Australia's 2019 health insurance reforms: live news

Stay up to date with the most significant shakeup to the industry since 2007

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What you need to know
Shopping for health insurance is now simpler with new categories

New health insurance clinical categories (38 in total) that outline exactly which hospital treatments are covered under each category and the extent of that cover, which all insurers must use from 2018 onwards.

New tiers for hospital policies – Gold, Silver, Bronze, Basic – which will each cover a minimum amount of clinical categories, and help customers easily compare (and understand) different policies. Insurers and health funds must use these tier names when naming their hospital policies, and cannot use the name of any other gemstone (e.g. diamond, platinum) in any hospital or extras policy. The new tiers do not apply to general treatment (extras) policies. Policies that cover more than the minimum requirement must include a ‘+’ or ‘Plus’ in the name. We explain how it all works and what’s covered in the four-tiered health insurance categories.

Certain natural therapy benefits are no longer covered by extras policies

Extras policies no longer include cover for 16 types of natural therapies. The natural therapies that are not covered anymore include Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, shiatsu, tai chi and yoga.

The National Health and Medical Research Council found ‘low to medium evidence’ or a ‘lack of evidence’ to conclude that natural therapies improved a person’s health condition, despite a Private Health Insurance Statistical Trends (Benefit) report by the Australian Prudential Regulation Authority (APRA) ranking natural therapies as the fifth most popular service claimed on extras policies.

Although, the backlash over this decision has urged the Australian Government to commission a natural therapies review. Stay tuned for updates.

Discounts are available for young Aussies (18 - 29)

Customers can be offered a two per cent discount on their hospital premiums for each year they’re under 30, up to a maximum of 10%. Discounts are only offered if the insurer chooses to do so, no insurer is obliged to offer them by law, and may not transfer from one policy to another.

DiscountAge
10%18-25
8%26
6%27
4%28
2%29

These discounts will start to gradually reduce after the customer turns 41, decreasing each year by 2% until it’s reduced to nil or when the customer turns 45 and aren’t eligible for discounts.

Everything else you should know
  1. 2019 health insurance rate rise was the lowest in 18 years with private health insurance premiums increasing by an average of 3.25 per cent.
  2. Cover for mental health. Customers with limited private health cover will also be able to upgrade their cover once in their lifetime without serving a waiting period to access higher benefits for in-hospital mental health services (provided they have already served their initial waiting period for any psychiatric benefits, which is usually two months).
  3. Travel and accommodation subsidies and benefits will be made available for regional Australians with private hospital insurance, for whenever they need to travel to access hospital services.
  4. Higher voluntary excess. The maximum excess that funds can offer for singles policies will increase from $500 to $750, and family policies will have a maximum excess of $1,500 (previously $1,000). If customers opt for a higher excess on their policy, they’ll save money on premiums.
  5. Health insurance price rises. Health insurance premiums usually rise by about 5-6% annually. However, the reforms hope to lower this figure.
  6. Cheaper prostheses for health funds. Insurers pay up to five times more for prosthetic medical devices (e.g. for hip and knee replacements). However, the reforms aim to reduce this price to make it cheaper for patients and health fund members.
  7. More power to the Private Health Insurance Ombudsman. The ombudsman will be allowed to conduct inspections and audit health insurers directly to address customer complaints.
  8. A ‘Private health information statement’ will replace the current ‘Standard Information Statement (SIS) as the required method for health funds to communicate with customers. Insurers should let their customers know of any detrimental changes well in advance before changing their policies.
  9. Privatehealth.gov.au website will be upgraded. The upgrade will provide personalised and up-to-date information on insurance products to make it easier for consumers to compare products.

The story so far…

The Federal Government has introduced a bunch of reforms to the health insurance industry, with some still pending to be implemented. The changes will potentially affect every Australian covered by a health insurance policy - now and into the future.

For example, younger Aussies now have more reasons to take out cover, shoppers will have an easier time comparing products, natural therapies coverage has dramatically changed, and much more.

Here’s the latest updates on the 2018/19 reforms - as they happen.

April 7, 2019
Natural therapies removal comes into question

Ever since the health insurance reforms were announced in October 2017, the decision to remove health insurance coverage of 16 different natural therapies like yoga, naturopathy and Pilates has been a hot topic of discussion.

This decision was based on a 2014-15 review of research by the National Health and Medical Research Council (NHMRC), which found these particular natural therapies weren’t effective. However, consumers and practitioners have called for another review as they weren’t convinced of the findings and weren’t happy losing cover for natural therapies.

Minister for Health Greg Hunt has stated the Liberal National Government will commission a review of natural therapies, including a five-year update to the 2014-15 natural therapies review.

April 4, 2019
Healthcare’s impact on the election and budget

Australia’s healthcare has always been a contentious issue during elections, and this year is no different.

Only two days ago, on 2 April, Treasurer Josh Frydenberg revealed the coalition’s 2019 Federal Budget – which is contingent on the current standing government being re-elected into parliament. Health was a significant focus of the budget, with a lot of funding going towards Medicare rebates, mental health, aged care and more. Here’s a breakdown of health spending in the 2019 budget:

  • $97 billion over four years to fund public hospitals.
  • $5 billion over ten years to fund world-class medical research, clinical trials and health innovations.
  • $1.3 billion to boost community health services, including funding for local infrastructure, chronic disease management, drug and alcohol treatments, and mental and preventative health.
  • $1.1 billion towards strengthening primary health care services, including care for high needs patients, increasing GP rebates for an extra 119 items under the Medicare Benefits Schedule (MBS) when visiting the doctor, and more.
  • $737 million over seven years invested into mental health – including $461 million going towards helping young Aussies (with a focus on youth suicide) – particularly to reduce waiting lists for mental health services and to fund new community support services, centres, programs and specialist residential facilities for patients with eating disorders.
  • $386 million to boost sport participation in Australia, support elite athletes, upgrade sporting infrastructure as well as fund school programs and activities for students.
  • $331 million to provide new medicines under the Pharmaceutical Benefits Scheme (PBS), or amend medicines already listed, with a focus on cancer and leukaemia medications.
  • $199 million for diagnostic imaging to help Australians pay for out-of-pocket costs for x-rays and ultrasounds.
  • $152 million for new Magnetic Resonance Imaging (MRI) licenses to improve access around Australia.
  • $32.6 million to help reduce the cost of an MRI scan for patients.

Sources: https://www.budget.gov.au/2019-20/content/overview.htm & https://www.budget.gov.au/2019-20/content/factsheets/health.htm.

The opposition has since hit back with their own budget, which they plan to implement if they’re voted into parliament. So, the question is: will Australia’s healthcare dictate who wins the next federal election?

April 2, 2019
The industry responds to the reforms rollout

With the health insurance reforms roll out starting from yesterday, it has triggered some health funds to make sure their products are compliant with the reforms. However, the monumental impact of the reforms has sparked both support and backlash from industry experts and bodies.

April 1, 2019
New reforms come into action

Almost 18 months after being announced, several of Australia’s private health insurance reforms will be implemented industry-wide from today.

As a result, the following changes are now rolling out:

  • health insurance policies will start to fall under a respective tier (Basic, Bronze, Silver or Gold, or their respective “plus/+” tiers) – health funds have until 1 April 2020 to make sure every policy is categorised under these tiers;
  • health insurance discounts of up to 10% may now be available for eligible Aussies under 30 years old (the actual discount amount will depend on the customer’s age and if their health fund offers a discount);
  • some policies may cover travel and accommodation costs for regional Aussies in need of medical care that they’d need to travel for;
  • a number of natural therapies will no longer be covered (including yoga, tai chi, naturopathy and more).

The good news is, with the policies becoming categorised in their new tiers, it will now be much easier for you to compare health insurance policies and determine exactly what each policy will cover and whether it will or won’t include an age-based discount.

April 1, 2019
Rate rise is here

It’s that time of the year again – when private health insurance gets that little bit more expensive. The rate rise occurs every April, and this year, policy premiums increased by a weighted average of 3.25% across the industry.

According to the Department of Health, this year’s weighted average rate rise equates to an extra $59.28 per year for singles, while families will spend an extra $122 from the household budget.

However, your policy won’t necessarily have gone up by this exact amount. Some health funds only put their premiums up by 1.94%, while others increased by 5.91%.

Learn more about how rate rise works and why we have one each year, or find out how much rate rises have cost you over the last few years (and what you could do with that money instead).

February 13, 2019
Department of Health launches new website

Although still in the beta phase, the Department of Health has released its updated website with a bunch of new and easy-to-use pages. If you’re looking for health information, you can now search by ‘health topic’, which organises the pages depending on whether they’re based on health, ageing or sport.

You’ll also be able to search for health initiatives and programs and filter these by topics, such as alcohol, immunisation, women’s health and more. Also, you can easily find local support services, like where to get flu vaccines or chickenpox immunisation (and more).

The website also allows you to filter through the Department of Health’s corporate publications (including annual reports and budget statements), general publications (fact sheets, reports, guidelines, statistics and data) and promotional and educational videos.

Lastly, it details information about current health ministers and allows you to keep up to date with health news, media releases (including transcripts and speeches), upcoming health events, health warnings and recalls, as well as providing a consultation hub.

February 11, 2019
Health insurance customers still unaware of reforms

The health insurance reforms will be implemented on 1 April and will bring with it a number of changes, including new tier categories for policies, standardised clinical terms for hospital treatments, discounts for Aussies under 30 and no more cover for a number of natural therapies.

However, according to an independent survey of over 1,000 nationally representative respondents, 65% of health insurance customers aren’t sure how these changes could affect them.1

The survey results also found that 75% of customers were worried they weren’t going to have enough information before the changes were set in place, and didn’t think the government and health industry were doing enough to help them understand how the reforms would affect their policies and premiums.

To help you prepare for the reforms, we’ve created a health insurance checklist and have detailed the advantages and disadvantages of the 2019 changes to alleviate confusion.

1 Survey conducted by Pureprofile and commissioned by Compare the Market, December 2018.

February 1, 2019
Health funds sending out letters

With health insurance reforms set to start categorising policies into Gold, Silver, Bronze or Basic tiers from 1 April 2019, health funds must notify customers well in advance before making any changes to their policy.

This means you could be receiving a letter or email from your health fund soon that details which tier and policy you’ll move to, as well as how your policy will be impacted by the 1 April rate rise.

We’ve detailed some tips on dealing with your health fund letter when the time comes.

Some health funds may have already changed over to the new tier system earlier than the 1 April date; however, not all have. Health funds have until 1 April 2020 to enact these changes.

January 30, 2019
Rising cost of healthcare to be addressed in Federal Budget

Private Healthcare Australia (PHA) Chief Executive Dr. Rachel David explains that a number of the reforms are targeting the rising costs of healthcare, as well as curtailing the number of private health members who flock to the public health system.

Dr. David said the aim is to reduce short-term spending and halve healthcare inflation to two to three percent per year over a longer period, making the private and public sectors more affordable and efficient.

December 18, 2018
2019 health insurance rate rise: the lowest in 18 years

From 1 April 2019, private health insurance premiums will increase an average of 3.25 per cent; the lowest rate rise since 2001.

Minister for Health Greg Hunt announced the 2019 increase this morning, revealing how a single person could pay an average of $59.28 extra per year for their cover, while a family could pay an average of $122.20 more annually.

However, health funds could increase their policies by a lower or higher percentage. For instance, one health fund will raise their premiums by as much as 5.91 per cent on average from 1 April, whereas another will increase their premiums by as little as 1.64 per cent, according to the Department of Health.

Mr Hunt advised Australians to keep an eye out for a competitive deal on their cover ahead of the rate increase.

‘There are 37 private health insurance funds operating in Australia and I encourage consumers to shop around to get the best deal for themselves and their families,’ he said.

While many Australians may see this price rise as an additional obstacle when it comes to their monthly budget, insurers and the Federal Government are hoping to ease these pressures in the new year. From 1 April, some insurers will offer discounts for Australians aged 18-29, which could mean significant savings for young policyholders.

Your health fund will notify you in writing before 1 April if your premiums are set to increase. The specific amount your policy could increase by will depend on your type of cover and your health fund.

October 11, 2018
New rules and clinical categories introduced to tiers

The Rules to accompany the reforms have been updated with the finalised clinical categories for each tier. Bronze has changed from 20 clinical categories to 21, Silver has changed from 27 clinical categories to 29 and Gold has changed from 36 clinical categories to 38.

Some clinical categories have been split up into separate definitions, and some hospital treatments have moved to a different category; for example, spinal fusions will now be covered under a silver policy (under the category of ‘back, neck and spine’) as opposed to gold, which it was originally.

You’ll start to see products with these clinical categories and tiers from 1 April 2019, however the government has advised that funds will have a 12 month transition period to categorise their products according to the new categories and tiers, meaning all products must comply by April 2020.

September 25, 2018
Reforms are registered

The Australian Government’s has registered Act No. 101 of 2018, Private Health Insurance Legislation Amendment Act 2018 in the Federal Register of Legislation.

September 21, 2018
Bill receives assent

Ten days after passing the Senate, the private health insurance reforms Bill has received the Royal Assent by the Governor General, Sir Peter Cosgrove. This means the reforms have officially become law, and we can expect to see them implemented by or after 1 April, 2019.

September 11, 2018
The Bill has passed the Senate

Only a day after its second (and third) reading, the Private Health Insurance Legislation Amendment Bill 2018 has passed the Senate with only a few minor amendments (which the House of Representatives has agreed to), according to the Parliament of Australia. Although the reforms have passed both Houses in Parliament, the Bill will still have to be passed by the Governor General, Sir Peter Cosgrove.

September 10, 2018
Bill has its second and third reading in the Senate

Almost three months after being introduced into the Senate, the private health insurance reforms are still in contention. According to the Parliament of Australia, the Bill has had its second and third parliamentary reading today. Stay tuned.

Australian government health insurance reforms 2018

July 16, 2018
Reforms draft released

Minister for Health, the Hon Greg Hunt MP, today released the 46-page exposure draft of the Private Health Insurance (Reforms) Amendment Rules (the Rules). This document will help clarify the broader changes set to rock the industry in the coming years.

Released alongside the reforms draft was a guide to the exposure draft, a draft clinical categories table, draft ofhospital tiers (Gold, Silver, Bronze and Basic), and a proposed example of what the new Private Health Information Statements might look like.

Want to find out exactly what’s changed since the reforms were first announced in October? Read our outline of the changes to the reforms draft in Appendix 2 at the bottom of this page.

June 18, 2018
Health Insurance Bill introduced to the Senate

Two and a half weeks after passing the lower house, the reforms Bill has been introduced to the Senate with the first reading set for today, according to the Parliament of Australia. However, there will be a second and (more than likely) third reading before it’s agreed on. More to come.

May 31, 2018
Health Insurance reforms pass the lower house of Parliament

According to the Parliament of Australia, the reforms Bill has passed the House of Representatives. The Bill will now be sent on to the Senate who can pass the legislation into law.

Parliament

More details to come.

March 28, 2018
Health Insurance Reforms introduced to Parliament

The lower house has gotten their hands on the latest legislation draft, according to Minister for Health, the Hon Greg Hunt MP, and the Parliament of Australia website.

Australian Parliament

January 25, 2018
Lowest annual private health insurance premium rate rise in 17 years announced

According to the Minister for Health, it was announced today that health insurance premiums are set to rise an industry weighted average of 3.95% from 1 April, 2018. This is the lowest rate rise since 2001.

Health Minister Greg Hunt suggests that from 1 April a customer on a singles health insurance policy will pay an extra $1.40 per week on average, while families will pay an extra $2.75 a week on average for their family health insurance policy.

While it may be the lowest rates rise in 17 years, Health Minister Greg Hunt admits there is still more work to be done.

Steve Price (The Project) discussed the premium rate rise on radio with the health minister, along with a chat about the importance of the new tier system and reforms:

November 17, 2017
The industry discusses the merits of health insurance reforms

Private insurers, health funds and medical industries continue to weigh up the merits of these reforms. Health funds and insurers seem to be behind them, however medical companies and industry professionals have mixed opinions on whether the reforms are good for them and if the reforms are going to make as much of a difference as they originally set out to.

October 13, 2017
Australian Government announces package of private health insurance reforms

New reforms to the private health insurance industry have been announced today by the Department of Health.

Building on the prostheses reform, the Australian Government states that it wants to make health insurance simpler, more affordable and easier to understand. As such, these reforms will introduce new clinical categories into the market (i.e. simpler ways of grouping and classifying treatments and services), new policy tiers, discounted premiums for younger Australians, and more. Many of these reforms will come into effect in April 2019.

The Government believes the new reforms will end confusion over what’s covered by policies as well as potentially lower the annual health insurance rate rise amount, which should save health insurance customers’ money.

The health insurance reforms were predominantly met with support from health funds and mixed support from industry bodies and professionals.

May 16, 2017
Prostheses reform could save Australians a lot of money, but scepticism remains

In February, the Australian Government delivered price reductions to around 2,400 medical devices, which aimed to provide around $500 million in savings over six years for patients and private health insurance customers - not quite the $800 million originally forecasted, but still a sizeable saving.

However, the prostheses reforms have been met with a mixture of support and scepticism.

February 5, 2017
The Australian Government reduces the price insurers will pay for prosthetic medical devices

Man with prosthetic leg

Currently, private health insurers are required to pay a fixed-price benefit for more than 10,000 medical devices. This fixed price is set by the Australian Government and the Prostheses List Advisory Committee (PLAC). By comparison, there is no set price in the public system, meaning insurers often pay double the amount for medical devices, which they must make up for by charging higher premiums to private patients and fund members.

Former Minister for Health, Sussan Ley, stated that Government pricing for a pacemaker could cost $26,000 more through the private system. Even common hip replacements could cost $6,000 in private, as opposed to $4,000 in public.

Prostheses contributes to around 14 per cent of hospital benefits that are paid by health funds and insurers.

October 19, 2016
The Australian Government announces reforms to lower the cost of medical devices and prostheses

Under these proposed reforms, health funds and insurers will have lower minimum benefits payable (i.e. they will pay less) for devices on the Prostheses List; such as pacemakers, lenses, and artificial hips and knees.

This will help put downward pressure on premiums for all health insurance members by potentially saving health funds millions of dollars.

We’ve been engaging with the Minister for Health for some time now in terms of achieving reforms to the PL [Prostheses List] that are evidence-based, sustainable and also ensure that prostheses, through the prostheses list, continues to actually contribute to private health insurance value proposition, which it does, and which it has done so over quite a period of time.

– Ian Burgess, CEO of The Medical Technology Association of Australia (MTAA)

September 19, 2016
Continued support for prostheses reforms from the Turnbull Government

The Turnbull Government has announced the new Private Health Ministerial Advisory Committee to provide recommendations on the private health insurance reforms.

Prostheses reforms were only the first step in the Australian Government’s broader health reforms agenda – to give consumers better value for money and choice from their policy.

According to Private Healthcare Australia, private health funds pay five times more for some medical prostheses products compared to the public system. In fact, they also suggest that reform to pricing could deliver huge savings and save $150 per private health insurance policy.

The Federal Government is discussing these changes with industry bodies.

February 4, 2016
Cheaper prostheses are on the agenda for Federal Government

The Australian Government announced its intention to reduce the costs of prostheses through reforms, which would in turn lower private health insurance premiums.

For private patients across Australia, this would mean thousands of medical devices would become more affordable; such as pacemakers, plates or pins.

The announcement was met with support from a variety of institutions, including the Australian Private Hospitals Association.

Progress – Private Health Insurance Legislation Amendment Bill 2018, Parliament of Australia
House of Representatives
Introduced and read a first time28 March 2018
Second reading debate / second reading agreed to31 May 2018
Third reading agreed to31 May 2018
Senate
Introduced and read a first time18 June 2018
Second reading moved18 June 2018
Second reading debate10 September 2018
Second reading agreed to10 September 2018
Third reading agreed to10 September 2018
Passed both Houses11 September 2018
Assent (Act no. 101, Year: 2018)21 September 2018
New rules and clinical categories applied to reforms11 October 2018
Main changes in the exposure draft of the Private Health Insurance (Reforms) Amendment Rules (the Rules).
1. Amendments to age-based discounts. These now clearly define what the discount entails, compliance requirements for discounted policies and details on calculating and transferring discounts between health funds.
2. Matching hospital treatments to tiers. Clear definitions of which hospital treatments are included in the Gold, Silver, Bronze and Basic policy tiers.  See what’s covered in our category tier breakdown.
3. Changing from standard information statements (SIS) to private health information statements (PHIS). Amendments for the shift to the new statements. Customers will be able to receive information digitally if they choose so, rather than through the post. These new statements will include:

  • product information, including premiums, excess amounts and greater detail about what a policy cover (i.e. who is covered, services/treatments covered, relevant waiting periods);
  • any extra features that your policy might include (such as travel and accommodation benefits); and
  • a customer’s Lifetime Health Cover information (which was previously found in a Lifetime Health Cover Statement).

Also, insurers will no longer send out tax statements unless customers request it. Instead, relevant tax details will be sent directly to the Australian Taxation Office (ATO). Check out an example of a PHI statement.

4. Defining hospital treatments. An outline of the roposed new clinical categories and definitions of covered treatments and scope of cover.
5. Natural therapies removal list. Removal of coverage for natural therapy treatments, including a list of which treatments will be removed (the full list is included in appendix 3)
11 Main Changes In Private Health Insurance Reforms 2018
1. New health insurance clinical categories (38 in total) that outline exactly which hospital treatments are covered under each category and the extent of that cover, which all insurers must use from April 2019 onwards for new hospital products, and by April 2020 for existing products.
2. New category tiers for hospital policies – Gold, Silver, Bronze, Basic – which will each cover a minimum amount of clinical categories, and help customers easily compare (and understand) different policies. Insurers and health funds must use these tier names when naming their hospital policies, and cannot use the name of any other gemstone (e.g. diamond, platinum) in any hospital or extras policy. The new tiers do not apply to extras (general treatment) policies. Policies that cover more than the minimum requirement must include a ‘+’ or ‘Plus’ in the name. We explain what’s covered in the four-tiered health insurance categories.
3. Discounted premiums for customers under 30 who are purchasing hospital insurance. Customers can be offered a two per cent discount on their hospital premiums for each year they’re under 30, up to a maximum of 10%.

  • Ages 18-25: 10%
  • Ages 26: 8%
  • Ages 27: 6%
  • Ages 28: 4%
  • Ages 29: 2%

These discounts will start to gradually reduce after the customer turns 41, decreasing each year by two per cent until it’s reduced to nil or when the customer turns 45 and aren’t eligible for discounts. Discounts are only offered if the insurer chooses to do so on a particular product; no insurer is obliged to offer them by law, and the fund can choose whether the discount transfers from one policy to another when members who have a discount switch funds.

4. Extras policies will no longer include cover for 16 types of natural therapies. The natural therapies that will no longer be covered include Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, homeopathy, iridology, kinesiology, naturopathy, Pilates, reflexology, Rolfing, Shiatsu, tai chi and yoga.

Why? The National Health and Medical Research Council found ‘low to medium evidence’ or a ‘lack of evidence’ to conclude that natural therapies improved a person’s health condition, despite a Private Health Insurance Statistical Trends (Benefit) report by the Australian Prudential Regulation Authority (APRA) ranking natural therapies as the fifth most popular service claimed on extras policies.

5. Cover for mental health. Customers with limited private health cover will also be able to upgrade their cover once in their lifetime without serving a waiting period to access higher benefits for in-hospital mental health services, provided they have already served their initial waiting period for any psychiatric benefits (usually two months).
6. Travel and accommodation subsidies and benefits will be made available for regional Australians with private hospital insurance, for whenever they need to travel to access hospital services.
7. Higher voluntary excess. The maximum excess that funds can offer for singles policies will increase from $500 to $750, and family policies will have a maximum excess of $1,500 (previously $1,000). If customers opt for a higher excess on their policy, they’ll save money on premiums.
8. Cheaper prostheses for health funds. Insurers pay up to five times more for prosthetic medical devices (e.g. for hip and knee replacements). However, the reforms aim to reduce this price to make it cheaper for patients and health fund members.
9. More power to the Private Health Insurance Ombudsman. The ombudsman will be allowed to conduct inspections and audit health insurers directly to address customer complaints.
10. A ‘Private health information statement’ will replace the current ‘Standard Information Statement (SIS) as the required method for health funds to communicate with customers. Insurers must let their customers know of any detrimental changes at least 60 days before changing their policies.
11. PrivateHealth.gov.au website will be upgraded. The upgrade will provide personalised and up-to-date information on insurance products to make it easier for consumers to compare between products.

Sources

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