Private Health Insurance in Australia: Cover Options

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Review Private Health Insurance Options

Private health insurance can help with the cost of eligible hospital treatment and everyday healthcare services, depending on whether you choose hospital cover, extras cover or both. What you can claim depends on your policy, waiting periods and benefit limits.

Complete our private health cover enquiry form and we’ll connect you with an insurance broker who can discuss cover options and provide quotes.

Hospital and Extras Cover

• Hospital cover: Helps pay for covered treatment as a private patient in a public or private hospital. Check which treatment categories are included, restricted or excluded, and whether your chosen hospital has an agreement with your insurer.
• Extras cover: Helps pay for eligible services such as dental, optical and physiotherapy. Benefits, recognised providers and annual limits vary by policy.
• Combined cover: Includes hospital and extras cover, but each component has its own benefits and conditions. Consider whether you need both.

Why Private Health Insurance?

Private health insurance can complement Medicare, but it does not cover every healthcare expense. Potential benefits include:

• Help with eligible private hospital treatment costs, subject to your level of hospital cover.
• Private health insurance may offer greater flexibility in choice of doctor, depending on the treatment setting and policy.
• Private health cover may provide access to shorter waiting times for some treatments. Actual access depends on the treatment, doctor and hospital availability.

Compare Costs, Limits and Waiting Periods

Review private health insurance premium rates and policy terms to see if you might be able to save money on your premiums. Also compare excesses, co-payments, benefit limits and potential out-of-pocket costs: a lower premium may come with less cover or higher costs when you claim.

Check waiting periods before joining or upgrading cover, including those for pre-existing conditions and pregnancy-related treatment. Read the policy’s Private Health Information Statement and full terms for exclusions, restrictions and benefit limits. If switching policies, ask the new insurer which waiting periods already served will be recognised and whether any new waiting periods apply.

Before Treatment or a Claim

Ask your insurer to confirm whether the planned treatment is covered and what benefits are payable. Request cost estimates from the hospital and treating doctors, including any gap payments. For extras, check the provider is recognised, your remaining limits and the documents needed to claim.

Lifetime Health Cover

The Australian Government introduced Lifetime Health Cover in 2000, which can affect premiums depending on the age at which a person first takes out private hospital cover.

Generally, a Lifetime Health Cover loading may apply if you do not hold eligible hospital cover by 1 July following your 31st birthday and take it out later. It applies to hospital cover, not extras cover. Special rules can apply, including for new migrants, time overseas and breaks in cover, so check how the rules apply to your circumstances.

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Please note that some of our calculators may use assumptions that are not necessarily applicable to your current specific circumstances and we therefore cannot always guarantee their accuracy. You should always seek professional financial advice from a licensed professional before proceeding with any financial recommendations.

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