One Step Closer:

On 19 June 2025, the PHI 51/25 Private Health Insurance Legislation Amendment Rules (No. 5) 2025 were issued.

At the bottom of this article are the relevant excerpts from the Rules.

Whilst the limitation for paying rebates for Pilates is being lifted from July 1, it is likely to be at least a few months before this is made available for our clients. We are deep in discussion with the health fund associations and some of the private health funds. These conversations range from high level issues like “what is treatment” and what should be covered by the health funds down to nitty gritty details like mechanisms for claiming.

At this stage, nothing has been firmly set, and the dialogue has been very constructive so far as we explore options.

We are considering running some focus groups to help inform these discussions. We are not sure how much we can influence the decision-making process of the private health funds but it would be good to know the views of our members. If you are interested, please email info@pilates.org.au.

We will be providing regular updates on progress on this matter.

Robyn Rix, PAA President

 

https://www.legislation.gov.au/F2025L00707/latest/text/explanatory-statement

The Amendment Rules make an amendment to the Health Insurance Business Rules to re‑include seven natural therapies as eligible for private health insurance (PHI) benefits from 1 July 2025. The seven natural therapies re-included are Alexander Technique, naturopathy, Pilates, shiatsu, tai chi, western herbalism and yoga. The change to re-include the seven natural therapies is achieved by replacing the definition of ‘excluded natural therapy treatment’ with one which does not list the seven therapies.

Consultation

Excluded natural therapy treatment

Stakeholders were provided the opportunity to submit evidence to the Review. Stakeholders were informed of completion of the Natural Therapies Review 2024 (the Review) at a teleconference on 13 February 2025. On 2 April 2025, the department published the outcomes of the Review, including the Chair recommendations to Government. The Minister announced on 14 April 2025 that the Government had accepted the recommendations of the Review to re-include seven of the 16 excluded natural therapies as eligible for private health insurance benefits. Feedback on the outcomes of the Review has been overwhelmingly positive.

The department advised private health insurance peak bodies Private Healthcare Australia and Members Health Fund Alliance in April and May 2025 of the department’s intention to implement the re-inclusion as early as possible. The department noted that it would remain at the discretion of insurers whether they covered any of the re-included natural therapies on their policies, the timing of any such re-inclusion and the level of benefits payable.