Product design information

The Department of Health commissioned research and analysis to support the Committee’s consideration of product design reforms. The main focus of the research and analysis was to consider potential consumer responses and premium impacts which might result from the possible introduction of Gold, Silver and Bronze product tiers.

Page last updated: 08 February 2019

Actuarial modelling was undertaken by Deloitte for the Private Health Ministerial Advisory Committee during 2017 and 2018 to examine the premium and participation impacts associated with introducing a tiered system of private hospital cover. The modelling was one of a number of inputs the Government considered in formulating the minimum requirements for the Gold, Silver, Bronze and Basic product tiers. The Government was also informed by other inputs, including feedback received from clinicians, private health insurers, consumer groups, private hospitals and the medical device sector.

Three of the major actuarial modelling reports produced by Deloitte are below:
1. Evaluation of proposed PHI product reforms, June 2017. (PDF 5017 KB)
2. Premium impact of benefit categorisation, June 2018 (PDF 2284 KB)
3. File note: Scenarios on extending mandatory service category coverage , August 2018 (PDF 446 KB)
If you are having difficulty accessing the PDF documents, please contact: PHMAC Secretariat for an alternate version to be sent to you.

A factsheet has been prepared on this actuarial modelling.
Product design actuarial modelling Factsheet (PDF 271 KB)
Product design actuarial modelling Factsheet (Word 212 KB)

Consumer research was undertaken to determine the likely consumer responses to the possible introduction of a new Bronze product category covering additional services.
Consumer research presentation (PDF 1088 KB)
If you are having difficulty accessing the PDF, please contact: PHMAC Secretariat for an alternate version to be sent to you.

Following consideration of the findings of the research and analysis, along with other stakeholder communication and policy advice, the Government decided not to make changes that would increase premiums for entry-level products. A factsheet has been prepared outlining the role of entry-level products in the private health insurance market.
Low Priced Products Factsheet (PDF 42 KB)
Low Priced Products Factsheet (Word 257 KB)

Following the Government’s announcement of the reform package, the Committee considered a product design issues paper at the 8 November 2017 meeting. The issues paper contains the key design principles for the implementation of Gold, Silver, Bronze, Basic product categories. The issues paper also includes draft minimum product standards for hospital products and general treatment products, and draft standard clinical definitions, which are being used for consultation with industry. The Government is continuing to consult through the Private Health Ministerial Advisory Committee on details of the new arrangements, which will take effect from 1 April 2019.
Gold Silver Bronze Basic implementation Issues Paper(PDF 295 KB)
Gold Silver Bronze Basic implementation Issues Paper(Word 157 KB)

A forum was held on 25 May 2018 with a selection of actuaries and other representatives from private health insurance funds to consider further product design modelling prepared by Deloitte for the Private Health Ministerial Advisory Committee. A summary of the forum can be accessed below.
Forum on Private Health Insurance categorisation modelling 25 May 2018

Clinical categories
In March 2018, consumer focus group testing was conducted on the draft clinical categories (formerly known as the standard clinical definitions).

In April 2018, the Department of Health sought feedback from medical colleges and the Private Health Ministerial Advisory Committee on the draft clinical categories and the list of procedures for each category.

A summary of the outcomes resulting from the consumer testing and consultation is available below.
Outcomes of Clinical categories consultation 2018 (PDF 346 KB)
Outcomes of Clinical categories consultation 2018 (Word 304 KB)

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