Health Fund Rebates Update – August 2025

Hopefully you saw the PAA posts that HCF has reinstated Pilates for exercise under their Health Management Program.

There have been a few comments made, and questions asked. And yes, most of the comments were correct.

The reintroduction by HCF of benefits at the exercise-level are not the end game. HCF provided this benefit prior to the removal of health fund rebates for Pilates in 2019. They rigorously applied the rules from 2019 to 2025, but they were happy to reinstate this benefit as soon as they could, as it did not require any major system changes for them.

They do not require the end service provider to be a member of an Association. In fact, they appear to have no criteria for the provider. What they do require is:

• a referral by a GP or Allied Health Professional
• that the program addresses a specific medical condition. (They explicitly state that it cannot be for general health and wellbeing.)

The HCF Health Management Program form has tick boxes for a number of conditions. They are:

Arthritis, Asthma, Cardiac conditions or heart disease, Chronic back pain, Diabetes, Hypertension, Mental health, Musculoskeletal, Neurological, Obesity (BMI >30)

There is also a box for “Other”.

Health

Whilst HCF have taken this action, there are some health funds that will only pay benefits where the provider is a member of an Association.

The PAA continue to have discussions with the health fund associations and the health funds. We are anticipating that Pilates will be included in a “Natural Therapies” category as well as in exercise, but the actual benefits will depend on decisions made by each individual health fund.

We are hopeful that these will be introduced soon, but anticipate that some will not be available until April 1^st, 2026. This is the time when the health funds introduce new premium rates and typically make changes to policies.

For those funds that have never provided Pilates benefits, there is a lot of system work to be done. There is a desire to give providers HiCAPS or HealthPoint terminals and the lead time for this is three months.

Our meetings with some of the health funds have been interesting. Some have run for well over an hour, as there is a significant amount of education required. In a meeting the other day, two of the three meeting attendees had attended large group reformer classes and were sceptical of my claims of the therapeutic benefits of Pilates. We have adopted strategies to help in this re-education process.

We are also reworking some of our guidelines and documents to ensure they explicitly cover the information and processes required by the health funds. More on this will be shared when they are ready for release.

Whilst we prepare on our side, assuming the reintroduction, the health fund associations and health funds are data-gathering. We will continue to provide evidence to inform their decisions and to ensure that Pilates is recognised for the incredible and worthwhile benefits it delivers to so many people.

 

Robyn Rix, PAA President

8/8/25