Below is a clarification of the current status of health fund rebates for Pilates.
The PAA have been in discussion with Private Healthcare Australia (PHA), who represent 22 registered health funds and Australian Regional Health Group (ARHG), who represent 32 registered health funds, as well as some of the individual health funds.
Each Health Fund already has a set of requirements in place for Ancillary Health Providers. For them, introducing rebates for Pilates is not a case of drawing up new rules, but rather incorporating Pilates into their existing rules. Each health fund has its own constitution, which dictates its specific rules.
Part of the work being undertaken by the health funds and their associations is setting specific item codes for each reintroduced modality, including Pilates.
Start date
The anticipated date for the inclusion of reinstated modalities is 1 April 2026. We are hopeful that at least some funds will include Pilates benefits. Which funds will introduce Pilates and at what level is still unclear, given there is a significant amount of work that needs to be undertaken by each health fund. This includes agreements being signed with relevant Associations, deciding benefits and limits, and setting up the relevant systems.
Requirements for provider eligibility
A number of provider eligibility requirements have already been confirmed by health funds. Some requirements make good business sense or are simple to comply with, and we will be adopting those for all members.
The list below shows the key requirements and whether these are existing PAA membership requirements:
- Must be a member of an accredited association (i.e. Pilates Association Australia)
- Qualification level plus hours of experience – Diploma* plus 3000 hours post recognised qualification or Advanced Diploma – existing requirement for Practitioner level 2 and above
- Possession of current Professional Indemnity Insurance of $2 million minimum per claim, plus minimum $10 million public liability covering each practice and each modality – existing requirement
- Current Provide First Aid – existing requirement
- Annual CPR – Whilst the PAA strongly encouraged this, it was not specifically required. Your CPR certificate must now be uploaded to your member file.
- Professional Development Points (PDPs) – 20 hours per year of modality-specific professional development – an increase above existing membership requirements
*Some health funds may accept courses equivalent to diploma-level provided they meet certain requirements. For example, they must be assessed and accepted by the PAA. Other funds may only accept RTO qualifications. This will, at least in part, be dictated by their constitution or Fund Rules.
Reporting of Currency
The PAA is required to report member eligibility every month. All criteria must be maintained throughout the year, to be included on the monthly list of eligible members sent to each health fund. For example, if your insurance document on file lapses, you will automatically be excluded from the monthly report.
The ARHG will also keep expiry dates on their system and will remove providers if any of the requirements are not current.
Changes to PDPs for PAA membership
- PDPs will be moving to an annual cycle from 1 April 2026 rather than the current two-year PDP cycle.
- Members with teaching level memberships will be required to accrue 10 PDPs per year, which is equivalent to the current Studio Instructor and Practitioner Level membership requirements of 20 points over two years. (Note that this is a slight increase for Group Instructor members in recognition of changes in the professional landscape of Group Pilates classes and in the interests of simplicity.)
Increased PDPs for provider recognition
Health fund provider eligibility requires 20 points per year which is an increase from current PAA requirements. This level of points is consistent with other health modalities.
As we recognise that not all members will aspire to provider status, the PAA has decided that qualifying for health fund provider status will be optional, achieved by meeting requirements set by Health Funds, the critical one being 20 PDPs per year
What happens next?
Health funds are still working on the finer details necessary to reintroduce Pilates to their existing programs. As we receive information from the Health Funds, the PAA is refining systems and procedures to accommodate the additional requirements and reporting required.
A review of PAA’s professional development programs has highlighted some additional opportunities for members to be recognised for their learning and education. As a result, the existing list of PDP-approved activities is about to be extended.
We will also be introducing a new Health Fund Dashboard to your membership profile to enable you to monitor your eligibility status. This dashboard will feature a checklist displaying how your membership aligns with Health Fund criteria.
More information to come
We will continue to provide information to members as more details become available.
If you have any questions about health fund provider status or PAA membership in general, please email info@pilates.org.au
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