|
What are the requirements for each tier?
The government release detailed the coverage any
given product must offer to be eligible for inclusion in each of the four new
tiers. The requirements were as follows:
| Hospital treatments by clinical category |
Basic |
Bronze |
Silver |
Gold |
| Rehabilitation |
xR |
xR |
xR |
x |
| Hospital psychiatric services |
xR |
xR |
xR |
x |
| Palliative care |
xR |
xR |
xR |
x |
| Brain |
RCP |
x |
x |
x |
| Eye |
RCP |
x |
x |
x |
| Ear, nose, and throat |
RCP |
x |
x |
x |
| Tonsils, adenoids, and grommets |
RCP |
x |
x |
x |
| Bone, joint, and muscle |
RCP |
x |
x |
x |
| Joint reconstructions |
RCP |
x |
x |
x |
| Kidney and bladder |
RCP |
x |
x |
x |
| Male reproductive system |
RCP |
x |
x |
x |
| Digestive system |
RCP |
x |
x |
x |
| Hernia and appendix |
RCP |
x |
x |
x |
| Gastrointestinal endoscopy |
RCP |
x |
x |
x |
| Gynaecology |
RCP |
x |
x |
x |
| Miscarriage and termination of pregnancy |
RCP |
x |
x |
x |
| Chemotherapy, radiotherapy, and immunotherapy
for cancer |
RCP |
x |
x |
x |
| Skin |
RCP |
x |
x |
x |
| Breast surgery (medically necessary) |
RCP |
x |
x |
x |
| Diabetes |
RCP |
x |
x |
x |
| Heart, lung, and vascular system |
RCP |
|
x |
x |
| Blood |
RCP |
|
x |
x |
| Back, neck, and spine |
RCP |
|
x |
x |
| Plastic and reconstructive surgery (medically
necessary) |
RCP |
|
x |
x |
| Dental surgery |
RCP |
|
x |
x |
| Podiatric surgery (provided by an accredited
podiatric surgeon) |
RCP |
|
x |
x |
| Implantation of hearing devices |
RCP |
|
x |
x |
| Cataracts |
RCP |
|
|
x |
| Joint replacements and spinal fusion |
RCP |
|
|
x |
| Dialysis for chronic kidney disease |
RCP |
|
|
x |
| Pregnancy, birth, and neonates |
RCP |
|
|
x |
| Assisted reproductive services |
RCP |
|
|
x |
| Weight loss surgery |
RCP |
|
|
x |
| Insulin pumps |
RCP |
|
|
x |
| Chronic pain |
RCP |
|
|
x |
| Sleep studies |
RCP |
|
|
x |
x: Indicates the treatment/service is a
minimum requirement of the product category. The service must be covered on an
unrestricted basis.
xR: Indicates the treatment/service is a
minimum requirement of the product category. The service may be offered on a
restricted cover basis.
RCP: Restricted cover permitted: indicates
the treatment/service is not a minimum requirement of the product category.
Insurers may choose to offer these as additional services on a restricted or
unrestricted basis.
Blank: Indicates the treatment/service is
not a minimum requirement of the product category. Insurers may choose to offer
these as additional services; however, where offered these must be on an
unrestricted basis.
|