October 2017: Government Announces Health Reforms
On Friday 13th October 2017 Health Minister Greg Hunt announced a reform package under sweeping Turnbull government changes. Many of these changes will benefit us on a personal level. However, this reform does present some significant changes to the public’s ability to claim on Pilates, taking effect from April 2019.
From 2019, private health insurance will no longer cover natural therapies, including aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.
This move comes after a recent review by the Commonwealth Chief Medical Officer found there was no clear evidence of the efficacy of these therapies. An expert committee will be established to consider the issue of ballooning and often opaque out-of-pocket costs..
The PAA will continue the major initiative of ‘Promoting Pilates as a Profession’. Our goal is to lobby government bodies, skilled services and the general public on our profession, education standards and ethics. We will combine with promoting clinical based research on the Pilates Method.
I understand that this is a significant announcement. Please be mindful that the impact for your clients may be minimal given the current rebate level. I will keep you informed of any further information I receive.
Regards, Jen xx
Health Fund List
|Health Fund||Requirements by the Health Fund|
|Australian Health Management (AHM)||Recent changes to ahm policy (notified 20/02/2017):
ahm members with relevant cover can only claim a benefit towards Pilates if the service is provided by a registered Physiotherapist, or if their cover includes Health Improvement benefit and relevant supporting information is provided to ahm before a claim is made. The ahm Health Improvement form can be completed by a medical or other practitioner and can be found on the ahm website here Health Improvement form
For more information on how to claim follow this link and select "Can I claim exercise classes' : Claiming on Extras
|HCF||Pilates is claimable as a Health Management Program for clients with eligible HCF extras cover (clients should be advised to confirm their level of cover and available limits with HCF prior to commencement so they are clear about their eligibility to claim). They must be referred by their GP/Physio/AEP in the first instance.
A Pilates exercise program that isn't delivered by a recognised physiotherapist or Accredited Exercise Physiologist must be claimed using HCF's Exercise and gym benefits authorisation and claim form completed by the relevant medical provider.
HCF do not register non clinicians within the Health Management Program, so there is no Provider Number.
|BUPA (Covers MBF, HBA, Mutual Community)||From 1 June 2017 pilates classes will no longer attract a benefit on Bupa products. Accordingly, Bupa will not register any further providers from 1 June 2017, and their agreement with the PAA will cease. Bupa state they have also communicated with individual providers and any of their customers who may be directly affected by this change.|
|CBHS Health Fund Limited||CBHS would like to advise that due to a change of Fund Rules Pilates now comes under our Health Management Program. Individual recognition of Pilates instructors is no longer required. CBHS members can only claim after they have a Health Management Program Authorisation Form completed by their medical practitioner and submitted to CBHS with their claim. This also applies to gym membership, yoga and personal trainers. The service provided must be to treat or ameliorate a medical condition|
|GMF Health Fund||When client wishes to claim, advise their name to the PAA System Support Officer, email@example.com, who will request a provider number|
|Health Care Insurance Limited (HCILTD)||When client wishes to claim, advise their name to the PAA System Support Officer, firstname.lastname@example.org, who will request a provider number|
|NIB||NIB are not issuing provider numbers. PAA full members need to include on their receipts:
(all of the above need to be on printed letter head or professional receipt book & stamp)
Plus the following information:
With regards to benefits/limits – please advise providers (PAA full members) they will need to direct their clients to NIB to establish this information.
Your NIB clients will have already received a letter with this content:
Benefits for Pilates classes
From 1 April 2012, we’ll pay a benefit for Pilates classes led by an NIB recognised Pilates instructor under the Healthier Lifestyle benefit. You’ll need to complete a Health Management form and have a health professional like a GP or Physiotherapist to confirm that Pilates is recommended for you as a part of a Health Management Program. You can download the Health Management form now from nib.com.au.
Remember, the Healthier Lifestyle benefit has a six month waiting period. You may have already served this waiting period, but give us a call to check. Rest assured, we’ll still pay a benefit for Pilates classes led by a registered physiotherapist, without the need for a form.
|Teachers Federation Health||Teachers Federation Health do not issue Pilates Instructors with provider numbers, they do receive a monthly update list. They state:
Pilates classes are paid under our Healthy Lifestyle Benefits.
An account should be issues on letterhead paper or a rubber stamp with all of PAA members details:
The receipt should include:
The Teachers Federation Health client/member would also need to obtain a letter from their GP confirming that attending Pilates classes will help prevent or ameliorate a specific medical condition
|Transport Health||The Invoice must display the Pilates instructor's name, PAA membership number and studio address for the claim to be processed.|
|HBF Health Fund||When client wishes to claim, please complete and submit this HBF Provider Application form to HBF to request a provider number.|
|Health Partners||When client wishes to claim, advise their name to the PAA System Support Officer, email@example.com, who will request a provider number|
|Australian Unity||Please ask clients to contact Australian Unity to check whether they may claim for Pilates under their particular insurance package. There is no requirement for instructors to register directly with the fund, however they must be a qualified instructor with a registered business, providing a valid receipt.|
|Medibank Private||To be recognised by Medibank you need to be a Physiotherapist registered with Medicare (i.e. on the HICAPS system). Medicare then issue the Provider numbers that Medibank recognise. Unfortunately Medibank do not recognise Pilates Instructors as Ancilliary healthcare providers unless they are a registered physiotherapist as well.|
|HIF||The instructor (or a GP if they have been referred to do Pilates) must complete an HIF Health Management Form, which indicates that the service is for the management of a health condition (write "N/A" for Provider Number). Your client will also require an itemised invoice and a completed HIF claim form.|