Private Health Insurance Reforms from 1 April 2019

Posted on March 11, 2019

As you are probably aware, the Federal Government has introduced reforms to remove rebates for many natural therapies paid under private health insurance policies.

These changes will come into effect from 1 April 2019 and may affect you if you have extras cover in your private health insurance.

From 1 April 2019, private health insurers will not pay any benefits for Pilates and a number of other natural therapies.

The Government’s original position was that Pilates would not be claimable, regardless of who delivers it or how it is delivered. However, the Australian Physiotherapy Association fought back.

The Department now considers that an insurer may pay benefits if a physiotherapist uses exercises drawn from Pilates as part of that client’s treatment. However,if a physiotherapist (or any other health professional) conducts a session where the only service provided is Pilates exercises, then benefits cannot be paid.

Physiotherapy is recognised by all parties as high-value, evidence-based care. Therapeutic exercises delivered by Physiotherapists are still eligible for rebates if they address a current injury or health problem, include regular follow ups and include extensive clinical notes.

Pilates Power & Physiotherapy Cronulla Pty Ltd has always been compliant to these guidelines.


At PPP Cronulla we are firm believers that Pilates-type exercises are an important aspect of the treatment and rehabilitation process. From 1April 2019 sessions eligible for rebates by private insurers must not consist solely of Pilates and must address a “current injury or health condition”.

Effective 1 April 2019 we will use the term ”Clinical Rehabilitation Session” when referring to sessions conducted by an allied health professional that include a combination of treatment and rehabilitative exercises (which may include some exercises drawn from Pilates). These will be eligible for rebates.

Clinical Rehab Sessions are conducted by Physiotherapists and Exercise Physiologists and ratios will be limited to 2-3 clients per allied health professional. Private 1:1 and Duet sessions will also be available.

Clinical Rehab clients will require regular re-assessment every 10 to 12 weeks to formally review progress and decide on further treatment and rehab needs. At this stage you may be assessed as ready to progress to Studio Pilates sessions or Reformer or Mat Classes to sustain your improvements with our highly experienced and qualified Pilates Instructors. These sessions are not eligible for health fund rebates. 

This will always place you in the most suitable and safe environment to strive for your goals, may it be rehabilitation or fitness.


  1. To assess your eligibility for Clinical Rehab Sessions with us from 1April 2019, we kindly ask you to book a 30 minute 1:1 assessment with the PPP desk.  If we assess you as requiring rehab for a current injury or condition, you will be seen in Studio 2 (former mat room) to work in Clinical Rehab sessions with Barbara, Karina, Nikki, Blake (Physiotherapists) or Jillian (Exercise Physiologist). In these sessions, we will provide you with clinical exercises to assist your recovery (and these may include Pilates style exercises). Client numbers will be capped at 2-3 participants per hour for Group sessions and Privates/Duets will also be available.
  1. Studio Pilates Sessions (Studio 1) - Traditional “Studio Pilates Group” sessions with Karina, Jillian, Kristy, Veronika, Michelle, Leanne, Andrea, Rhonda and Delene will continue as normal (3-4 clients per instructor) and will remain a non-claimable service.
  1. Reformer Classes/Mat Classes – No change to current rules.
  1. If you are not sure, please speak to any of us.

Important note: If any of our Physios or Exercise Phys staff teach a Studio Pilates or Reformer class or general mat class then this session will NOT be claimable with your health fund when our health professionals jump into their Pilates Instructor role.

Rest assured we will continue to provide the highest standard of Rehabilitation and Pilates at PPP, and we look forward to seeing you all in our studio soon!