AUSactive and Private Healthcare Australia work towards driving health insurance reform

Following recent legislative changes allowing private health insurers to offer rebates for select natural therapies, AUSactive is currently working closely with Private Healthcare Australia (PHA) to lead reform in private health insurance.

The collaboration is aimed at expanding access to evidence-based preventive health services, including Pilates, Yoga, Tai Chi, and structured exercise programs delivered by accredited professionals.

The legislative changes were reinstated following the 2024 independent review of their clinical effectiveness. The review recommended the re-inclusion of seven therapies previously excluded in 2019, providing a significant opportunity to embed preventive health into the private health insurance system.

 Private health insurers are working with industry associations to create accreditation, claims and other required processes to support the change. With the assistance of professional associations, the processes are expected to be in place in early 2026.

In response, AUSactive has proposed a national model for delivery that prioritises accreditation, safety, and clinical effectiveness. This includes the development of new item numbers for eligible services and a robust framework to guide implementation by both practitioners and insurers.

AUSactive Chief Executive Barrie Elvish said it was a timely opportunity for private health insurers to take a proactive role in preventive health.

Elvish noted “by supporting structured, evidence-based services delivered by accredited professionals, we can improve the health of Australians while also reducing long-term healthcare costs.

AUSactive’s contribution to this reform includes:

• A national accreditation framework to support how accredited exercise and active health professionals can deliver services under private health insurance

• Industry consultation through surveys to ensure the model reflects current practice, billing, and consumer needs

• Practical implementation tools such as draft item schedules, rules of use, and FAQs to support both insurers and practitioners.

The partnership also aligns with broader industry efforts to establish the necessary claims processes that will allow health funds to offer rebates for clinical applications of natural therapies.

This includes meeting regulatory obligations such as defining treatment eligibility, developing referral pathways, and ensuring service quality through recognised accreditation processes.

AUSactive’s framework offers an immediate opportunity for private health insurers to:

• Deliver increased member value

• Improve long-term health outcomes

• Reduce the cost burden of chronic disease

• Modernise the delivery of preventive healthcare.

Elvish added “we value the constructive collaboration with Private Healthcare Australia and look forward to progressing the next steps of this important national initiative.”

For more information visit privatehealthcareaustralia.org.au/health-insurers-working-with-natural-therapists-to-develop-accreditation-and-claims-framework/

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