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 costs

    Explains what a 'gap' or out of pocket cost is for both hospital and medical treatment and what you can do

  • 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.

  • Australian Government Private Health Insurance Rebate

    Describes what the private health insurance rebate is and how to claim it.

  • Age-based Discount

    An age-based discount may be available to people between 18 & 29 years-old who take out private health insurance.

  • Lifetime Health Cover

    Details of the Lifetime Health Cover loading and how it works.

  • Medicare Levy Surcharge

    Details of the Medicare Levy Surcharge.

• 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

  In 2019 the Australian Government introduced 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. Further changes were introduced in 2021.