to 22 in April The number of hospital products available for purchase which include one or more exclusions has increased from 65 products (or 24 per cent of total products) to 85 products (or 34 per cent of total products). This upward trend is consistent with the upward trend in the last two years in the number of hospital policyholders holding a policy with an exclusion (see Figure 3). 30 KPMG s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page An example is that many advertising campaigns by health insurers (such as nib) are targeting the young low health risk consumer. 32 KPMG s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page PHIAC estimates. 34 Confidential submission to Discussion Paper No 1, Competition in the Private Health Insurance Market.
14 2. Risk sharing through coverage adjustment 13 Benefit limitation periods PHIAC does not specially collect data on the number of policies or insured persons with hospital cover products which contain a benefit limitation period. 35 However, a review of hospital products open for new policyholders shows that benefit limitation periods are not commonly used. In fact, in April 2015 only 6 out of the 34 health insurers included benefit limitation periods in at least one of their hospital products currently on the market for purchase in NSW compared with 8 insurers in April Furthermore, 2 out of these 6 health insurers include a benefit limitation period for only one treatment (either psychiatric, palliative, reproductive or gastric banding treatments), while the other 4 insurers use benefit limitation periods more extensively. Restricted products Restricted products fall into two categories. The first is those which provide coverage in both private and public hospitals but limit the benefits payable on particular treatments. A common restriction is limiting the benefits payable on psychiatric, rehabilitative and palliative care to the default rate or limiting particular treatments to public hospitals. PHIAC does not specially collect any data on the number of policies or insured persons with a restriction of this type. 36 However, in April 2015, 22 of 34 health insurers offered for purchased at least one hospital product limiting benefits payable for a particular treatment compared with 14 insurers in April The number of hospital products currently on the market for purchase in NSW covering two adults with dependants and with this type of restriction is 75 (or 30 per cent of the total number of hospital products). This compares with 52 products (or 19 per cent of the total) in April Consequently, there has been a shift towards products with restrictions between April 2015 and April This upward trend is consistent with the upward trend in the last two years in the number of hospital policyholders holding a policy with a restriction (see Figure 3). The second category is those products which limit coverage to being treated as a private patient in a public hospital. This means that the policyholder is not covered for treatment in a private hospital. These products may or may not include an excess, restriction or exclusion. They are amongst the cheapest products on the market, comparable in price to products offering cover for treatment at a public or private hospital but with a significant number of treatments excluded. PHIAC does not specifically collect data on the number of policyholders with a public hospital cover product. 37 In April 2015, 10 of the 34 health insurers offered for purchase in NSW at least one product providing public hospital cover only compared with 13 insurers in April While the number of insurers offering a public hospital only policy has fallen, the percentage these policies comprise of the total on the market has remained unchanged at around 7 per cent between April 2013 and April Caps on hospital treatment Health insurers may offer a product where the costs of hospital treatment, including accommodation as a private patient in a private or public hospital, may be capped to a particular number of days. PHIAC does not specially collect data on the number of policies or insured persons with this product. However, in April 2015, only 1 of the 34 insurers offered for purchase a product of this kind. This product caps benefits for hospital treatment at 100 days per year. This product does not have exclusions, restrictions or benefit limitation periods. 2.5 Trends in full cover policies Figure 4 shows the market share of hospital cover policies with full (or comprehensive) cover with or without an excess since March Policies with full cover have been declining slowly since March In March 2015, 47.0 per cent of policies provided full cover, and 72.9 per cent of these included an excess. 35 A policy with a benefit limitation period where the benefit is restricted for more than 12 months is considered to offer reduced cover (and hence a restricted product) for the purposes of PHIAC s statistics. 36 PHIAC s statistics on restricted policies include both categories of restricted products. 37 PHIAC s statistics on restricted policies include both categories of restricted products. 38 In April 2015, there were 17 non-corporate public hospital only products on the market in NSW compared with 20 in April 2013.
15 2. Risk sharing through coverage adjustment Proportion of policies with full cover Percent of total hospital policies Full cover policies with or without an excess Full cover policies with an excess Full cover policies with no excess Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar Mar 15 Note: Full cover means policies that have no restriction on benefits paid after 12 months and no exclusions (except an exclusion for ambulance and treatments which are not covered by Medicare). Policies which meet this test but have a co-payment and/or an excess and/ or a fixed percentage amount are considered to be full cover policies. Source: PHIAC 2.6 Difference between the top and bottom of the market Hospital products at the top of the market are defined as those having no exclusions (with the possible exception of ambulance), no restrictions, no copayments and no excess. Hospital products at the bottom of the market can be categorised into two groups. The first category contains products which provide very limited cover in private and public hospitals. These products have numerous exclusions or restrictions, and typically include an excess. An example of such a product is one providing cover only for injuries incurred in an accident. The second category contains products which provide cover for treatment as a private patient in a public hospital. This category of products may also contain exclusions, restrictions and an excess. These two product types at the bottom of the market are similarly priced (for example, in the $70 to $120 per month pre-rebate price range for a policy covering a single person and $140 to $240 for family cover). About 25 per cent of hospital products available for purchase on the NSW market in April 2015 fall into these two groups. The difference in pricing between the top and bottom hospital products is shown in Table 5. In annual terms, this difference is $1,212 for a single adult policy and $2,796 for a two adults with dependents policy. This suggests that insurers have considerable scope to design products to achieve particular pricing points to target particular segments of the market. 2.7 Matters for discussion There is a wide range of views on the impact of hospital products with less than comprehensive coverage on the private health insurance market. Competition On the positive side, many argue that products with less than comprehensive coverage enhance competition in the industry. Private health insurers are able to design products to meet the particular needs of consumers, and consumers are able to choose the product that best meets their perceived needs and financial circumstances. It has been noted that the capacity of health insurers to offer products at the cheaper end of the market spectrum
16 2. Risk sharing through coverage adjustment Price of top and bottom hospital products in NSW A Bottom hospital products (per month and before the rebate) Top hospital product (per month and before the rebate) Per cent difference Single adult $93 $ % Two adults with dependants $192 $ % A These prices are on the weighted average (by market share) across those insurers offering the particular hospital product. Source: PHIAC promotes competition in the low health risk, low claiming and price sensitive segment of the health insurance market. 39 Furthermore, insurers appear to be strategically targeting either the whole market by having a range of products, or the top end of the market by only offering products with comprehensive coverage, the middle of the market in terms of pricing, or particular segments of the market (such as the young). This is a sign the health insurance market is behaving in a competitive way by seeking to meet the demands of the market. On the negative side, many argue that the wide range and complexity of hospital cover products currently available impedes competition in the market. This argument is based on the view that the wide variation in the inclusion of restrictions, exclusions, co-payments, excess, and benefit limitation periods makes it very difficult for consumers to compare products and to choose the best value product for their particular circumstances. This is one explanation for the low level of consumer movement between insurers despite the wide dispersion in prices of similar products. Both these points together (low movement and wide dispersion) suggest that the level of competition in the private health insurance industry may not be what it should be. 40 Other consumer issues A major concern with products with less than comprehensive coverage is that consumers may become dissatisfied with private health insurance when they seek to undergo a treatment which has been excluded, particularly in the circumstance where the consumer was not aware of the exclusion. Some argue that this undermines the long term value of private health insurance. 41 Another concern is that many of the low cost products promoted to the younger segment of the market provide restricted benefits on psychiatric services even though the prevalence of mental health issues among young adults is reasonably high. 42 These concerns highlight the importance of consumer information and awareness in ensuring that products with less than comprehensive coverage are fully understood at the time of purchase and beyond. Regulatory measures such as the requirement for health insurers to annually provide consumers with a Standard Information Statement (SIS) and the requirement to inform policyholders of any changes to their policy are directed at achieving this outcome. Consumers can also obtain information from their insurer s website and 39 Teachers Union Health Fund s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page The Research Paper No. 2, Portability, Switching and Competition in the Australian Health Insurance Industry, June 2015, available at discusses both these points in some detail. 41 Defence Health s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, pages 6 to Consumers Health Forum of Australia s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page 2.
17 2. Risk sharing through coverage adjustment 16 Community rating There are mixed views of the impact of products with less than comprehensive coverage on the principle of community rating and the sustainability of the private health insurance industry. On the one hand, it is seen as a positive because these products enable consumers to purchase a product suitable to their perceived health risks. This attracts low risk young consumers into the private health insurance market earlier than otherwise, and they will possibly retain and upgrade their cover over time as their health risks change. It is argued that having these low risk young consumers in the private health insurance system is better for everyone in the system as they subsidise high cost claimants on comprehensive policies, and for this reason allowing products with less than comprehensive coverage supports a community rated private health insurance industry. Furthermore, low risk young consumers purchasing products with exclusions and restrictions make the same contribution to the risk equalisation pool as consumers on comprehensive products. 43 On the other hand, many argue that products with less than comprehensive coverage undermine the principle of community rating. 44 The policy objective of community rating is universal price and coverage so as to remove the ability of insurers to price on the basis of risk so low risk groups (the young and healthy) subsidise the high risk groups (the aged and unhealthy). However, products with less than comprehensive coverage effectively introduce risk-based pricing by enabling the low risk groups to pay lower premiums based on their perception of health risk. Regulation of premium changes The Minister for Health is required to approve requests for premium changes, unless the change is contrary to the public interest. 45 This approval process occurs on an annual basis. An option available to insurers if they are unable to obtain their preferred increase in premiums is to increase the level of exclusions, restrictions and benefit limitation periods for existing policyholders to achieve a particular profit target. Some industry stakeholders consider that the ability of health insurers to do this arguably undermines moves to constrain premium increases. 46 Government incentives The policy objectives of the MLS and the Private Health Insurance Rebate are to encourage consumers to take out private health insurance in order to relieve pressure on the public hospital system. As mentioned above, private health insurance products as a minimum only need to provide cover for psychiatric, rehabilitative and palliative care at the default rate. This means that a health insurer can offer a minimalist health insurance product at a comparatively low price (see Table 5) while the consumer avoids the MLS and obtains the private health insurance rebate. As mentioned above, included in this category of products are those that either: limit cover to being treated as a private patient in a public hospital; or provide for treatment as a private patient in a private and public hospital but with a large number of exclusions or restrictions. 43 The Australian Health Service Alliance s and hirmaa s joint submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page Defence Health s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, pages 6 to This requirement is set out in section of the Private Health Insurance Act Consumers Health Forum of Australian s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, page 2.
18 2. Risk sharing through coverage adjustment 17 There are two opposing views on the merits on these low cost products. One view is that these products do little to relieve pressure on the public hospital system and should not then qualify for the Private Health Insurance Rebate and be exempt for MLS purposes. The alternative view is that these products either provide an additional revenue source for public hospitals (those that pay benefits for treatment as a private patient in a public hospital), 47 or at least relieve some pressure on the public hospital system and in this way help achieve the Government s policy objectives. 48 Again, it is noted that, through the Risk Equalisation Transfer Fund, purchasers of these products do contribute to the treatment costs of higher risk groups. In this way, low cost products do assist in sustaining the private health system. Other issues Other observations about the current market environment made by industry stakeholders include the following: Insurers which only offer comprehensive products face the prospect of losing market share over time and attracting only consumers at the higher end of the health risk profile. Consequently, these insurers may face increasing market pressure to offer products with less than comprehensive coverage to remain competitive and to manage their risk profile. The question arises whether products with exclusions are actuarially priced with no cross subsidisation or risk adjustment. One insurer has suggested that current industry pricing practices take into account the age group and risk profile of the market being targeted in pricing products with exclusions. 49 This argument suggests that there could be a case for some form of government invention to ensure insurers price such products actuarially only on the basis of the impact of the treatments excluded and not on the age group or risk profile of the consumer taking up this product. The alternative view is that products with exclusions are appropriately priced and there is no case for government intervention. Exclusionary and restricted benefit products result in an increased administrative burden for hospitals as they introduce added complexity to claiming, billing and payment collection process. Hospitals are also exposed to additional financial risk particularly if it cannot be foreseen and confirmed whether a patient s policy will provide adequate cover For example, in private health insurers paid $952 million in benefits to public hospitals, or 12.5 per cent of total benefit payments to public and private hospitals. In percentage terms, is the equal highest level (with ) since when this data was first collected in and the low point was at 8.3 per cent. It is important to note that these benefit payments relate to all hospital products (public only products and public and private products). 48 That is, consumers with a product with a lot of exclusions may still be covered for the particular treatment they need in a private hospital. 49 Defence Health s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, pages 6 to Submissions to Discussion Paper No 1, Competition in the Private Health Insurance Market, Australian Private Hospitals Association s submission, page 2, and the Little Company of Mary Health Care s submission, page 5.
19 18 References Australian Health Service Alliance s and hirmaa s joint submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, PHIAC, available at Australian Private Hospitals Association s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, PHIAC, available at Little Company of Mary Health Care s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, PHIAC, available at Consumers Health Forum of Australia s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, available at Defence Health s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, available at Discussion Paper No. 1, Competition in the Australian Private Health Insurance Market, PHIAC, November 2012, available at KPMG s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market,, available at Medibank Private s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, available at Research Paper No. 1, Competition in the Australian Private Health Insurance Market, PHIAC, June 2015, available at Research Paper No. 2, Portability, Switching and Competition in the Australian Health Insurance Industry, June 2015, available at Teachers Union Health Fund s submission to Discussion Paper No 1, Competition in the Private Health Insurance Market, available at Legislation Medicare Levy Act 1986, available at Private Health Insurance Act 2007, available at Private Health Insurance (Benefit Requirements) Amendment Rules 2011, available at Supplementary Explanatory Memorandum, Taxation Laws Amendment Bill (no 6) 2000, page 8 and 9, available at Produced by Surveillance.net.au
Private Health Insurance Administration Council Portability, switching and competition in the Australian private health insurance market 02 Research Paper 2 June 2015 1 About PHIAC The Private Health Insurance
PORTABILITY, SWITCHING AND COMPETITION IN THE AUSTRALIAN PRIVATE HEALTH INSURANCE MARKET Premiums and Competition Unit DP 2 Discussion Paper Disclaimer 31 July 2013 This is a discussion paper whose purpose
06 August 2009 Mr David Kalisch Commissioner, Hospital Studies Productivity Commission Locked Bag 2, Collins Street East Melbourne Vic 8003 Australian Unity s Submission: Productivity Commission Issues
Submission to the Private Health Insurance Consultations 2015-16 The AMA welcomes the opportunity to provide a submission to the Private Health Insurance Consultations 2015-16. The Review will no doubt
Private Health Insurance Australia Quarterly Statistics September 2014 Contents Snapshot of the industry..... 3 Membership and coverage.... 4 Benefits paid..... 6 Service utilisation... 9 Out-of-pocket
Private Health Insurance Australia Quarterly Statistics March 2015 Contents Snapshot of the industry......3 Membership and coverage.... 4 Benefits paid..... 6 Service utilisation... 9 Out-of-pocket payments..
7 December 2015 The Hon Sussan Ley MP Minister for Health Parliament House CANBERRA ACT 2600 Email: PHIconsultations2015email@example.com Dear Minister Actuaries Institute submission to the Private Health
finding the balance between public and private health the example of australia By Zoe McKenzie, Senior Researcher This note provides an overview of the principal elements of Australia s public health system,
Community Rating More Trouble Than Its Worth? Prepared by Jamie Reid, Ashish Ahluwalia and Sonia Tripolitano Presented to the Actuaries Institute Actuaries Summit 20-21 May 2013 Sydney This paper has been
HIRMAA SUBMISSION to the Review of Australia s future tax system Health Insurance Restricted Membership Association of Australia Level 2, 826 Whitehorse Road, Box Hill, Victoria, 3128 Telephone : 03 9896
The facts. Private health insurance. Fact. The rebate on private health insurance reduces pressure on public health spending. Private healthcare is funded through a combination of private health insurance
PHIAC Discussion Paper: COMPETITION IN THE AUSTRALIAN PRIVATE HEALTH INSURANCE MARKET Submission by TUH - January 2013 General comments TUH believes that competition is generally good for consumers and
Private Health Insurance (PHI) Proposed means testing not consistent with Community Rating 12 July 2011 On 7 July 2011, the Commonwealth government introduced legislation into Parliament to establish a
Committee Secretary Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600 Email: firstname.lastname@example.org Dear Dr Holland Re: Inquiry into the Private Health
Health 13 May 2014 Commonwealth of Australia 2014 ISBN 978-0-642-74982-6 This publication is available for your use under a Creative Commons Attribution 3.0 Australia licence, with the exception of the
Private Health Insurance Administration Council (PHIAC) 16 June 2009 Increase in the Council Administration Table of Contents 1. OVERVIEW 1.1 Purpose 1.2 Background 1.3 Australian Government Cost Recovery
Restrictions and Exclusions in Private Health Insurance Carol Bennett Executive Director Consumers Health Forum Advocates for appropriate and equitable healthcare Undertakes consumer-based research Raises
An economic assessment of the Private Health Insurance system Prepared by Econtech Pty Ltd September 2008 ACHR AUSTRALIAN CENTRE FOR HEALTH RESEARCH AUSTRALIAN CENTRE FOR HEALTH RESEARCH LTD ABN 87 116
Statistics Private Health Insurance Quarterly Statistics June 2015 (issued 18 August 2015) www.apra.gov.au Australian Prudential Regulation Authority Contents Snapshot of the industry......3 Membership
THE AUSTRALIA INSTITUTE Health insurance tax rort November 2002 This report concludes that private health insurance funds are facilitating and, in some cases, encouraging tax avoidance by providing products
Private Health Insurance in Australia For: Australia & New Zealand Study Tour Canadian College of Health Leaders Sydney, Australia 21 February 2012 By: Shaun Larkin Managing Director HCF Outline Definition
Department of Health and Ageing Increase of the Income Tax Thresholds for the Medicare levy Surcharge September 2011 Table of contents: PURPOSE OF THE POST-IMPLEMENTATION REVIEW... 1 EXECUTIVE SUMMARY...
CAPITAL STANDARDS REVIEW Consultation paper A paper detailing the proposed operation of the Capital Adequacy and Solvency requirements established by PHIAC to apply to health insurers in the private health
11 August 2014 Review of Australia s Welfare System CANBERRA ACT 2600 Dear Sir/Madam Welfare Review Submission The Financial Services Council (FSC) represents Australia's retail and wholesale funds management
Australia s health system offers a comprehensive range of public and privately funded health services. You can choose whether to have Medicare cover only or a combination of Medicare and private health
PrivateHealth.gov.au Australia s leading independent source of information about private health insurance There are many things to consider when looking into private health insurance how does it all work?
Private Health Insurance cost pressures and product pricing Prepared by Andrew P Gale Presented to the Institute of Actuaries of Australia 2005 Biennial Convention 8 May 11 May 2005 This paper has been
T Tour de d PHI David Torrance 29 November 2013 Some observations, thoughts, questions 1 Community Rating Not defined explicitly but is the backbone of Australian health insurance Consistent with the funding
Effective 1 April 2015 Hospital Cover PLEASE CAREFULLY READ AND RETAIN THIS BROCHURE. PLEASE READ IN CONJUNCTION WITH THE IMPORTANT INFORMATION GUIDE. Whether you re starting out, raising a family or just
Journal of Economic and Social Policy Volume 8 Issue 2 Article 5 1-1-2004 The Costs of Claytons Health Insurance Products Clive Hamilton Australian National University, ACT Richard Denniss Australian National
COMPETITION IN THE AUSTRALIAN PRIVATE HEALTH INSURANCE MARKET Page 1 of 11 1. To what extent has the development of different markets in the various states had an impact on competition? The development
Using cheap private health insurance to avoid the Medicare Levy Surcharge What is the cost to taxpayers? Research Paper No. 46 July 2007 Andrew Macintosh 1 Summary The Medicare Levy Surcharge (MLS) aims
Optus Submission to Productivity Commission Inquiry into National Frameworks for Workers Compensation and Occupational Health and Safety June 2003 Overview Optus welcomes the opportunity to provide this
Insurance Insights When markets hit motorists How international financial markets impact Compulsory Third Party insurance August 2012 Chris McHugh Executive General Manager Statutory Portfolio Commercial
Barriers to entry in the Australian private health insurance market 03 Research Paper 3 June 2015 1 About PHIAC The Private Health Insurance Administration Council (PHIAC) is an independent statutory authority
ACA Impact on Premium Rates in the Individual and Small Group Markets Paul R. Houchens, FSA, MAAA BACKGROUND The Patient Protection and Affordable Care Act (ACA) introduces significant changes in covered
CANSTAR S GUIDE TO Choosing health insurance AUSTRALIA HAS A TERRIFIC UNIVERSAL HEALTH CARE SYSTEM, CALLED MEDICARE. THIS SYSTEM ENSURES THAT ALL AUSTRALIANS HAVE ACCESS TO FREE HOSPITAL TREATMENT IN THE
Explanatory Paper TPB(EP) 03/2010 Professional Indemnity Insurance This TPB explanatory paper (TPB(EP)) is intended as information only. It provides a detailed explanation of the Board s professional indemnity
AMA submission ACCC report to the Senate on private health insurance email@example.com The AMA welcomes the opportunity to inform the ACCC about anti-competitive and other practices impacting on consumers
Risk Equalisation 2020 Is the current system sustainable? Prepared by Ashish Ahluwalia, Jamie Reid and Sonia Tripolitano Presented to the Institute of Actuaries of Australia Biennial Convention 10-13 April
Private Health Insurance: What Consumers Want Presentation to PHIO Industry Seminar 17 March 2011: Consumer Issues in Private Health Anna Wise Senior Policy Manager Consumers Health Forum Advocates for
BBY 2007 Healthcare & Life Sciences Conference nib holdings limited Michelle McPherson, Deputy CEO & CFO 4 December 2007 Disclaimer By attending this presentation, you agree that no part of this presentation
Parliament of Australia Department of Parliamentary Services Parliamentary Library Information analysis and advice for the Parliament BILLS DIGEST 4 June 2008, no. 121, 2007 08, ISSN 1328-8091 Tax Laws
June 2012 IN THIS ISSUE Private health insurance rebate and Medicare Levy surcharge changes 30 June is around the corner Tax Changes affecting Small businesses Changes to the timing of Trust resolutions
ACCC Report REPORT TO THE AUSTRALIAN SENATE On anti-competitive and other practices by health insurers and providers in relation to private health insurance For the period of 1 July 2012 to 30 June 2013
State of the Health Funds Report 2 010 An independent assessment of the comparative performance and service delivery of Australia s private health insurance providers. Private Health Insurance Ombudsman
Compulsory Health Insurance: Should government still be the health insurer of first resort? Prepared by Matthew Crane, Kris McCullough, Jamie Reid and Collin Wang Presented to the Actuaries Institute Actuaries
Introduction Chapter 5 Private health insurance 5.1 The private health insurance industry in Australia comprises 34 private health insurers. At the end of 2012 13, 47 per cent of the Australian population
RURAL DOCTORS ASSOCIATION OF AUSTRALIA Submission to the Private Health Insurance Consultation Via email: PHI Consultations 2015-16 Contact for RDAA: Jenny Johnson Chief Executive Officer Email: firstname.lastname@example.org
Parliament of Australia Department of Parliamentary Services Parliamentary Library Information, analysis and advice for the Parliament BACKGROUND NOTE www.aph.gov.au/library Private health insurance premium
Private Health Insurance Administration Council Competition in the Australian Private Health Insurance Market Research Paper 1 June 2015 1 About PHIAC The Private Health Insurance Administration Council
2004-2006 THE PARLIAMENT OF THE COMMONWEALTH OF AUSTRALIA HOUSE OF REPRESENTATIVES GENERAL INSURANCE SUPERVISORY LEVY IMPOSITION AMENDMENT BILL 2006 EXPLANATORY MEMORANDUM Circulated by the authority of
Implementing a Diverted Profits Tax May 2016 Commonwealth of Australia 2016 ISBN 978-1-925220-92-6 This publication is available for your use under a Creative Commons Attribution 3.0 Australia licence,
18 August 2011 Australian Healthcare & Hospitals Association Position paper Private Health Insurance (Rebate and Medicare Levy Surcharge) Introductionn The Australian Healthcare & Hospitals Association
RISK MANAGEMENT FOR PRIVATE HEALTH INSURERS January 2013 Consultation Paper Disclaimer This is a discussion paper whose purpose is to stimulate discussion, debate and feedback to the Private Health Insurance
April 2015 Gold Hospital Cover (as at April 2015) Contracted Hospitals When a hospital agreement is in place the RBHS will rebate the agreed amount to the hospital from the date the agreement commences.
Health expenditure Australia 2011 12: analysis by sector HEALTH AND WELFARE EXPENDITURE SERIES No. 51 HEALTH AND WELFARE EXPENDITURE SERIES Number 51 Health expenditure Australia 2011 12: analysis by sector
April 2015 Membership Guide simply better benefits A Contents About the Reserve Bank Health Society 1 Why join the RBHS? 2 Private health insurance coverage 3 New to private health insurance? 4 Benefits
Turning Logic and Evidence on it Head: Australia's Subsidy to Private Insurance Jeremiah Hurley Centre for Health Economics and Policy Analysis Department of Economics McMaster University Thank Jamie Daw
14-16 Chandos Street St Leonards NSW 2034 All Correspondence to: PO Box 520 St Leonards NSW 1590 30 January, 2014 Mr John Edge First Assistant Secretary Medibank Sale Taskforce Department of Finance John
4 May, 2011 Mr Tony Windsor MP Member for New England PO Box 6022 House of Representatives Parliament House CANBERRA ACT 2600 Dear Mr Windsor I am writing to you regarding the Federal Government s intended
Clarifying the definition of limited recourse debt Discussion paper July 2012 Commonwealth of Australia 2012 ISBN 978 0 642 74838 6 This publication is available for your use under a Creative Commons Attribution
PRIME MINISTER A NEW MEDICAL INDEMNITY INSURANCE FRAMEWORK Today I am announcing the Government s package of measures to address rising medical indemnity insurance premiums and ensure a viable and ongoing
.... About your membership Important information booklet for Australian Residents Contents 2 How do I make a claim? Making hospital claims Your hospital benefits from Medicare Making claims for medical
GROUP HIGHLIGHTS 1H12 1H11 % Premium revenue $554.4m $495.0m 12.0 Total policyholders 457,768 430,582 6.3 Net underwriting profit $42.7m $40.9m 4.5 Net investment income $12.4m $18.6m (33.2) Net profit
ACCC Report Information and informed decision-making A report to the Australian Senate on anti-competitive and other practices by health insurers and providers in relation to private health insurance For
LC Paper No. CB(2)1237/12-13(01) For information on 4 June 2013 Legislative Council Panel on Health Services Subcommittee on Health Protection Scheme Design of Private Health Insurance Policies Regulated
Submission to Private Health Insurance Review December 2015 About National Seniors Australia National Seniors Australia is a not-for-profit organisation that gives voice to issues that affect people aged
APRIL 2014 ELECTRICITY PRICES AND NETWORK COSTS 1 WHAT MAKES UP THE RETAIL ELECTRICITY BILL? Retail electricity bills are made up of a number of components: Wholesale costs reflecting electricity generation
Health Insurance Premiums for Seniors New Zealand Society of Actuaries Conference November 2008 By Robert Cole Introduction This paper looks at health insurance premiums for seniors (older ages generally
EXPLANATORY STATEMENT Issued by the Authority of the Minister for Health and Ageing Private Health Insurance Act 2007 Private Health Insurance (Complying Product) Rules 2007 Section 333-20 of the Private
Private Health Insurance Premium Change Process: A Review Dr David Charles, Director, Insight Economics July 2011 Special Note: The objective of the Australian Centre For Health Research Limited (ACHR)
Department of the Parliamentary Library I NFORMATION AND R ESEARCH S ERVICES Bills Digest No. 56 2001 02 Health and Other Services (Compensation) Legislation Amendment Bill 2001 ISSN 1328-8091 Copyright
A Report to the Competition in the Irish Private Health Insurance Market Executive Summary January 2007 EXECUTIVE SUMMARY AND RECOMMENDATIONS E 1. E 2. The Irish private health insurance market is community
Prime Time Advisory News Update May 2016 Newsletter Topics AMA Private Health Insurance Comparison 2016 Budget Breakdown Top Ten Tax Tips for 2016 AMA Private Health Insurance Comparison Recent price increases
UHI Explained Frequently asked questions on the proposed new model of Universal Health Insurance Overview of Universal Health Insurance What kind of health system does Ireland currently have? At the moment
Parliament of Australia Department of Parliamentary Services Parliamentary Library Information analysis and advice for the Parliament BILLS DIGEST 18 September 2007, no. 49, 2007 08, ISSN 1328-8091 Health
8 Private health one of the things that is often overlooked is just how significant the private health insurance sector is in terms of total funding. If you look at how much health funds pay collectively
More changes to private health insurance Australia Country: Australia Partner Institute: Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney Survey no: (12) 2008
APHA Response to the Draft Report (Sept 2014) The Competition Policy Review - 2014 Australian Private Hospitals Association ABN 82 008 623 809 Executive Summary The Australian Private Hospitals Association
Consulting Health & Benefits 2011 Health Insurance Trend Driver Survey 2011 Health Insurance Trend Driver Survey Contents 2 Introduction Comparison to Other Surveys About the Survey 6 9 Trend and Premium