Frequently asked questions

If you can't find what you need in these Frequently Asked Questions, try our Glossary or our explanation of how Standard Information Statements work.

Premium Increases 2018

Premium increases usually occur in April of each year. 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 closer to the date.

From 1 April 2018, private health insurance will increase by a weighted industry average of 3.95%.

Please note: prices on the website will not reflect the premium increases until the date when the increase becomes effective.

For more information on this topic, see Health Insurance Premium Increases factsheet.

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 fund.

For general information about the exemption, see the Department of Health website: Supporting mental Health - Waiting period exemption for higher benefits

Benefit Limitation Periods

Before 1 July 2018 some private health insurers imposed benefit limitation periods (BLPs) of up to 24 months for some categories of hospital treatment. During a BLP, you are only entitled to restricted benefits for a particular condition or treatment for a set period of time.  Insurers have now ceased this practice.

For more information, see: Waiting periods


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
Changes for Norfolk Island residents

From 1 July 2016, residents of Norfolk Island will be eligible for Medicare benefits and will therefore also be able to purchase Australian private health insurance policies. Residents of Norfolk Island can purchase the same policies as residents of NSW.

Norfolk Island residents who are aged over 31 will have a 12 month grace period to purchase insurance without incurring a Lifetime Health Cover loading. If purchasing from or after 1 July 2017, a loading will apply.

For younger residents, they will have until their normal LHC base day of the 1 July following their 31st birthday to purchase insurance without incurring LHC loading.

For more information about changes to health and aged care arrangements from 1 July 2016, see the Department of Health's Information for residents of Norfolk Island

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 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 2017-18 financial year - You have until 30 June 2018 to purchase private hospital cover without incurring LHC ‘loading’. If you purchase hospital insurance from 1 July 2018 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 2017-18 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 have commenced or intend to commence 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 (Department of Human Services) or visit your local Medicare branch. Supply the letter to your health fund 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'm applying for a 457 or 485 visa; do I need private health insurance?

Yes. It is a condition of applying for a Visa Subclass 457 or 485 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 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 457 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.
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.
Private Health Insurance Reforms

The Australian Government announced on 13 October 2017 a wide ranging package of reforms to private health insurance. As part of the reforms, we are managing an upgrade to this website.

From 1 April 2019, health funds can choose to 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 will be removed from coverage.

Between 1 April 2019 and 31 March 2020, health funds may choose to offer hospital policies that fall under the tiers of Gold, Silver, Bronze, and Basic. From 1 April 2020, these tiers will apply to all hospital policies and all policy information will be presented in Private Health Information Statements (PHIS), which will replace the current Standard Information Statement (SIS).

Your health fund will contact you about any changes that affect your policy. We will be updating this website with more information as the Reforms progress. To find out more, please see Department of Health - Private Health Insurance Reforms 2017.


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