Private health insurance

Links to information about private health insurance for consumers, including Lifetime Health Cover, Australian Government Rebate on private health insurance and frequently asked questions.

Page last updated: 10 December 2018

Note: If you have an enquiry regarding the conditions of your health insurance policy for hospital or ancillary (extras) cover, please contact your health insurer in the first instance.

What is Private Health Insurance?

There are two types of private health insurance - hospital policies cover you when you go to hospital, while general treatment policies (sometimes known as ancillary or extras) cover you for ancillary treatment (e.g dental, physiotherapy). Most health funds offer combined policies that provide a packaged cover for both hospital and general treatment services, or you can buy separate hospital and general treatment policies to 'mix and match'.

Private Health Insurance Rebate

The Australian Government provides an income tested rebate, (the Australian Government Rebate on private health insurance) to help people meet the cost of private health insurance.

Lifetime Health Cover

Lifetime Health Cover is a financial loading that can be payable in addition to the premium for your private health insurance hospital cover.

Lifetime Health Cover is a Government initiative that started on 1 July 2000. It was designed to encourage people to take out hospital insurance earlier in life, and to maintain their cover over their lifetime.

Supporting Mental Health - waiting period exemption for higher benefits

This policy enables patients with limited cover to upgrade without serving a waiting period for access to higher benefits for psychiatric care. The waiting period exemption for psychiatric care benefits can only be accessed by a person once in their lifetime, and is only available after a person has served their initial two month waiting period for any psychiatric benefits.

Access to the waiting period exemption for psychiatric care benefits has been available since 1 April 2018. Further information on the waiting period exemption can be accessed on the Supporting Mental Health - waiting period exemption for higher benefits web page.

Private Health Insurance Benefit Limitation Periods – Changes to improve information for private health insurance members

Some private health insurers have previously imposed benefit limitation periods of up to 24 months for hospital treatment, and offered lower premium costs for these policies. BLPs are no longer applied to any treatments under any hospital policy since 1 July 2018. For more information see: Private Health Insurance Benefit Limitation Periods – Changes to improve information for private health insurance members


Government's contribution to the Private Health Insurance Rebate - presentation to industry 19 December 2013

A presentation was made to the private health insurance industry on 19 December 2013 explaining proposed changes to the calculation of the Government's contribution to the Private Health Insurance Rebate.

Private Health Insurance – Prostheses

Private Health Insurance – Prostheses formerly known as Schedule 5 – Benefits payable in respect of surgically implanted prostheses, human tissue items and other medical devices.

Under the Private Health Insurance Act 2007, private health insurers are required to pay benefits for a range of prostheses that are provided as part of an episode of hospital treatment or hospital substitute treatment for which a patient has cover and for which a Medicare benefit is payable for the associated professional service.

Prostheses List (PL) Cost Recovery Implementation Statement (CRIS)

The PL CRIS provides information on how the Department of Health implements cost recovery for the Administration of the Prostheses List.

Informed Financial Consent

Informed Financial Consent (IFC) is the provision of cost information to patients, including notification of likely out of pocket expenses (gaps), by all relevant service providers, preferably in writing, prior to admission to hospital or treatment.

Medicare Levy Surcharge

The Medicare Levy Surcharge is a tax on people who earn over a certain amount and don’t have private health insurance hospital cover. The Medicare Levy Surcharge is in addition to the normal Medicare Levy.

Overseas Visitors Health Cover

For more information about this type of health insurance, please visit the Overseas visitors & overseas students web page on the Private Health Insurance Ombudsman website.

Overseas Students Health Cover

For more information about this type of health insurance, please visit the Overseas visitors & overseas students web page on the Private Health Insurance Ombudsman website.

Private Health Insurance Premiums

Private health insurers are required to apply to the Minister for Health for premium increases.

Private Health Insurance Circulars

These circulars are distributed to all Australian registered health insurance funds, Australian licensed private hospitals and day hospital facilities, Australian state and territory health authorities, other Australian health organisations and health service providers. The circulars contain important information related to Australian Commonwealth Government legislation which governs the operation of private health insurance and the licensing of new private hospitals and day hospital facilities in Australia.

National Joint Replacement Registry (NJRR) Cost Recovery Implementation Statement (CRIS)

The NJRR CRIS provides information on how the Department of Health implements cost recovery for the National Joint Replacement Registry (NJRR). The NJRR CRIS reports financial and non-financial performance information.

The Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies

The review of the Australian Government Rebate on Private Health Insurance for natural therapies examined the evidence of clinical efficacy, cost effectiveness, safety and quality of in-scope natural therapies.

Terminating Products – Information Provision

The Government has introduced strong consumer protections should a private health insurer plan to terminate a particular product and transfer people insured under that product to a different policy. From 22 September 2018, private health insurers are required to provide a range of consumer information to fully inform affected adults when their existing product is being terminated.

Further information on the new information requirements can be accessed on the Terminating Products – Information Provision web page.

Second-tier default benefits consultation

The Department of Health is seeking feedback from the private health insurance and private hospital sectors on draft guidelines for administration of second-tier default benefits eligibility, a draft application form for second-tier default benefits eligibility and draft categorisation of hospitals for second-tier default benefits. The consultation process closes on Friday 30 November 2018. More information can be found on the second-tier default benefits consultation page.