Consultation on Standard Clinical Definitions

20 April 2018

The Department of Health is consulting with interested stakeholders on the draft standard clinical definitions for private health insurance hospital treatment policies. 

The standard clinical definitions take effect from 1 April 2019 and are designed to increase consumer understanding and improve transparency of health insurance. The standard clinical definitions will cover all treatments and services offered under hospital treatment policies. All insurers will be required to use these terms (and no others) in all materials - to provide consistency and give consumers certainty about coverage. If an insurer lists a category as included in a product, the insurer must provide cover for all MBS items listed in that category (i.e. no partial cover). The attached table contains the MBS items for each definition and a summary of the feedback received during the previous consultation process. 

In addition to the introduction of standard clinical definitions, the Government has a1mounced that from 1 April 2019 all private health insurance products will be classified as Gold, Silver, Bronze or Basic. The Gold, Silver, Bronze or Basic classification will use the standard clinical definitions. 

The department requests feedback by email to [email protected]. The consultation process is open until 5pm, 27 April 2018. 



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