Frequently Asked Questions
Click on a question to see the answer.
- Covering dependants to age 31 and covering dependants with a disability
The Government previously announced that it will increase the maximum age of dependants for private health insurance policies from 24 to 31 years and remove the age limit for dependants with a disability. These changes were passed by Parliament in June 2021. It is optional for insurers to implement these policy changes. Consumers can search this website for the new policies.
What is the definition of a dependent?
It will be up to individual insurers to define a dependent in their policies. However, the legislation outlines certain requirements for some aspects of the definition, including age ranges and partner status. While the legislation defines a dependent as a single person aged from 18 to 31 years, an insurer can choose to define and implement their own age range for dependants. For example, an insurer that currently has a maximum age for dependent as 24 years in their insurer rules, may increase the maximum age to 29 years rather than 31 years.
What is the definition of a dependant with a disability?
The legislation defines a person with a disability as a participant in the National Disability Insurance Scheme (NDIS) who is aged 18 years or over. They may have a partner. However, insurers will have some discretion to offer cover to people with a disability who are not participating in the NDIS.
For more information, see the Department of Health and Aged Care website.
- Premium Increases
Premium increases usually occur in April of each year. From 1 April 2022, private health insurance will increase by a weighted industry average of 2.7%. Not all products will change by the same percentage - some products may be offered with either a lower or a higher price change when compared to the industry or your insurer’s average. If your premium is increasing, your health insurer is required to notify you in writing with updated policy information and more information about the change.
Note that the Australian Government Rebate is adjusted each year in late January. Because of this, insurers are not able to provide definitive information on premium changes until February 2022. Your insurer will contact you if they are making any premium changes. You can also contact your insurer for advice about your premium.
For more information on this topic, see Health Insurance Premium Increases factsheet.
- Coronavirus (COVID-19) update
If you are experiencing financial hardship and finding it difficult to pay your premiums, please contact your insurer. Some insurers are offering premium waivers or membership suspensions for members affected by the pandemic.
If you have any difficulty contacting your insurer or would like to lodge a complaint, please contact the Commonwealth Ombudsman at www.ombudsman.gov.au.
- Medical Costs Finder
The Medical Costs Finder is an online tool that is an initiative of the Australian Federal Government. It lets you find out more about the cost of specialist medical services.
It covers common services in and out of hospital that patients want to know more about.
The tool’s results are based on the most recent publicly available Government data about what people have paid for medical services. Select the link below to find out more about this tool and to use the Medical Costs Finder.
Please note this link will take you away from the PrivateHealth.gov.au website: Medical Cost Finder
The Australian Government has announced the Medical Costs Finder tool will be enhanced as part of a suite of private health insurance reforms. For further information, visit the Department of Health and Aged Care website.
- Mental Health – waiting period exemption for higher benefits
- If you are on a hospital policy which provides restricted benefits for psychiatric care, then to access higher benefits you usually upgrade and complete a two month waiting period.
However, from 1 April 2018, you can upgrade without having to serve this waiting period to access higher benefits for psychiatric care in a private hospital.
This exemption applies only once per lifetime and can only be accessed if you have already completed an initial two months of membership on any level of hospital cover.
For more information about accessing the exemption, please contact your health insurer.
For general information about the exemption, see the Department of Health website: Supporting mental Health - Waiting period exemption for higher benefits
- 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.
- 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 your first interim (blue card) or full (green card) Medicare benefits to purchase private hospital cover without incurring a loading.
If you are under 31, you have until the 1 July following your 31st birthday to purchase private hospital cover without incurring a loading.
See Lifetime Health Cover for further information.
Please note that general treatment (extras) cover, overseas visitors' cover, overseas student cover or international health cover does not qualify for Lifetime Health Cover purposes.
- I’ve just received a letter about Lifetime Health Cover. What do I need to do?
- Each year, the Department of Health and Aged Care posts letters to Australian citizens and permanent residents who recently turned 31 or registered for full Medicare benefits. The letters are sent to inform you about the Lifetime Health Cover (LHC) rules, which may affect whether you decide to purchase private hospital insurance.
Please note that general treatment (extras) cover, overseas visitors’ cover, overseas student cover or international health cover does not qualify for Lifetime Health Cover purposes.
Private health insurance is optional in Australia but you should be aware that if you want to join, the cost of hospital insurance will vary depending on your age:
If you have turned or will turn 31 during the 2021-22 financial year - You have until 30 June 2022 to purchase private hospital cover without incurring LHC ‘loading’. If you purchase hospital insurance from 1 July 2022 onwards, then you will incur a loading which increases the cost of insurance. The older you are at the time of purchase, the higher the cost. If this applies to you and you have already taken out eligible hospital cover, then you don’t need to take any further action.
If you are aged 31 or over, and you registered for interim or full Medicare benefits (usually a blue or green card) during the 2020-21 financial year – You have until the first anniversary of the date you registered for your Medicare card to purchase private hospital cover without incurring LHC ‘loading’. If you purchase hospital insurance after the anniversary date has lapsed, then you will incur a loading which increases the cost of insurance. The older you are at the time of purchase, the higher the cost. If you start private hospital cover within 1 year of Medicare registration, you will need to confirm your registration date by requesting a letter from Medicare - contact Medicare (Services Australia) or visit your local Medicare branch. Supply the letter to your health insurer on or after joining to have your loading reassessed.
Some exceptions may apply if you are overseas on your LHC deadline day. For more information, please refer to Lifetime Health Cover.
I already have hospital insurance - do I need to take any action? If you already have hospital insurance and the correct LHC loading has been applied to your policy, then you don't need to take any further action. If you are not sure if the correct LHC loading has been applied, or if you think there has been an error, contact your health insurer for more information.
If you are experiencing financial hardship due to COVID-19, please contact your insurer or potential insurer to discuss your options.
- I'm applying for a 482 or 485 visa; do I need private health insurance?
- Yes. It is a condition of applying for a Visa Subclass 482 or 485 to make arrangements for a minimum level of health insurance. See Overseas visitors & overseas students 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 Medicare, but should still consider taking out cover.
Some visas may require you to hold private insurance while you're in Australia, such as the 482 visa, 485 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, Norway, or Belgium 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 aged-based and income tested. The rebate is available for people with Medicare eligibility. If you have a Lifetime Health Cover loading, the rebate does not apply to the LHC loading portion of your premium.
If you are eligible for the rebate, you can have the rebate automatically deducted off your premiums 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. Currently, the income threshold is $90,000 for singles and $180,000 for couples and families.
To be exempt from the surcharge, your hospital cover must be held with a registered health insurer 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 insurer in the List of Health Insurers and click on its name
- Search for your policy under the Policies tab
- Select your product and click 'Compare Policies'
- Changes to Private Health Insurance
- The Australian Government announced on 13 October 2017 a wide-ranging package of reforms to private health insurance.
Since 1 April 2019, health insurers can offer Age-based Discounts for people aged 18-29 years, increased maximum excess levels, and travel and accommodation benefits under hospital policies. Some natural therapies were removed from coverage.
Since 1 April 2020, all hospital policies fall under the tiers of Gold, Silver, Bronze, and Basic. All policy information is now presented in the Private Health Information Statements (PHIS) format. For more information, see: Product tiers and Clinical categories.
In 2021, private health insurance laws were amended to increase the maximum age of dependants for private health insurance policies from 24 to 31 years and remove the age limit for dependants with a disability.
To find out more, see Private Health Insurance Changes or Department of Health and Aged Care - Private Health Insurance Reforms.