Frequently asked questions
- What should I look out for when reviewing my insurance?
The Private Health Insurance Ombudsman recommends reviewing your policy at least once a year - your circumstances may change from time to time, so it’s important to review your health insurance policy regularly to make sure it still meets your health needs. For example, if you chose a hospital policy with restricted or excluded hospital services, you may want to increase your hospital cover as you reach certain life stages. For more information, see Managing your policy and the Ombudsman’s bulletin, Health Insurance Insider Issue #1
- I have just received a letter about Lifetime Health Cover. What do I need to do?
Lifetime Health Cover is a set of rules that determines how much you pay for private hospital cover.
If you turned or are turning 31 during the 2012-13 financial year, then you need to purchase hospital cover by 30 June 2013 if you want to avoid paying LHC loading later in life. If you don’t purchase cover, then you will pay the Lifetime Health Cover loading on top of the premium of any hospital cover you may later purchase.
If you are a new migrant to Australia aged over 31, then you have one year from the date you were registered for Medicare benefits to purchase private hospital cover without incurring a loading. You can check with Medicare to confirm what date you registered for LHC purposes.
If you have received your letter but you already have private hospital cover with zero LHC loading, then you don't need to take any further action. If you think you may have been charged a loading in error, contact your health fund for more information.
If you are overseas on the 1 July following your 31st birthday, or if you are a new migrant overseas on the anniversary of your Medicare registration, then some exemptions may apply. See Lifetime Health Cover for further information.
Please note: overseas visitors cover, overseas students cover, travel insurance, health cover that is provided by an international policy and general treatment (extras) cover are not considered as complying hospital cover for the purposes of Lifetime Health Cover. Only private hospital cover from an Australian registered health fund counts for LHC purposes.
- I've just turned 30; do I have to purchase private health insurance?
Private health insurance is optional - however if you don't purchase hospital cover by the 1st of July following your 31st birthday, you will pay the Lifetime Health Cover loading on top of the premium of any hospital cover you later purchase. See Lifetime Health Cover for further information.
- I've just become a permanent resident; can I purchase private hospital cover without Lifetime Health Cover loading?
Yes. If you are over 31, you have one year from the date you registered for Medicare benefits to purchase private hospital cover without incurring a loading. See Lifetime Health Cover for further information.
- I'm applying for a 457 visa; do I need private health insurance?
Yes. As of 14 September 2009, it is a condition of applying for a Visa Subclass 457 to make arrangements for a minimum level of health insurance. If your Visa was granted prior to this, your sponsor remains responsible for the cost of any treatment received in a public hospital. See 457 Visa Applicants for further information.
- I am visiting Australia from overseas; do I need to take out health cover?
Even if it's not a requirement under your visa, it is well worth considering taking out cover. If you need to visit a doctor or stay in hospital while you're here, you could be responsible for the full cost of treatment, which can be very expensive.
If you are visiting from a country that has a reciprocal health care agreement with Australia you may be eligible to receive immediate necessary treatment in Australia's public system, but should still consider taking out cover.
Some visas may require you to hold private insurance while you're in Australia, such as the 457 visa or the temporary student visa.
See Overseas Visitors Health Cover for further information.
- I am a student from overseas coming to study in Australia; do I need to take out health cover?
If you are coming to study in Australia on a temporary student visa it is a condition of your visa to take out appropriate health cover. Students from Sweden or Norway may have special arrangements. See Overseas Student Health Cover for further information.
- What is the Private Health Insurance Rebate?
Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums. The rebate, known as the Australian Government Private Health Insurance Rebate, is income tested. Most people receive a rebate of 30 cents for every dollar that paid for private health insurance. The rebate is available for people with Medicare eligibility.
If you are eligible for the rebate, you can have the rebate automatically deducted off your premiums, receive a direct payment from the Government, or claim it back at tax time. See Private Health Insurance Rebate for further information.
- Do I have to pay the Medicare Levy Surcharge?
The Medicare Levy Surcharge (MLS) is levied on payers of Australian tax who do not have private hospital cover and who earn above a certain income.
To be exempt from the surcharge, your hospital cover must be held with a registered health fund and must cover some or all of the fees and charges for a stay in hospital. General treatment cover without hospital cover will not provide an exemption. See Medicare Levy Surcharge for further information.
- How do I find my policy?
To find your policy and compare it with others:
- Find your fund in the List of Health Funds
- Search for your policy on the fund details page (search is located at bottom of page)
- Select your product and click 'Compare Policies'
- Click the 'Find more policies' button
- Search for similar products from the compare page
- Once you have selected some extra products (we suggest 6 maximum) click on 'Compare selected policies'
Contact the individual funds for detailed information about any policy you are interested in.
- Premium Increases 2013
- The government has announced that private health insurance premiums will increase from April 2013. If your premium has increased, your health fund is required to notify you in writing and you will receive updated policy information with more information about the change.
The average increase in 2013 will be 5.6%. If your increase is higher than the average, your health fund was able to demonstrate that the rise is necessary to cover the benefits offered by your policy.
This year's average increase is significantly less than the 9.3% increase in benefits that private health insurance companies paid to their members in the 2011-12 financial year. Benefits paid by private health insurers to their members in the last financial year have risen by $1.2 billion to more than $14 billion. The benefits paid by health funds can increase when hospital, medical or other health related costs rise, and if their members have an increase in the use of health services. Factors leading to cost increases can include wages for nurses and hospital staff, doctors’ charges, the cost of medical equipment and technology and more complex and costly procedures being available through private hospitals.
The Private Health Insurance Act 2007 requires health funds to submit detailed financial information to the Minister for Health and Ageing before they can increase premiums. If the funds cannot provide sufficient information to demonstrate to the Minister that an increase would be necessary to meet their obligations to pay benefits to eligible contributors, then there is no change to the premium.
If you consider that you cannot afford the increased premium, there are still a number of options for you to maintain private health insurance. (You may need to maintain hospital cover if you wish to preserve your Lifetime Health Cover status and to avoid the Medicare Levy Surcharge.). It is worth shopping around, as your current health insurer or another insurer may be able to offer you a cheaper alternative private health insurance policy that still meets your needs.
You can check your current health fund's policies under Health Funds or use the Compare Policies tool to compare policies across all health funds. Please note: prices on the website will not reflect the premium increases until 1 April 2013 when the increase becomes effective.
For more information on this topic, you can read about Managing your policy or visit the Private Health Insurance Ombudsman's website to read the Health Insurance Premium Increases factsheet.