Thank you for standing by, and welcome to the Medibank Private Half Year 2024 Results Investor and Analyst Teleconference. All participants are in a listen-only mode. There will be a presentation followed by a question and answer session. If you wish to ask a question via the phone, you will need to press the star key followed by the number one on your telephone keypad. If you wish to ask a question via the webcast, please type your question into the Ask a Question box. I would now like to hand the conference over to Mr. David Koczkar, Chief Executive Officer. Please go ahead.
Good morning, everyone, and welcome to the Medibank 2024 half year results presentation. I'll begin by acknowledging the traditional owners and custodians of country throughout Australia and their long-standing connections to land, sea, and community. I join you today from Naarm, the home of the Wurundjeri Woi-wurrung people. I pay my respects to the elders, past, present, and emerging, and I extend my respect to all elders on the lands on which we work and live. Today, I'm joined by our executive leadership team, including our Group Lead, Chief Financial Officer, and Group Strategy, Mark Rogers. Starting on slide 5. So this is a new slide for our investor presentation. In my mind, these are the key themes that I'm keen for you to take away from our presentation this morning. I hope you find this a useful guide.
Today, we've delivered a solid first half result, which reflects our focus on our customers and our disciplined approach to growth. Our health insurance business remained resilient despite the inflationary environment, and we delivered a strong performance in Medibank Health. We've also made some substantial steps in our expansion in health. Our aim to invest between AUD 150 million and AUD 250 million in our target health markets further supports our growing role in health as we look to add scale, capability, and geographic coverage. We made solid progress this half. We're a strong business with a constant focus on our customers, and we are making disciplined choices, a combination that supports our sustainable growth into the future. Despite ongoing cost of living pressures, our customers continue to prioritize their health and wellbeing, and we remain focused on delivering greater value to them.
While the industry and Medibank continue to grow, we have remained disciplined in the way we grow, and that won't change. We continue to manage our own costs and are targeting AUD 10 million of productivity savings for the full FY 2024 year, with AUD 3.5 million of productivity savings delivered in the first half. While health insurance has been our core business for 48 years, our growth in health is what differentiates us. More broadly, the health transition is underway. From overnight stays in expensive acute hospital care to virtual short stay at home care, from treatment to prevention, and from generalized care to personalized health. We have been at the forefront of this transition, making targeted investments in these emerging and growing health markets that are expanding our business and that also improve the way healthcare is delivered in Australia.
Today, I'll take you through our first half performance and provide an update on our strategy. I'll then hand over to Mark, who'll talk about our financial performance and share his financial priorities for the rest of the year. I'll then provide an update on our outlook and then happy to take your questions. Let's go to slide 6 for customer highlights. Cost of living pressures are leading customers to make deliberate spending cuts, cutting back on eating out, buying coffee, entertainment, and travel. But health remains high on the priority list as people continue to hold on to their health cover. However, customers are increasingly seeking more value and shopping around to get it, which is why we've been finding more ways to deliver value.
Through the unique combination of our two brands, our products and services, and network of partners, and the service provided by our amazing team, we have a differentiated offer that is delivering hip pocket savings to our customers. We know that value starts with premiums, which is why we've worked hard to keep premium increases as low as we can, despite rising health costs in the private system. We're also just announced a further AUD 200 million dollar cashback to Medibank customers as part of our COVID support package and giveback program, and ahm customers will have another year to use their unused extras limits, valued at up to AUD 15 million dollars.
This announcement will bring the total amount of support Medibank has provided to our customers since the start of the pandemic to a record AUD 1.37 billion, and we remain focused on reducing out-of-pocket costs for customers. While out-of-pocket costs for hip and knee replacements are up to 35% over the past five years, our No Gap program, as well as our new products, have helped thousands of our customers save an average of AUD 1,600 per procedure. Our customers have also saved more than AUD 12 million over the past six months through our Members' Choice Advantage network. This month, we've launched a AUD 50 voucher for all Live Better rewards members with extras to further help with out-of-pocket costs at the dentist.
Our Live Better program has delivered more than AUD 10 million in rewards to our customers, including AUD 3 million of savings on premiums or top-up for limits. The program is a real differentiator in the market, especially for younger customers. For our Amplar Health business, we're making it easier for our customers to access health and wellbeing services. Over the half, this team delivered 136,000 virtual advice and navigation interactions for our private health insurance customers, up from 87,000 the same time last year. We also introduced complimentary health checks for customers to help them get the most out of our health programs, completing 14,000 checks over the half. Our ongoing focus on streamlining our customers' experience is reflected in the increasing service and Net Promoter Score for both brands.
Now to slide seven, and an overview of our financial results, which Mark will talk to in more detail shortly. People continue to choose private health insurance in record numbers. Despite the strong growth in the resident market, the market dynamics continue to change. And in the last six months, we have seen some significant competitor intensity in some parts of the market, with some competitors increasing their discounts and offers substantially. As a result, switching across the market is up around 11%, which has driven up market lapse rates and acquisition costs in some customer segments. And while our goal is to get back to growing market share in the resident business, we won't be chasing growth at all costs, and we won't be following some of the practices we are seeing in some parts of the market.
We're managing Medibank for the long term, and growth at all costs only undermines affordability for customers and the strength of our business. In our resident business, first half growth came from families and those taking out cover for the first time, with policyholders up 3,400. This increase is somewhat less than we had set out to achieve at the start of the financial year, given the competitive dynamics. But importantly, the quality of our new joins is improving, with more combined hospital and extras policies than in the same period last year. In the second half, we will look to increase our resident policyholder growth by investing further in differentiating our brands and growing in our priority customer segments.
Our aim for the second half is to get the Medibank brand back to growth and improve retention in both brands, particularly as the second half of the year is seasonally stronger than the first half. In our non-resident business, we've been very pleased with our continued strong performance, growing 33,800 policy units in the half and 34% over the last 12 months, with particularly strong growth in the student market. Our business is strong and resilient, demonstrated in our health insurance operating profit, which was up 4.3% to AUD 317 million. In Medibank Health, segment operating profit was up a pleasing 8.5% to AUD 26.7 million, led by growth in health and wellbeing and travel insurance.
Over the half, management expenses were up 10.9%, reflecting higher sales commissions and what we believe to be the peak of inflation. However, we continue to have one of the lowest management expense ratios in the market and remain committed to delivering our productivity program. At a group level, underlying NPAT was up 16.3% to AUD 262.5 million, including net investment income of AUD 83.6 million. In line with our strong capital position, we are delivering shareholders an interim, fully franked, ordinary dividend of AUD 0.072 per share. Down to slide eight. Our strategy to grow as a health company is enabling us to differentiate our PHI offering and improve the health and wellbeing of our customers, our people, and the community.
Our customers are experiencing the benefits as we reinvent the way we work. We're seeing promising initial results from our four-day workweek pilot, including greater health and wellbeing for our people. Among the frontline teams taking part in the pilot, average sick leave has dropped two-thirds, and we've seen no reduction in outcomes. As I mentioned before, we have continued to provide our customers with more value, focusing on ways to deliver long-term benefits. This includes our No Gap program, which is the largest in the industry, and we've expanded both the procedures covered and the network of acute and day hospitals where it's available, to save customers around AUD 2.4 million to date.
Meanwhile, we've seen a 14% increase in the take-up of our silver health insurance cover among Medibank customers, and our investment in our diversified insurance products have seen the number of customers taking out additional policies increase 39% in the half. Our focus on prevention is providing more health and well-being support. Around 57,000 people enrolled in our Live Better Back Smart challenge, while enrollments in our nine preventative programs are up by more than 48% year-on-year. Our current health investments and partnerships have also reached some significant milestones. In addition to our increased investment in Myhealth, the world-class Orthopedic Institute at Macquarie University Hospital has just opened, as well as our second hospital as part of our iMH joint venture with Aurora Healthcare.
In April, East Sydney Private Hospital will open two new operating theaters and a new floor, and later this year, Adelaide Private Hospital will welcome its first patients. These investments are driving our growth as a health company while helping catalyze the innovation needed to advance the health transition our country needs. Now turning to slide nine. The fundamentals of the resident and non-resident PHI market remain strong, but there is no doubt that cost pressures are driving a change in consumer behavior. The resident market has seen continued strong growth, with 2.3% growth in people with hospital cover over the last 12 months, and even higher among those under 30. The latest APRA data shows the percentage of Australians holding hospital cover is at the highest rate it's been since March 2018.
While in the non-resident market, visa number growth remains strong, and Australia remains an attractive destination for students, workers, and visitors. The number of Australians who see private health insurance as essential is at the highest it's been in nine years, particularly as confidence in the public hospital system is declining. We remain committed to a disciplined approach to profitable growth, and continue to differentiate in the market with our two brands and our offering in health. We remain focused on growth in key segments, including families and those new to the industry, corporate and non-resident customers. You've heard us talk before about the significant challenges facing our overall health system as our population ages, which is projected to increase health spending by 40% over the next 40 years.
Because of our current reliance on expensive, acute, overnight hospitals, unless we change our approach to delivering care, particularly for people with chronic disease conditions, Deloitte modeling estimates Australia would need to build a hospital a month for the next 15 years to keep up with demand. This is clearly unsustainable, which is why we need to change. As we know, hospitals play an integral role in our health system and will remain vital for providing expert acute care in the future, and we do know the past few years have been challenging for the sector. Cost and workforce pressures have impacted the sector, hospital admissions are still recovering, and new COVID variants and community infections have caused spikes in hospitalization.
But these challenges have also prompted different discussions with our private hospital partners on how we can ensure our customers' access to quality health care remains sustainable, now and in the future. And this, too, is part of the health transition. Through our recently formulated partnership approach with private hospitals, we can better align incentives, encourage innovation in patient care, outcomes, and experience, and support the adoption of new care settings that take unnecessary costs out of the system. Now, these new arrangements cover almost two-thirds of the private hospital episodes experienced by our customers. In addition to our partnerships and investments, we continue to invest in further innovation, in payment integrity, and our health engagement and prevention programs, all supported by continued investment in digital and analytics platforms. Now let's turn to slide 10. We understand what our customers want and what drives value for our business.
We also know that more than eight out of ten of our customers want us to support their health and wellbeing, and that's why we're investing in improving value, choice, and control for our customers to both differentiate our PHI brands and to grow our business. This strategy is enabling us to expand in health, which is focused on growth in our three target health sectors and driving our long-term sustainable growth as a company. In pursuing this strategy, we are scaling our prevention programs and rewarding healthy behaviors, differentiating our health insurance products with personalized health and wellbeing offerings to support our customers to be better.
We are providing more support when our customers need to get better, building a growing network of community care and short-stay hospitals, investing in virtual health and primary care, and accelerating the take-up of new care models in partnerships with health providers. The broader uptake of which could deliver savings of around AUD 1.3 billion to the private system. People want access to the benefits that these innovative models of care offer. More than four out of five Australians are seeing care at home as appealing, particularly women and families. Telehealth continues to be well-utilized, now making up around 15% of all GP visits, and our health system needs this innovation. We know these new care models can save billions and free up much-needed hospital beds, and importantly, avoid beds being built in the future.
Yet Australia still lags behind other countries in adopting these new models of care. Our customers are embracing this change, with around 44% of Medibank policyholders already engaging with our health and wellbeing support, up 19% on last year. Just last week, we heard from a customer taking part in our virtual type two diabetes program. He told us he's lost 17 kg in 12 weeks so far, and couldn't be more positive about his experience, and his relationship with Medibank. This strategy is key to differentiating our health insurance offering, to strengthen our core business, and help us grow our business by expanding in health and drive change that everyone benefits from. Now, on to slide 11.
Looking at the health and wellbeing market, as people spend more on their health and wellbeing, the approximately AUD 35 billion health and wellbeing and prevention sector is thriving in Australia and is expected to grow to more than AUD 57 billion by 2030. Our investments in this industry have been all about actively encouraging and supporting our customers to look after their health and wellbeing, such as inspiring them through our Live Better program or supporting them through our prevention programs. As an example, Live Better is one of the largest and fastest-growing health and wellbeing programs in Australia. In just five years, it has grown from 0 to 800,000 members. With around 40% of Medibank policyholders now members, it's a key point of difference for the brand. It is attracting new customers to our PHI business, particularly younger people.
It's building loyalty, with lapse rates 13% lower among those using Live Better. It helps strengthen our partnerships with providers, as if we reward customers for using their services. And most importantly, we are deepening our relationships with our customers, whether that be as simple as encouraging them to drink more water, through to connecting them to their healthcare they need, including their mental health needs. But we're only just getting started, and as we scale and grow our prevention programs, Live Better will play a bigger role in connecting our customers to the support and services we offer and enable us to grow in this sector. To slide 12 now. As we lead through the health transition, we are growing as a health company. With our increased investment in Myhealth, together with Medibank and Amplar Health, we've now created one of Australia's largest multidisciplinary primary care networks.
From GPs to nurses, from psychologists to physios, and other health, other health specialists, we are delivering care in clinics, in homes, and virtually. With primary care being at the heart of the health system, this investment will help us support and improve the health of millions of people in Australia, including those with chronic conditions. It is also another differentiator for our insurance business, enabling us to grow our health offerings for Medibank and ahm customers. We have already been working with Myhealth team to develop programs such as our virtual psychology offering, which has been rolled out across all 106 Myhealth clinics, and a virtual GP service for our overseas students. We know the current challenges faced in primary care.
Australia spends more than AUD 38 billion a year on care for people with chronic health conditions, yet almost half of all adults have health conditions that could be better supported. But for many patients and their families, the health system is neither connected nor coordinated, and this has flow-on effects, as evidenced by long surgery wait lists and pressure in emergency departments. And we know that GPs want to do more for their patients and keep them out of hospital. But also, what I'm hearing from GPs is that they are spending an increasing amount of time, around two hours a day, on administration. We've been working with three Myhealth clinics in Western Sydney to design a change in the way that GP-led care is organized and delivered.
Together, we are looking at how to intervene earlier to support patients with chronic conditions such as type 2 diabetes and cardiovascular disease. And on top of better patient experiences, there'll be benefits for doctors and allied healthcare professionals, who will be able to work better together and where they can make the biggest impact. We are also implementing recommendations from the government's Strengthening Medicare Task Force Report, working with the Health Minister's office and the Department of Health. And we'll share what we learn with the Australian government along the way to help inform their own work. However, current regulations limit how and where we can support our customers as they move through the health system, such as restrictions on supporting out-of-hospital medical services, often required by our, by our customers, especially with chronic conditions.
There will be many benefits if we could expand our coverage to include things like GP-led care for chronic disease management programs and hospital substitution, so as an industry, we can have a stronger focus on prevention and community-based care. As we look ahead, we will continue to grow in our selected high-growth sectors in health, including an increased focus on connecting our primary care offering to better support the health needs of our customers and the community, virtually and in person. And a continued investment in Myhealth provides additional pathways to support this growth, whether by expanding its clinic footprint, increasing its efficiencies, or building our technology and data capabilities. I'll now hand over to Mark.
Thanks, David, and good morning. Pleasingly, the result reflects how resilient the resident health insurance business has been in challenging economic conditions, continued momentum in non-resident, and strong growth in Medibank Health. Group operating profit was up 4.2% to AUD 319.4 million, and with a significant increase in investment income, profit before tax, excluding COVID impacts, increased 13.9% to AUD 376.6 million. With the implementation of AASB 17, we are reporting health insurance performance excluding COVID impacts and group operating profit and showing COVID impacts separately. During the last six months, there were AUD 17.6 million of IT security uplift, legal, and other costs associated with the cybercrime, which is lower than in the previous two halves, and we expect between AUD 30 million and AUD 35 million of costs for the full year.
As a result, reported EPS was up 103.2% to AUD 0.125 per share, and underlying EPS, which adjusts for the normalization of investment returns and COVID impacts, was up 16.3% to AUD 0.095 per share. Moving to slide 15. With improving workforce capacity and more limited COVID-related disruptions to services. Total claims paid have increased. However, in the six months of November, they were still AUD 74 million or 2% below expectations. While the number of private surgical admissions are now modestly above expectations, claims paid continue to be favorably impacted by a higher proportion of admissions happening on a same-day or short-stay basis. Softness continues across all other hospital claim types, particularly private non-surgical claims, including rehab referral rates not increasing in the last six months as expected.
Importantly, procedures reform continues to favorably impact claims, and while public hospital claims growth has increased, it remains below private hospital claims growth. Extras claims are also below expectations, with this increasingly appearing linked to economic conditions impacting customer demand for services. Slide 16 covers the health insurance result, which, as mentioned, excludes COVID impacts, which are reported separately and reconciled against the COVID Equity Reserve. At 31 December, the reserve was AUD 286.3 million, and this will be used to offset the cost of customer givebacks and deferred hospital procedures. Revenue increased 3.6%, and gross profit was 7.4% higher, including the benefit of a AUD 5.7 million lower risk equalization payment.
While this improved risk equalization outcome is partly driven by impacts that we expect to unwind, it also reflects favorable changes to age claiming patterns that we will monitor in the second half. Price margin improved 60 basis points to 15.7%, including 20 basis points from the strong growth in higher-margin non-resident policies. And while the management expense ratio was 50 basis points higher at 7.6%, operating margin was up 10 basis points to 8.1%, and operating profit up 4.3% to AUD 317 million. Now, turning to slide 17. The resident health insurance market remains buoyant, with policyholder growth in the 12 months to 31 December expected to be similar to the 1.9% growth we saw in the 12 months to 30 June.
And this is despite the implementation of adult dependent reform, which has increased the number of 25- to 30-year-olds staying on family policies. The market continues to be competitive, with customers seeking to offset cost of living pressures, resulting in a modest increase in the number of customers, both switching funds and lapsing at a higher cost of acquisition. Over the last 12 months, our number of policyholders increased by almost 13,000, including 3,400 policies in the last six months, which is a typically seasonally weaker period across the industry for growth. The acquisition rate increased 30 basis points to 5.3%, with Medibank back in line with pre-cyber levels and ahm improving in line with increased aggregate sales.
While the lapse rate increased in 20 basis points to 5.1% is indicative of higher switching levels across the industry, it also reflects the timing of our premium increases relative to many of our competitors, particularly in the case of ahm, where customers are more price sensitive. Aided by further benefit from adult dependent reform, growth in hospital lives of 0.8% was 20 basis points above policyholder growth and skewed to younger customers. We expect further benefit from this reform over the next four to five years, including the percentage of insured lives that are under 30 years of age increasing. For the remainder of FY 2024, we will look to increase policyholder growth through improving retention rates for both brands, investing further in differentiating the Medibank brand, and increasing focus in our priority segments. Turning to slide 18.
Resident gross claims increased 2.4%, and risk equalization had a 20 basis point benefit to net claims growth this period, compared to a 20 basis point cost in the prior period. Resident claims growth per policy unit of 2% was 30 basis points lower, with a 20 and 100 basis point decrease in hospital and extras claims growth, respectively. The decrease in hospital includes the improved risk equalization outcome, with higher private hospital indexation largely offset by the benefit of continued lower rehab claims. For extras, the reduction includes the economic impact on customer demand that I just mentioned, and that the prior period included investment in additional benefits.
With the favorable risk equalization outcome, continued low non-surgical claims growth, and softness in extras claims, our expectation for FY 2024 resident claims growth per policy unit has reduced from the 2.6% we indicated at the full year result to between 2.2% and 2.4%. However, we will continue to closely monitor key claims trends, including rehab referral rates, the mix of hospital admissions, and demand for extra services. Slide 19 details health insurance performance, which shows continued growth in both the resident and non-resident businesses. In resident, gross margin was up 40 basis points to 15.1%, with revenue and claims growth per policy unit of 2.5% and 2%, respectively.
Growth in revenue per policy unit increased 10 basis points, with the lower average premium increase more than offset by a 20 basis point improvement in downgrading to 50 basis points. With the impact of economic conditions on downgrading more than offset by the benefit from Adult Dependent Reform. For the full year, we expect downgrading of around 50 basis points, with any further economic impacts largely offset by portfolio management and sales mix activities. Recently, the momentum in non-resident has continued, with policy units increasing 34.3%, with particularly strong growth in the student segment. Gross profit increased 39% to AUD 43.1 million, and with stable tenure and mix, gross margin was up 20 basis points to 34.3%. And as policyholder growth has continued since 31 December, we expect gross profit to be higher in the second half.
We see non-resident as an attractive market, and we will continue to invest in product value, expanding our health offering, and increase our focus in the worker and visitor segments to support growth in the medium term. Moving to slide 20. Management expenses are up 10.9% to AUD 298.9 million, reflecting the impact of higher sales commissions and what we expect is the peak of the impact of the inflation cycle. And with lower revenue growth this period, the management expense ratio was 50 basis points higher at 7.6%. As a result of strong customer growth, non-resident sales commissions increased to AUD 5.3 million, with the increase in resident sales commissions in line with higher aggregated sales this period.
Operating expenses were up 7.9%, with cost inflation of approximately 5%, modest volume impacts, and an AUD 4 million uplift in IT security and Victorian payroll tax costs. These increases were partially offset by AUD 3.5 million of productivity savings, and we are targeting a total of AUD 10 million of savings in FY 2024. Based on our expectation for inflation in the second half, we expect FY 2024 management expenses of between AUD 610 million and AUD 615 million, and a modestly higher management expense ratio. Turning to slide 21 on Medibank Health. Medibank Health returned to more normal operating conditions this period, with operating profit up 16.1% to AUD 27.4 million. However, this is partially offset by a lower contribution from our healthcare investments due to initial losses in our growing portfolio of short-stay hospitals.
Revenue of AUD 141.4 million was 1.4% higher, with strong growth in health and well-being and diversified insurances, improving home care revenue in line with increased hospital activity, partially offset by a reduction in telehealth as we progressively optimize this business. Gross profit was up 17.1% to AUD 73.1 million, and gross margin improved 700 basis points to 51.7%, with strong growth in higher margin businesses, improved efficiency, offsetting inflationary pressures in home care, and a higher telehealth margin. The AUD 6.9 million increase in management expenses reflects business mix, inflation, and investment in future growth. While the management expense ratio increased, operating margin was up 250 basis points to 19.4%.
We continue to target on average organic profit growth of at least 15% per annum between FY 2024 and FY 2026, with key areas of focus, volume, and performance uplift in health services, broadening the scale and scope of our well-being and prevention programs, and meeting the needs of more Medibank and ahm customers. We also aim to invest between AUD 150 million and AUD 250 million over the same period in healthcare M&A that adds scale, capability, and expands geographic coverage, including in Myhealth clinic footprint and virtual health capabilities. Moving to slide 22. Investment income of AUD 83.6 million includes a AUD 28.1 million increase in the defensive portfolio, partially offset by a AUD 5.2 million decrease in the growth portfolio.
The decrease in the growth portfolio reflects a lower return in all asset classes other than international equities, and the increase in the defensive portfolio includes a AUD 17.9 million benefit from the higher RBA cash rate and an improved, but still below expected, return on international fixed interest holdings. The AUD 37.2 million increase in underlying net investment income to AUD 83.6 million includes the benefit from the higher RBA cash rate and improved manager performance in property, and resulted in a 116 basis point increase in underlying net investment income to 2.61%. On an annualized basis, this is a 104 percent basis point spread to the average RBA cash rate.
While this is higher than in the prior period, it remains below the target range of 150-200 basis points, with achieving this target more difficult in a higher interest rate environment. Slide 23 covers capital. The 31 December capital position includes the impact of AASB 17 and the new capital standards that came into effect on 1 July, which collectively had a AUD 167 million favorable impact on capital. The business continues to be well-capitalized, with health insurance capital at 1.9 times the PCA and an allocated capital of AUD 225 million. While the health insurance capital ratio target is between 10% and 12% of premium revenue, the current ratio of 14% sits above this range to offset the AUD 250 million temporary APRA supervisory adjustment.
The increase in other required capital includes the AUD 50.8 million further investment in Myhealth. With the level of unallocated capital, we are well placed to fund our AUD 150-250 million M&A aspiration and raise Tier 2 debt if further attractive investment opportunities become available. In line with the strong capital position, the board has declared a fully franked interim dividend of AUD 0.072 per share, which is an increase of 14.3% and a 75.5% payout of underlying net profit after tax. To finish, a few comments on our financial priorities for the remainder of this year.
In the health insurance business, revenue momentum is key, and our immediate imperatives are to increase resident policyholder growth in a disciplined way and continue to manage downgrading, maintaining strong growth in non-resident customers, and an increasing focus on customer lifecycle management. We continue to target ways to offset claims inflation, including through investing in and broadening our partnership approach to hospital contracting, and increasing focus on prevention and chronic condition management programs, and investing to support the shift to new care settings and scale. The markets that Medibank Health operate in have attractive fundamentals, and in addition to meeting the needs of more Medibank and iMH customers, we have the opportunity to service a broader set of customers with existing programs such as My Home Hospital, and increasingly address emerging customer needs in both corporate and virtual health.
Delivering synergies between our businesses will be important, as will balancing short-term aspirations with investing for medium to longer-term growth. And finally, despite the management expense ratio being impacted this year by both higher inflation and additional costs, we believe our scale, direct distribution strength, and productivity focus means we are well placed to continue targeting a stable to modestly improving management expense ratio going forward, while balancing the need to invest for growth. Pass back to David to make some closing comments.
Thanks, Mike. Let's look at slide 26 now. We've made some strong progress in our strategy to grow as a health company and continue building our momentum into FY 2025. We will always put our customers first, working to deliver greater value through our products and services and integrated health offerings, and investing in our digital and analytics platforms. With our non-resident business continuing to grow share in a growing market, we are focused on returning our resident business back to growing share, but not at all costs. We will remain disciplined in how we do this. In the shorter term, we are focused on increasing resident policyholder growth through improving retention rates of both brands, investing further in differentiation, especially for the Medibank brand, and will remain focused on growth in our priority customer segments.
We have a long track record of navigating competitive and economic challenges, and we will remain focused on driving sustainable long-term growth. Our capital position remains strong, and we will continue to strengthen our business, including through our IT security uplift program. We are well positioned to continue to grow in health, investing to both differentiate our insurance offering, strengthen our core business, and expand our offering. We will continue to grow Medibank Health by supporting the needs of our Medibank and ahm customers in health.
We expect to invest between AUD 150 million and AUD 250 million in our target health markets as we continue to innovate and invest in the health transition, empowering our customers to give them more choice and control in all parts of their health and wellbeing experience, and to play our role to ensure the health system remains affordable and accessible into the future. We are also continuing to target organic profit growth of Medibank Health of more than 15% on average between FY 2024 and FY 2026. We are excited about the future and pleased with our progress, and are committed to the work ahead as we progress our strategy. And finally, slide 27. Turning to our FY 2024 outlook.
We continue to assess claims activity and remain committed to not profit from the pandemic, returning any permanent net claims savings due to COVID to customers through additional support in the future. Targeted organic and inorganic growth of Medibank Health and health insurance remains an area of focus. As a result of our disciplined approach to growth, we are modestly adjusting our FY 2024 outlook to reflect the current market dynamics. We anticipate resident industry growth will moderate in FY 2024 relative to FY 2023. We're aiming to achieve between 1.2% and 1.5% resident policyholder growth for FY 2024, and expect to return to market share growth in the second half of 2024.
We've updated our expectations for claims per policy unit growth, reducing this from 2.6% to between 2.2% and 2.4% for FY 2024 among resident policyholders, and we'll continue monitoring trends in rehab, hospital admission mix, and extras. Our management expenses for FY 2024 are expected to be AUD 610 million to AUD 615 million, and we are targeting AUD 20 million of productivity savings across FY 2024 and FY 2025, including AUD 10 million in FY 2024. We expect cybercrime costs of between AUD 30 million and AUD 35 million in FY 2024, the further IT security uplift, and legal and other related regulatory investigation and litigation costs. This does not include the impacts of any further potential findings or outcomes from regulatory investigations or litigation.
Finally, I'd like to recognize the wonderful team of people we have at Medibank, who are the driving force behind these results that we've shared today.
Inspired by our vision, they're working to create the best health and well-being for Australia. Now we've got some time for any questions that you may have.
Thank you. If you wish to ask a question, please press star one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press star two. If you are on a speakerphone, please pick up your handset to ask your question. Your first question comes from Kieran Chidgey with Jarden. Please go ahead.
Morning, guys. Two questions, one on acquisition costs and one on claims inflation. Just starting on the acquisition costs, just looking at that strong pickup in the resident sort of commissions, just wondering if you can sort of unpack in a little bit more detail exactly what you're seeing in the market there, particularly given the policy growth in the period wasn't particularly strong. Just wondering sort of if, you know, that's reflecting much higher commission rates?
Yes. So, Kieran, the first half 2023 resident commission cash commission cost was pretty low. That was smack in the middle of the cyber event, and then we had very low sales through the third-party channels. And so under AASB 17, we're actually now expensing those costs rather than capitalizing them. So the uplift year-on-year reflects a pretty big impact of the cyber event on the first half 2023. So that's the major driver of that uplift. If you go back to what we actually reported at the half last year, we actually reported AUD 19.5 billion of aggregated costs, but the restatement is actually AUD 15.2 million. So that's a big driver of the impact.
Okay. So you're not seeing any change in sort of commission practices across the market?
Yeah, Kieran, in terms of that-
Or cost of that?
No. Yeah, yeah, the answer is no. What we are seeing is, you know, because of the cost of living pressures in the market, there is, you know, and people seeking more value. But there's some channel shifts to the aggregators in some parts of that market. But, you know, that's where we're being disciplined. We are seeing some of those segments, you know, have much lower revenue per policy and much higher lapse rates. So even at the same commission level, it's just not good practice to be growing in those parts of the market. So while we haven't seen much change in the absolute commission rates, we are being very clear and careful about how and where we grow.
Okay. Thanks. And just secondly, on the claims inflation sort of quote, is it inside of 2% that... There's sort of one factor, but obviously your revised guidance for the full year implying maybe you, you see that lifting to 2.6% in second half. So just wondering if you can, what you're assuming from a risk equalization perspective moving forward, and just elaborate on sort of the, the age claiming pattern comment you, you made on the call, Mark.
So I only heard part of your question, Kieran, but I'll, I'll give it a go. So you, you're right, we've got a 2% claims growth for the first half, and we're, we're guiding to 2.2%-2.4% for the full year. So that would infer, infer somewhere between 2.4% and 2.8% for the second half. But I'd just caution doing that simple math, because there is gonna be a contribution from risk equalization, the benefit we saw in the first half unwinding. And if you look through last year, we probably had a 20 basis point cost and risk equalization in the first half, but it was zero cost across the full year.
So probably guide to the FY 2023 impact from risk equalization as being more indicative of what we should see for the full year.
Okay. So is that sort of revised full year guidance, assuming no risk equalization benefit in second half?
Yeah.
Or-
No, it assumes the timing component unwinds. So there's a 40 basis point shift year-over-year. I'd say half of that's because of timing, and half of that's because of the age claiming patterns. And maybe onto the second part of your question. Largely, what we're seeing is in the Medibank customer base, a slightly better recovery rate, so that's saying our customers that are making claims are slightly older. But the biggest impact's actually in ahm. So ahm's a big net contributor to the pool because of its younger customer base, but that contribution or the calculated deficit was down significantly this period. And that affects it, that reflects that we're now selling more silver and gold products than we used to, and we've got a more higher coverage policyholder mix through our sales channels.
Okay, thanks. And just one last related question. There's been some talk in the market, obviously, around hospital recontracting and you revisiting in particular with Ramsay, and just wondering if you can make a comment as to whether or not you have revisited some of those contracts that were struck earlier last year.
Thanks, Kieran. Well, firstly, hospital partnerships are sort of an always on conversation. Yeah, we've had quite a number of conversations with a number of hospital partners in the last six to 12 months about how we can, you know, address their needs. But, you know, we start those conversations with, "Well, what's right for our customers? How can we preserve access to quality healthcare?" But we need to make it sustainable. So yeah, we have had a number of conversations, and the results of those are really as we expected.
We've been able to, you know, meet some of the needs of the sector, but more importantly for us- ... to move to much more of these partnership approach type contracts. Now, around two-thirds of our pay, our customers' benefit outlays are covered by these contracts. They enable us together to create incentives to invest in new models of care and invest, continue to invest in high quality outcomes, better experiences, and actually that's really as we expect, and it's helping us to manage this in the long term. So, you know, as we sit here today, going forward, I think the vast majority of [we sort of contracts with all of our partners, and actually there's not that many contracts now, you know, due for renewal. In fact, it's probably less than 20% of our benefit outlays.
So, yeah, it's been an important set of conversations, but, we're happy with how they've ended up.
And Kieran, when I think through the second half claims trajectory and then into FY 2025, I'm more thinking about the structural shift in claims patterns and whether rehab referral rates are ever gonna recover. I'm more thinking about the economic environment impacting extras demand. They're the things I'm thinking about more rather than whether one or two hospitals are gonna turn up at a door wanting to renegotiate. It's really the structural shift in claims and the cyclical impact of the economic conditions on extras demand, which are the things that are gonna drive the claims trajectory into 2025.
Okay. So that hasn't been a big factor driving this step up into second half? Off what is a very low first half base. Yep.
Well, there will be. There were some contracts that we renegotiated in the first half, so you'll get the full period impact on into the second half. But really, where we land in the range is gonna be largely governed by the risk equalization outcome rather than hospital contracting.
Okay. All right, thanks, guys.
Your next question comes from Sean Laaman with Morgan Stanley.
Good morning, David and Mark. I hope you're both well. Just a point of clarification on the first question. What do you think system might have grown at during the period and your expectations for the balance of the year? I know we get the APRA stats next Wednesday, but any thoughts on that?
Yeah, thanks, Sean. Yeah, I think we're ... I'm well. You well, Mark?
I'm living, yeah, Sean. Thanks for asking. We don't get that question very often.
Thank you very much for that. Look, we saw, as Mark said in his comments, policyholder growth up to September was 1.9% for the trailing 12 months. We think that'll pretty much hold for the balance of the half year. When you look through that, though, we are still seeing that trend of, or the impact of ADR, where for the September year, I think it's 2.34% increase in hospital lives, and a very strong increase in younger customers. So the quality of growth is still there, and, you know, penetration rates in the community of hospital cover is five-year high. So I think all of that's very strong. You know, it is challenging out there for the consumer. They are prioritizing their health and wellbeing.
We're certainly not taking that for granted and continue to invest in value. But, you know, we do think that the overall market growth in terms of policy numbers will modestly moderate in the second half, which is why we've put out our guided guidance.
Thank you. With April 1 approaching, you know, what's the latest on the government and the premium increases?
Yeah, it's been, look, it's been a pretty normal process, certainly similar to last year. We've approached our application, you know, in the same way we always do, looking at our expectation of claims and downgrading. We've had very similar interactions with the department. So probably the only thing that's slightly different is just the timing of the completion of that process, and it's really a matter for the government.
Thanks, David. And lastly, just to clarify your investment in Myhealth, the AUD 150 million or whatever it was, is that sort of targeting primary care, or should we be thinking beyond that?
I want to start with the AUD 150 million-AUD 250 million. That's across all of our markets, including health and wellbeing, primary care, virtual care, and also, short stay and community care. And, you know, we're just restating with our strong balance sheet and, you know, strong performance in these platform areas, that we continue to target growth of inorganic growth in those all those three sectors. That's in addition to, you know, our aspiration to continue to grow organically by around 15% on average between 2024 and 2026. Within that, yes, Myhealth, sixty odd million dollars for just recently, and Mark can go through the overall investment that that brings us to, for Myhealth, which is not up to AUD 150 million.
That's a part of that, and yes, we see further growth opportunity in Myhealth and actually within our, as we've outlined today, you know, that primary care network that really combines the Myhealth business with our platforms in Amplar and Medibank.
Cool. Thank you.
Yeah-
Maybe just squeeze one last one in, if I can. I may have missed it. Any sort of numbers or quantification on the short stay, no gap joint replacement surgeries?
Yeah, well, and I might hand over to Milosh to give a bit more detail. But we continue to see, you know, both the number of procedures we're covering expand and also the number of hospitals that offer this program expand. Joints, as I think we've talked about before, in the last half, 4.6% of our Medibank members had a No Gap joint replacement experience. We then moved on to scopes and general surgeries. In fact, last half, about 2.5% or so of our Medibank customers had a No Gap scope. But what's really important here is that we continue to see that evolve and grow. It's part of a health transition, but it also provides value to our core business and most importantly, differentiation for the product.
But I might hand over to Milosh to talk about that in a bit more detail.
Thanks, David. As you've noted, that there is broadening of the services and some of our hospital partners in these surgeries. We're also looking at a few pilots in mental health, and that growth is underpinned by strong resonance with consumers, evolving our partnerships with our hospital partners as well, to create a easier, more integrated experience for our customers. And also, we are seeing the additional benefits to our silver and gold product of no access or no gap, contributing to that appeal and affordability of, of those partnerships and procedures. So we expect that will continue.
Great. Thank you, gentlemen. That's all I have.
Your next question comes from Vanessa Thomson with Jefferies.
Good morning. Thanks for taking my question. I just wanted to extend a bit more in about the hospital partnership agreements, and the contract negotiations. You mentioned the hospital admission mix that you'll be looking at reviewing. I wonder how that feeds into contract negotiation. Thank you.
I want to start with just the approach to contracting, and then, yeah, Mark, feel free to if you can add about the claims outlook. But, you know, progressively over the last few years, we've moved what was the industry standard with just a contract based on indexation, very simplistic arrangement, through to we're the first fund, to really introduce, measures that incentivized, improved quality outcomes for customers. And more recently, we've extended that even further to expand the partnership arrangements to provide incentives to not just, deliver affordable access for our members today, but also drive change in the system and innovate. Part of the, you know, contract has some, you know, is providing assurance for the private hospital partner.
Part of it is providing incentives, where it encourages our partners to invest in things like our No Gap network, to accelerate the adoption of new settings of care, to implement things like the [processes reform]. And it creates a win-win arrangement so that we can help sustain those that access for our customers in the future. I think what we've we've said today is that the number of episodes that our customers receive in-hospital and the partnership contracts across which they they cover, have gone from a very small number a few years ago to now being two-thirds of our coverage, effectively.
You know, the last six to 12 months has seen a very strong uptake in those sort of partnership agreements, which really sets us up for success, and our partners for success, in the future.
And Vanessa, if you think about how the partnership would work, so, I'll use the example of a hernia. So if a hernia is done with a one-night bed stay, then the cost of doing it versus a 23-hour or less procedure, you effectively lose the cost of a five-star hotel accommodation. That's effectively what we have to pay as an increased DRG payment. So if we can do that procedure on a same-day basis, we make more money. We can share that with the customer, so they don't have to pay out of pocket to the surgeon, and then we can pay the hospital more. So that's the way we if we've got a claim saving, we'll benefit, and the shareholders will benefit, the customer benefits, and the hospital benefits. So it's effectively that model is actually occurring anyway.
The level of procedures happening without an overnight stay, it's probably gone up 2% or 3% to 72% of all admissions currently. So the hospital's losing that bed day or the accommodation day, so we're sharing some of the benefit with them. So that gives them an incentive to support the shift in the model of care to a kind of a more international basis, where overnight procedures are for high acute operations rather than low acuity operations.
Thank you. Just one more question. I wanted to ask about cybercrime costs, expecting 30-35 in FY 2024. Any color you could give us on expectations for FY 2025? Thank you.
Maybe let me start with what's making up those costs. So two-thirds of those costs are actually in remediation and uplift, and the balance is in litigation. So we're making really good progress on the remediation and uplift. I'm not sure that necessarily will be completely finished this year, so it'll go into 2025, I suspect, and then the litigation will actually have a pretty long tail. So we'd expect the same trajectory in terms of going down, but we still will have some costs in 2025.
Thank you. That's all I had. Thanks.
Your next question comes from Andrew Goodsall with MST Marquee.
Thanks very much for taking my question, and glad to hear you're well. So just on the premium round, obviously, just following that up, we are hearing that's due out next week and expected to land below inflation. Just, you've talked to the competitive landscape, just wondering if you're expecting that next week you'll get a positive signal, just where you land versus peers? So just talking about proportionately where relative to how you think you're going to land?
Thanks, Andrew. I hope you are well.
Very well, thank you.
Look, that's all probably just difficult to talk about. I'm not going to speculate. I certainly don't know what everyone else has applied for, nor should I. What I know is what we've done, which is to look at our forecasted claims, downgrading, and applied for a rate. We are doing all we can to keep premium increases as low as we can for our customers, but we need to balance that with sustainability for our business. So I think we are, you know, we've put our best foot forward, and we look forward to hearing, you know, where that round completes. But as I said, it's been pretty normal in terms of everything else, apart from maybe the timeline. So if it is next week, that'll be good.
We'll check the second page of the press release that normally has all 35 funds and their price increases, Andrew, so I suspect we'll find out about the same time, Shane.
Okay.
Where we sit with the competitors.
Hopefully, that shows up for those that are willing to pay a lot more to get people across. Just coming back to extras, Mark, I think you mentioned you're doing a bit of work looking at what's happening there. Obviously, claims are slowing there. Just wondering whether you're thinking that's an affordability issue or is there any capacity issues amongst the service providers there?
Yeah, we actually think this is cyclical and linked to inflation rather than structural, and probably for three reasons. The impact is bigger in the more discretionary modalities. So if you look at dental, dental claims are still pretty high. We're not seeing the same workforce limitations in allied health and furlough that we're seeing in the hospital market. And then we've done a few trials where we've actually encouraged customers to use their products, saying, "Your limits are going to expire," and we've shown we can stimulate demand that way. So that tells us it's more affordability than structural. And we've taken-
That's great.
In the guidance we've given, the 2.2%-2.4% as our expected claims growth. We've taken about a 40 basis point reduction in consumption, but we are still running well below that level in terms of extras claims. So the question is, does it or does it not recover in the second half? There's still some potential risk that consumption falls even further in extras.
Final one for me, just in terms of the equity reserve or the old DLP, I guess just trying to understand at what point do you sort of say or just call time on catch-up opportunity through that reserve?
Andrew, I'm pretty sure you called it DLP, but you meant the DLC, didn't you?
DLC, sorry. Yeah.
Yeah.
DCL. DCL. DCL.
So the givebacks that we've announced today, that will go against the equity reserve.
Got it, so-
Should there be surgical claims growth exceed our expectations, and we have to fund those claims, that'll get drawn against the reserve as well. So it's largely, again, it's going to be used for further customer givebacks or funding the cost of deferred hospital procedures that are undertaken.
Sorry, just final one, just on the givebacks. Do you get any pushback at a sort of political or regulatory level, just that the preference would be to see those in the premium round rather than givebacks? Just a bit of noise we were hearing.
Well, yeah, let me just start on the... I think you asked when. So I think I got asked the same question six months ago, and I said, "Yeah, I really hope COVID is going to be over by the end of 2014." And we're now in 2023. Sorry, we're now in 2024, and in November and December, we had a pretty severe further infection and outbreak. And so there's very clearly a big impact on claims, hospital claims. I'm going to say it again, I really hope FY 2024 is the last year that we're talking about COVID. We get back to what is the new norm in FY 2025. Daniel?
Yeah, just on the department. I think we are progressively, you know, just making sure that we deliver on our commitment, which we have always done, which is to not profit from pandemics.
Yeah. Got it.
So-
Yep.
You know, I think given we're seeing, as Mark said, still signs there of impact to claims, then we will continue to do the right thing by our customers. Or if claims do recover, as Mark said, we're ready to support that with the reserve. So I think, you know, that is a different issue than the premium round, and we've always been clear on our underlying expectations, you know, and we remain committed to that promise.
Great. Thank you. That makes sense. Thank you.
Your next question comes from Andrew Buncombe with Macquarie.
Hi, guys. Thanks for taking my questions, just one from me. I'm just thinking about the policyholder growth targets that you've changed today. Just in the context of the market seeing higher acquisition costs and a little bit of rotation to more aggregators, but then at a company level, you've only done 20 basis points of growth in the first half. That implies that there needs to be something structural on your side of things that changes in the second half to even hit the new targets. What's that structural change that you're essentially putting in place now, that's going to get you to the new numbers? Thanks.
Yeah, thanks, Andrew. Look, I think when we look through the first half, you know, as we entered in that first half, we did see some impact of the rate change we put through on 1 June, which is the second one we've done in the last half of last financial year. The momentum actually improved, you know, quite considerably through that half, but we did see this increase in competitive intensity. Yeah, when I look at the second half, you know, it gives me comfort. You know, in the first half, we continued to grow share in NTIs, and we know that NTIs are a larger part of the market in the second half than the first half.
Again, our target segments, when we look at corporate, we actually had one of the highest or strongest corporate acquisition rates we've had in a couple of years. And, we've seen some really strong account wins, in the first half. So that's very strong momentum. And, lastly, we have, you know, announced the giveback, today, and that will, we know, or it's the right thing to do by our customers. We know that will improve, you know, that trajectory. I guess the other way of looking at it is, you know, you're right, we need, to, to get to the outlook, we need around 20,000 or a bit more policies. A couple of years ago, we grew more than 32,000 in the second half.
Last year, in the first quarter, we grew 15,000 in one quarter. So I think all of those things, you know, give us confidence. You know, we will, you know, continue to invest in that differentiation and continue to grow in a disciplined way. Because, you know, we could always hit 2% if we wanted to, but that's not the right thing, for our, for our business, and it wouldn't be the right thing for, ultimately for our customers.
And so, Andrew, part of the reason we've given MA guidance and downgrading guidance is that we're actually showing you that we intend to grow policy holder growth without overspending on offers or overspending on MA. So we're actually giving you all three metrics. So that would actually, you know, we're confident that we don't need to pull the offers lever, we don't need to overspend on marketing, and that we're actually going to grow between 1.2% and 1.5% in a sustainable way. And if you look through the MA number, you'll actually see if we land between AUD 610 million and AUD 615 million in MA, that actually, that would infer a much lower expense growth for the full year than what we had for the half.
So we're not overinvesting, we're not overpaying acquisition costs.
Excellent. That's it from me. Thank you.
Your next question comes from Julian Braganza with Goldman Sachs.
Good morning, guys. Just a couple of questions from me. Firstly, just in terms of the, the claim savings that you're seeing continue to persist, into first half 2024. Just in terms of the composition, and just trying to understand, have you, have you now assumed the full permanent benefits coming through from COVID-19 in this latest pricing round?
Thanks, Julian. Hope you're well. So we had AUD 74 million of favorability on claims versus expectations, so 2% of our total claims. That's largely coming through in non-surgical, and within non-surgical, it's largely in rehab savings. We've built some of those into the guidance. In fact, we've built some of those into the 2.6% guidance we had at the full year. But largely, we are not assuming any further structural shift in claims and benefits from that in the second half. That's probably more a contemplation for the premium round.
So to the extent rehab savings went backwards, to the extent extras utilization growth was much lower than the 1.5% we're expecting, that could potentially be a benefit to claims and push us towards the bottom end of the range we've given or below.
Okay, great. But just to understand, I mean, to the extent you can provide a bit of color in terms of how you've thought about claims inflation into FY 2025, given that that would be a pivotal part of your thinking in your rate submission for this round.
So as we've discussed this before, it's all premium round and claims inflation, it's a whole series of headwinds and tailwinds. So we start at the top level, which is the economic environment. So what's that going to do to downgrading and extras utilization? Then we think about the ongoing hospital contracting cycle, because that's an always-on activity. A period of our contracts will turn every year. And then the biggest area of focus is the structural or benefit we may get from further structural claim savings as a consequence of the COVID-19 pandemic. So that's where we think about the majority of the rehab savings that we've not yet built into our underlying claims expectation. That's where that comes into our consideration, Julian.
Okay, great. Thanks for that, Mark. And then maybe just a last question on MER. I just want to understand, obviously, gross margin continued to expand this period. MER also did expand, offsetting some of that benefit. But if I think about your view on pricing and that pricing also should reflect the higher MER going forward, and also just your views on the MER, sort of, that'll come back over time.
Yeah, so maybe what typically happens, we typically think about growing our number of customers and our revenue with a flat or flatish gross margin, and then we get any operating margin leverage through our an improving MER. That's what we typically aim for over an extended period of time. We are actually at a point of inflection here, where we've got very high inflation impacting costs, but also impacting consumption.... So that may mean in the short term that we end up with the same operating margin trajectory, but the shape of that result may be slightly different. Because you're never gonna get the MER, and you're never gonna get the claims inflation exactly right in any one short period of time.
But that is our long-term aspiration, but we are going through a period of inflection, Julian, so we may see this year an uplift in resident gross margin, but an uplift in MER as well. But I—the thing I'd call out that hasn't got much conversation yet today is the importance of the non-resident business. So that business is growing very strongly, it's got a higher margin, and it's contributing to the overall fund gross margin, and that's gonna be a very important component of our full year result.
Okay, great. And just one last clarification for me: that COVID reserve accrual of AUD 140 million lower claims versus expectations, is that versus 2%, is that right, for the first half?
Yes, that's correct.
Okay, perfect. Thank you so much for that.
Your next question comes from Siddharth Parameswaran from JP Morgan.
Good morning, gentlemen. A couple questions, if I can. Firstly, just on the rate negotiations. Can I just clarify, have you not been told yet what your rate increases are? Because my understanding is some funds have. So just wanted to clarify, given that you haven't mentioned it today, does that mean you haven't yet been told what you're getting?
Hi, Sid. Good to hear from you. Yeah, I can confirm that we haven't been told. If we've been told, we would've told you.
Yep. Okay, great. Okay, thank you. Can I just also clarify a couple of questions on just recognition of the low claims environment. Mark, last year, it seemed like there was quite a bit of seasonality in terms of the gross margins between the first half and the second half when you showed us your underlying margins on residents. And I think you recognized the claims benefits, you know, a bit, a bit more in the second half. I was—I'm just wondering if, given the, there's still quite a difference between your assumptions and what's actually occurring on a cash basis. I was just wondering if we should expect any similar trends here, as in there might be a revisitation of some of those assumptions in the second half?
Let me start with the-
So, so-
Yeah, let me start with seasonality.
Yeah.
Second half normally has higher gross margin because there are less hospital service days. January is a very low claiming month. Over restart, there's a lot less surgery. We've typically had a higher gross margin in the second half than what we've had in the first half, but that's already contemplated in the forward view of claims that we've given you today in the outlook.
Okay. And just the revision of assumptions?
We said in the presentation, we will monitor the key claims trends. So if rehab, as an example, the rehab referral rates drop, or if extras consumption is lower than what we expect, then when we land the full year result, there could be a different outcome to 2.2%-2.4% for the full year.
Yeah. Okay, great. Okay. And I just want to touch on one of the earlier questions. I wasn't quite sure about your answer, Mark, around the COVID promise. So this, the $215 million that you're giving back, are we to take that that's the last give back? Or are you saying that, you know, that it's still open and you might give back more? I just want to be categorically clear, 'cause there'll still be a significant provision that's there in your what do you call it? Your COVID-19 Equity Reserve.
Yeah, so we'll have somewhere around AUD 100 million residual amount left in the equity reserve. And so, if that's not used to offset the cost of hospital procedures that have been deferred due to COVID, that will also go back to customers.
Okay. Okay, great. Okay, thank you. And then one last question, just the non-residents. I mean, you touched on that earlier. Just, the growth from here, I mean, we've seen very strong growth, for a little while. Going forward, you know, government seems to be cracking down on migration and students. I'm just wondering if... Are we - should we be expecting a slowdown or a shrink or shrinking in volumes in the market in that segment?
Yeah, thanks. So I want, I want to kick off with a bit on that. Yeah, we have purposely invested in this market, particularly during COVID, when the borders were closed, so that we could grow share in this market as it returned to growth. I think we've done, we've definitely done that, and continue to see strong growth in this half, particularly in students. There's a record number of students in the country right now, and still a lot of positivity there from many in the sector about forward growth. I think there has been some commentary on immigration, but particularly the areas that we're focused on, around skilled workers, and visitors. Yeah, that's probably gonna be less impacted.
So my turns are Milosh, just in terms of what you're seeing with some of our partnerships and, you know, what you're seeing in terms of the market.
Yeah. Thanks, David. Hi, Sid. I think on the market, we did see a bit of a catch-up in FY 2023, and so far, student bodies in country are back at, pre-COVID, above pre-COVID levels. And if you look at some of the forecasts from the Census of Population-
... while the FY 2024 student volumes and inbounds are gonna be a little bit lower than FY 2023, it's still higher than pre-COVID. So the resilience of the student market and the sector is there. And then as David highlighted, we have invested in our partnerships and our proposition to serve not just private health insurance, but broader health needs of our student population and our partners. And those have resulted in 100% renewal of our accounts and continuing to serve more universities and higher education institutions. So that's pleasingly progressing well and fueling both our current performance, but also our positive expectations for the rest of the year.
Sid, I think the opportunity for us, and I may have said this before, is share in workers and visitors. We're doing really well in the student segment, been winning share, but still say we're underweight share versus our, where we are with students. So our opportunity, even if the market actually starts to soften, is to actually increase the share in both workers and visitors. I was really happy with the trajectory we had in workers this half, but there's definitely more we can do there and still quite a bit more opportunity in the visitor segment.
Okay, thank you very much.
Your next question comes from Nigel Pittaway with Citi.
Morning, guys. When you were explaining the lapses, you said that that reflected the timing of the premium increases versus your competitors. And yet it looks, if I'm comparing like with like, that you lost about 1,800 policyholders in the months of November and December, which suggests that lapses spiked in those last two months. So I guess firstly, is that correct? And secondly, can you, if it is correct, explain what went on? What went on?
Yeah, thanks, Nigel. Look, there was probably, as I said before, two thematics in the first half. One was more at the first part of the half. In that first quarter, we did see some impact, residual impact from the premium increase that was implemented in 1 June, but followed on from the increase that we deferred from November to January. I think the second, you know, part of the half, you know, those impacts had diminished, but we did see, you know, some increasing competitor intensity. Some, you know, unsustainable, quite frankly, practices in some parts of the market that we just weren't prepared to follow. That drove increased switching rates.
In fact, we've seen the whole industry lapse rate increase, you know, which is in line with what we've seen. So very much two thematics coming through there, Nigel.
Okay, that's clear. Thank you. Secondly, I mean, just briefly back to the sort of claims growth. I mean, when we were sort of talking six months ago, you, you were quite firm that the 2.6% was realistic, not, not conservative. So I mean, you've probably largely covered it, but I guess what did most surprise you? And then secondly, I presume that given what you said about sort of extras and, you know, utilization, and that could see you down below the bottom end of that guidance, so that guidance is on a similar basis to, to the, 2.6?
Yeah, good question, Nigel. So what's really changed, I guess the risk equalization outcome's better than what I was expecting. And you're right, extras... We've contemplated, I think when we last met with you, that extras growth could deteriorate given it's a more discretionary service and it has eventuated. So they're largely the factors that have improved the outlook. We were expecting also that rehab claims would recover more quickly than what they have. There's such a big financial incentive for hospitals to fill empty beds. There's such a lot of capital that's been invested in the rehabilitation specialty. So we expected, we've been expecting for a while that the rehab claims would recover, but, you know, they're still down somewhere between 17%-20% compared to where they were pre-COVID.
Okay, thank you.
And you're right, Nigel, you're right, Nigel, the bias would be towards the bottom end of the range or below rather than to the top end above, if I had to make that call, is where we sit today. And you'd expect that given claims are 2% below that expectation as we speak.
Yeah. Okay, thank you. And then maybe just finally, I mean, I was just wondering, I guess, how you think the economic conditions are relative to what you assumed, because, I mean, another sort of assumption that's just slightly changed is obviously your downgrading assumption, where you're now expecting that to be a, a little bit worse than you were. So is that because the economic conditions are worse than you expected, or just that the way people have reacted to the economic conditions is slightly different to what you expected?
Look, it's broadly in line, Nigel. From an economics impact, I think the switching conversation we've been having and the propensity for other funds to offer, you know, joint offers to switch customers, that's impacting the downgrading rather than it being on customers wanting to drop cover or increase their excess.
Yeah, and that, just to add to that, I think from what we're seeing with consumers, as I've said before, you know, they are under pressure, there's no doubt, and they are, you know, wanting more value from their product and looking around, for offers. But they're also, they're prioritizing their health and wellbeing. So the, you know, economics of the industry actually remain, you know, fundamentally pretty positive, with, unemployment still relatively low, with, wage growth, as was, revealed yesterday, you know, improving. I think that's certainly above historical premium increases or recent premium increases. So the affordability equation is, is still, you know, strong.
But, you know, we are continuing to try and drive value and support both our current customers and attract new ones, to offset that. But as we look forward, we have signaled that we think that the growth rate will moderate slightly because, you know, we expect that there will be a slight impact in this half.
Nigel, maybe to put it in context, though, a couple of years ago, we were running at 1% downgrading, and we were in a very low interest rate environment. First half 2023, we're 70 basis points. So while our guidance has gone up a little bit, we're still, notwithstanding the economic conditions, doing a lot better than what we were 12 months ago and, and demonstratively better than what we were doing two or three years ago.
Okay, that's great. Thank you very much.
Thank you. That does conclude our question and answer session, as well as our conference for today. Thank you for participating. You may now disconnect.