Site map

This map of the PrivateHealth.gov.au website shows all sections and pages on the site. You can also use the search at the top right of this page to find information on the site.

  • Home
    • How Health Insurance Works

      How Private Health Insurance works in Australia.

      • Overview of Health System

        An overview of what is covered by private health insurance and what is covered by Medicare for hospital, medical services (general treatment), pharmaceutical benefits and ambulance.

        • What is covered by Medicare?

          Describes what is and what is not covered by medicare for hospital, medical and pharmaceutical benefits.

        • What is covered by private health insurance?

          Describes what is covered by private health insurance for ambulance, hospital and general treatment (also known as ancillary or extras) cover. Also covers what may not be covered owing to exclusions, restrictions or benefit limitation periods on your policy.

        • Ambulance

          Depending on which state you live you may need to organise ambulance cover to cover the costs of using an ambulance.

      • Private Health Insurance Basics

        Describes how health insurance works, the different levels (categories) of cover for both hospital and general treatment (ancillary/extras).

        • Product tiers

          Four new tiers of hospital cover will begin rolling out from early 2019 and will become mandatory from 1 April 2020. All hospital insurance policies will be classified as Gold, Silver, Bronze or Basic. All hospital treatments are now listed under clinical categories to describe what is and is not covered under each policy.

        • Clinical categories

          Details of what is and is not covered by the clinical categories, with links to their MBS item numbers.

        • General Treatments

          Definitions of some services covered under General treatment private health insurance in Australia.

        • Registered health insurers

          Overview of the operation of health insurers registered under the Private Health Insurance Act 2007 in Australia

        • Private Health Information Statements

          Private Health Information Statements provide a summary of the services covered under private health insurance policies in Australia.

        • Waiting periods

          Most private health insurance policies will have a waiting period associated with the services it covers, this means that when you take out the insurance you will have to serve the waiting period before you claim especially if you are claiming for treatment for a pre-existing condition.

        • Out of pocket expenses (gap cover)

          Explains what a 'gap' or out-of-pocket expense is for both hospital and medical treatment

        • Managing your policy

          You may be eligible for a discount on your premium or some insurers offer rate protection policies. You may be able to lower your premiums by choosing to not be covered for certain services (exclusions), receive limited benefits (restricted benefits), or to pay a set amount towards the costs of treatment (excess or co-payment).

      • Government Surcharges & Incentives

        Australian government incentives and surcharges for private health insurance.

      • Overseas Visitors & Overseas Students

        Students and visitors from overseas may be required, or should consider, to take out private health cover whilst visiting Australia.

        • Overseas Visitors Health Cover

          Visitors to Australia on a temporary visa are generally not eligible for free health care as resident of Australia are, you should consider taking out Overseas Visitors Health Cover to cover any medical costs while you are in Australia.

        • Overseas Student Health Cover

          Students from overseas may be required, or should consider, to take out private health cover whilst studying in Australia.

        • Working visa applicants

          Applicants for working visas - such as 482 and 485 visas - may be required to hold Overseas Visitors Health Cover.

      • Private Health Insurance Changes 2019

        From 1 April 2019, the Australian Government will introduce new rules to help make private health insurance simpler including Gold, Silver, Bronze and Basic hospital tiers, and standard clinical categories to describe what is and is not covered.

    • Health Insurers

      Policies, contact details & performance.

    • Compare Policies

      Find policies that match your needs.

    • Contact Us

      Got a question? Contact us today.

    • Frequently Asked Questions

      Frequently asked questions.

  • Compare policies

    This link in the footer redirects to the Compare page.

  • Agreement hospitals

    Insurers can negotiate agreements with hospitals to minimise out-of-pocket expenses.

  • Lifetime Health Cover calculators

    Calculators to help you determine the lifetime health cover (LHC) loading payable on your hospital cover.

    • Lifetime Health Cover calculator

      This calculator determines your Lifetime Health Cover loading.

    • Ten Years Continuous Cover calculator

      This calculator is for people who are already paying for hospital cover with a Lifetime Health Cover (LHC) loading. It will help you determine if you have paid a loading on your hospital cover for at least ten years.

  • Restricted insurers

    Restricted Insurers cover specific industries or groups.

  • Gap cover doctors

    Gap Cover Doctors may limit your out-of-pocket expenses.

  • MBS item numbers

    These pages list the MBS items associated with clinical categories, as well as common and support items.

    • Assisted reproductive services

      Hospital treatment for fertility treatments or procedures. For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).

    • Back neck and spine

      Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion. For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis.

    • Blood

      Hospital treatment for the investigation and treatment of blood and blood-related conditions. For example: blood clotting disorders and bone marrow transplants.

    • Bone joint and muscle

      Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.

    • Brain and nervous system

      Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.

    • Breast surgery

      Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.

    • Cataracts

      Hospital treatment for surgery to remove a cataract and replace with an artificial lens.

    • Chemotherapy, radiotherapy and immunotherapy for cancer

      Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

    • Dental surgery

      Hospital treatment for surgery to the teeth and gums. For example: surgery to remove wisdom teeth, and dental implant surgery.

    • Diabetes management

      Hospital treatment for the investigation and management of diabetes. For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections. Treatment for diabetes-related conditions is listed separately under each body system affected. For example, treatment for diabetes-related eye conditions is listed separately under Eye. Treatment for ulcers is listed separately under Skin. Provision and replacement of insulin pumps is listed separately under Insulin pumps.

    • Dialysis for chronic kidney failure

      Hospital treatment for dialysis treatment for chronic kidney failure.

      For example: peritoneal dialysis and haemodialysis.

    • Digestive system

      Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.

    • Ear nose and throat

      Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck. For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.

    • Eye

      Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket. For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.

    • Gastrointestinal endoscopy

      Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).

    • Gynaecology

      Hospital treatment for the investigation and treatment of the female reproductive system. For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.

    • Heart and vascular system

      Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system. For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.

    • Hernia and appendix

      Hospital treatment for the investigation and treatment of a hernia or appendicitis.

    • Hospital psychiatric services

      Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.

    • Implantation of hearing devices

      Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.

    • Joint reconstructions

      Hospital treatment for surgery for joint reconstructions. For example: torn tendons, rotator cuff tears and damaged ligaments.

    • Joint replacements

      Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.

    • Kidney and bladder

      Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example: kidney stones, adrenal gland tumour and incontinence.

    • Lung and chest

      Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest. For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.

    • Male reproductive system

      Hospital treatment for the investigation and treatment of the male reproductive system including the prostate. For example: male sterilisation, circumcision and prostate cancer.

    • Miscarriage and termination of pregnancy

      Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.

    • Pain management

      Hospital treatment for pain management that does not require the insertion or surgical management of a device. For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.

    • Pain management with device

      Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).

    • Palliative care

      Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.

    • Plastic and reconstructive surgery

      Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital. For example: burns requiring a graft, cleft palate, club foot and angioma.

    • Pregnancy and birth

      Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth. Treatment for the baby is covered under the clinical category relevant to their condition.

    • Skin

      Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included. For example: melanoma, minor wound repair and abscesses.

    • Sleep studies

      Hospital treatment for the investigation of sleep patterns and anomalies.

    • Tonsils adenoids and grommets

      Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.

    • Weight loss surgery

      Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure. For example: gastric banding, gastric bypass, sleeve gastrectomy.

  • Glossary

    Definitions of common terms used in private health insurance policies in Australia.

  • Ask a question

    You can ask a question of the Private Health Insurance Ombudsman (PHIO) using this online form.

  • Links

    Useful links for health insurance in Australia.

  • Brochures

    Brochures relating to private health insurance in Australia.

  • Privacy

    The privacy policy of PrivateHealth.gov.au.

  • Site map

    Sitemap for PrivateHealth.gov.au

  • About this site

    About PrivateHealth.gov.au.

  • Survey

    A short survey using Survey Monkey to ask users how they see the site.