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Lifetime Health Cover Loading (LHCL)
Key Points
- Lifetime Health Cover (LHC) Loading: Adds 2% to hospital premiums for every year after age 31 without private hospital cover.
- Maximum LHC Loading: Capped at 70% and lasts for 10 years once applied.
- Scope of LHC Loading: Applies only to hospital cover, not extras cover.
- Couples’ Loading Calculation: The LHC loading is averaged between both partners’ individual loadings.
- Cost of Delayed Cover: Postponing private hospital cover can result in thousands of dollars in additional costs due to LHC loading and annual premium hikes.
- Avoiding LHC Loading: Taking out hospital cover before turning 31 completely eliminates LHC loading.
- Maintaining Cover: You can maintain continuous hospital cover with a gap allowance of up to 1,094 days to avoid LHC penalties.
- Special Considerations for New Migrants: New migrants’ LHC base day is tied to their Medicare registration date, offering specific flexibility.
- Removal of LHC Loading: LHC loading is removed after 10 years of continuous hospital cover.
What Is Lifetime Health Cover (LHC) Loading?
Lifetime Health Cover (LHC) Loading is a government initiative designed to encourage Australians to take out private hospital insurance earlier in life. Introduced on July 1, 2000, this policy rewards individuals who secure private health cover before turning 31 and imposes penalties on those who delay. But why does the government encourage early adoption of private health insurance?
The answer lies in the balance of our healthcare system. Australia has a dual healthcare system consisting of public and private sectors. While the public system provides care for everyone, it often faces challenges like long waiting times for elective procedures and restricted access to certain treatments. By incentivizing more Australians to take up private hospital cover, the government aims to reduce the strain on public healthcare resources, allowing for better access to treatments and services.
How Does LHC Loading Work?
If you delay taking private hospital cover beyond July 1 after your 31st birthday, your premiums will increase by 2% (LHC Loading) for every year you delay, up to a maximum of 70%. Once applied, this additional cost stays on your premium for 10 years.
Why Understanding LHC Matters
Learning how LHC Loading works and how to avoid it can help you make smarter decisions about your health insurance, saving you thousands of dollars in the long run. At Compare Your Health, we’re here to break it down and guide you toward the right choices.
Take control of your health insurance today and let us help you navigate the complexities of LHC Loading with ease.
How Does Lifetime Health Cover (LHC) Loading Work?
LHC Loading is a financial penalty designed to motivate Australians to take out private hospital insurance before turning 31. For every year you delay getting hospital cover after your 31st birthday, an additional 2% loading is applied to your premium, up to a maximum of 70%. Once applied, the loading remains in effect for 10 years.
Breaking It Down with an Example
If you take out private hospital insurance at 35, you’ll pay an extra 10% on your base premium compared to someone who had coverage before turning 31. The longer you wait, the more you’ll pay:
At 40, your loading is 20%.
At 50, it’s 40%.
These percentages might not seem like much at first, but the costs add up quickly.
For instance:
A single person in NSW taking out a Silver Hospital Plan with a $500 excess at age 35 would have a base premium of $182.66 per month.
With a 10% LHC loading, they’d pay an additional $18.27 per month, or $438.38 annually.
Over 10 years, that’s an extra $4,383.84—without accounting for premium increases.
The Impact of Premium Increases
Health insurance premiums typically rise annually due to inflation and healthcare costs, with average increases of 2-4% per year. A modest 3% annual increase could mean paying over $5,000 extra in loading over 10 years.
Important Considerations
Hospital vs. Extras Cover: LHC Loading applies only to hospital cover. If you only have extras cover (e.g., dental or optical) without hospital coverage, you’ll still incur LHC loading penalties.
Delaying Can Be Costly: Every year you postpone hospital cover can significantly impact your long-term healthcare costs.
At Compare Your Health, we make understanding and managing LHC Loading easy. Our comparison tools help you find the right hospital policies to avoid or minimize these penalties and save on your premiums. Don’t wait—start comparing now!
Who Is Affected by Lifetime Health Cover (LHC) Loading?
LHC Loading impacts Australians who don’t take out private hospital insurance by July 1 following their 31st birthday. Starting from that point, an additional 2% loading is added to your health insurance premium for every year you delay getting hospital cover, up to a maximum of 70%. Even after securing coverage, the accumulated loading will stay on your premium for 10 years.
Let’s explore how LHC Loading affects different groups:
Individuals (30+)
For individuals, the LHC Loading is straightforward:
- If you don’t have hospital cover by July 1 after your 31st birthday, you’ll incur a 2% loading for every year you delay.
Example:
Luke, aged 35, decides to take out private hospital insurance. Since he delayed coverage for 4 years, he incurs a 10% loading.
- Base Premium: $1,500 per year.
- Loading: 10% of $1,500 = $150.
- Total Annual Premium: $1,650.
Over 10 years, Luke will pay an extra $1,500 in loading—assuming no premium increases.
Couples
For couples, LHC Loading is calculated as the average of both partners’ loadings.
Example:
Layla and John recently took out a joint hospital policy.
- Layla has had private hospital cover since she was 28, so her loading is 0%.
- John, aged 41, never had cover and incurs a 22% loading (11 years overdue).
- Their combined loading is the average of 0% and 22%, or 11%.
This 11% increase is applied to their joint premium and split between the two partners.
Families
In families, LHC Loading applies only to the adult members of the household. Children are exempt from the loading and do not affect the surcharge.
Example:
When Layla and John add their child to their family policy, their LHC Loading remains 11%, as it only applies to the adults. However, their total premium will increase to account for the added family member.
Key Takeaway
Delaying private hospital cover beyond July 1 after your 31st birthday increases premiums across all policy types—singles, couples, and families. The best way to avoid LHC Loading is to secure hospital cover before this milestone.
How to Avoid or Minimize LHC Loading
Lifetime Health Cover (LHC) Loading impacts those who don’t have private hospital insurance by July 1 after turning 31. Thankfully, there are two simple ways to avoid or reduce this additional cost:
Taking out private hospital cover early
Maintaining continuous cover
Let’s explore how these strategies can save you money:
1. Take Out Private Hospital Cover Before 31
The best way to avoid LHC Loading entirely is to ensure you have hospital cover by July 1 following your 31st birthday. If you miss this deadline, you’ll be charged a 2% loading for every year of delay, up to a maximum of 70%.
If you secure hospital cover before turning 31, you’ll avoid any LHC Loading and pay only your standard premium.
Extra Savings with a Young Persons Discount
If you’re aged 18–30, you might also qualify for a Young Persons Discount, which can reduce your premiums by up to 10%. This discount decreases gradually from age 41 but provides great savings for young policyholders who maintain continuous coverage.
2. Maintain Continuous Hospital Cover
Even after securing hospital cover, it’s essential to keep your policy active to avoid future LHC Loading. If your cover lapses for an extended period, you’ll incur additional loading when you reapply.
The government allows a “permitted gap” of 1,094 days (roughly 3 years) over your lifetime, where you can pause or drop your cover without penalty. However, exceeding this gap will result in a 2% loading for every year without cover.
Key Tip: Avoid Lapses in Cover
Life can be unpredictable, and financial or policy changes might tempt you to drop your hospital cover. However, even maintaining basic hospital cover can protect you from future LHC penalties.
By keeping your policy active, you avoid compounding costs and ensure continued access to private healthcare benefits.
LHC Loading Myths: Debunked
There’s a lot of confusion around Lifetime Health Cover (LHC) Loading. Let’s bust some common myths so you can make informed decisions about your health insurance.
Myth 1: LHC Loading is Permanent
Fact: LHC Loading is not for life. While the loading applies if you delay taking out private hospital cover, it only lasts for 10 years. After that, you’ll return to paying your normal premium without the added cost.
Myth 2: Extras Cover Can Reduce LHC Loading
Fact: Extras cover (e.g., dental, optical) does not impact LHC Loading. LHC Loading only applies to hospital cover, not extras policies. Even if you have extras cover, it won’t help you avoid the loading. Only taking out private hospital insurance counts toward avoiding or reducing LHC Loading.
Key Takeaways
- To avoid LHC Loading, take out hospital cover before 31 and maintain it.
- If you’re hit with LHC Loading, remember it only lasts for 10 years.
- Extras cover is great for specific health services, but it won’t reduce your LHC Loading.
Long-Term Effects of LHC Loading
The financial impact of Lifetime Health Cover (LHC) Loading can be significant if you delay taking out private hospital cover. For every year you wait after July 1 following your 31st birthday, a 2% loading is added to your premium. While it might seem small initially, these additional costs can accumulate quickly over time.
Example of the Long-Term Costs
Let’s look at an example to understand the long-term effects.
- Scenario: A single person in NSW takes out private health insurance for the first time at age 50.
- LHC Loading: This person will have 20 years of delayed cover, which results in a 40% LHC loading on their premiums.
Let’s assume they choose the nib Silver Hospital policy with a $500 excess and a base premium of $182.66 per month. With the 40% loading, they will pay an additional $73.06 per month due to the LHC.
- Annual extra cost: $876.76
- Total over the 10-year loading period: $10,521
And keep in mind, this example doesn’t include the typical annual premium increases (usually 2-4% per year), which can raise the total cost even further.
The Cost of Delaying vs. Acting Early
If the same person had secured hospital cover before turning 31, they would have avoided the LHC loading altogether. That means thousands of dollars in savings over the years.
Key Takeaways
Delaying hospital cover can lead to significant additional costs due to LHC Loading.
LHC Loading applies a 2% penalty per year of delay, up to a maximum of 70%.
By acting early and taking out hospital cover before 31, you can save thousands of dollars in the long run.
At Compare Your Health, we make it easy to find the best hospital cover to suit your needs and avoid costly LHC penalties. Start comparing today to save on premiums and avoid unnecessary long-term costs!
Benefits of Private Hospital Cover Beyond LHC Loading
While avoiding LHC Loading is a key reason to get private hospital insurance early, there are many other advantages to having private cover that can significantly enhance your healthcare experience.
1. Shorter Waiting Times
Public hospitals can have long waiting times for elective surgeries and non-emergency procedures. With private health cover, you gain access to faster treatment options and shorter waiting times, ensuring you receive timely care when needed.
2. Choice of Doctor
One of the standout benefits of private hospital cover is the ability to choose your doctor or specialist. Whether you have a trusted healthcare provider or require ongoing specialist care, private cover gives you the freedom to select the medical professionals you prefer.
3. Private Room Options (Where Available)
Unlike public hospitals, where you may need to share a room, private hospital cover gives you the option to stay in a private room when available. This added comfort is especially valuable for overnight stays or if you need a more personal and quieter environment for recovery.
4. Tax Benefits
Holding private hospital cover can help you avoid the Medicare Levy Surcharge, a tax that applies to Australians who earn above a certain income and don’t have hospital cover. This provides an additional financial incentive to maintain your hospital insurance and avoid the surcharge.
In Summary:
Taking out private hospital cover early not only saves you from LHC Loading but also provides numerous benefits that enhance your healthcare experience and financial security. From faster treatment and access to specialists to potential tax savings and extra comfort during hospital stays, private hospital cover is a smart choice for your health and well-being.
Exemptions and Special Circumstances
While Lifetime Health Cover (LHC) loading applies to most Australians who delay taking out private hospital cover beyond age 31, there are some exemptions for certain groups. Let’s explore these special circumstances where LHC loading doesn’t apply.
1. Australian Defence Force (ADF) Members
Active members of the Australian Defence Force (ADF) are exempt from LHC loading. Since ADF members receive health cover through the military, they do not need private hospital cover to avoid the loading. As long as they are in active service, LHC loading won’t be a concern.
2. Department of Veterans Affairs (DVA) Gold Cardholders
If you hold a DVA Gold Card, you are also exempt from LHC loading. The Gold Card provides full medical services, so veterans with this card are not required to take out private hospital insurance to avoid the LHC surcharge. The government recognizes the healthcare entitlements of DVA Gold Cardholders, offering this exemption.
3. Born Before 1st July 1934
Anyone born on or before 1st July 1934 is legally exempt from LHC loading. This exemption was created for older Australians who may not have had the opportunity or need to take out private health insurance earlier in life. Regardless of when or if they choose to take out hospital cover, those born before this date are not subject to LHC penalties.
In Summary:
While most Australians need to be mindful of LHC loading, certain groups such as ADF members, DVA Gold Cardholders, and those born before 1934 are exempt from this financial penalty. These exemptions help ensure that specific individuals or groups, with unique circumstances, are not unfairly impacted by LHC loading.
Special Circumstances: “Days of Absence”
If you’re not part of an exempt group, the Days of Absence rule offers flexibility by allowing you to temporarily pause your private hospital cover without incurring LHC loading. This rule enables you to go without hospital cover for up to 1,094 days (roughly three years) without facing any additional costs.
Here’s how it works:
How the Days of Absence Rule Works
- Eligible Period: If you have had private hospital cover on or after your LHC Base Day (the 1st of July following your 31st birthday), you can temporarily drop your cover without penalties, provided the total time without cover does not exceed 1,094 days. This period allows for a reasonable gap without facing the LHC surcharge.
- Spread or Use All at Once: You have the option to use these 1,094 days in one go or spread them out over your lifetime. This provides flexibility in managing your health cover based on personal or financial circumstances.
- Exceeding the Limit: If your break from private hospital cover exceeds the 1,094 days limit, LHC loading will apply. For every additional year you go without cover, a 2% LHC penalty will be added to your premiums for the following 10 years.
In Summary:
The Days of Absence rule offers valuable flexibility by allowing you to pause your hospital cover for up to 1,094 days without incurring LHC loading. If you exceed this period, the 2% penalty for each additional year without cover will apply. It’s important to manage your cover carefully to avoid future costs and ensure that your healthcare needs are met.
Overseas Considerations
If you’re planning extended travel overseas and need to suspend your health insurance, the time spent abroad won’t count towards the 1,094 Days of Absence rule if your trip exceeds 12 months. However, once you return to Australia and stay for more than 90 consecutive days, the clock on your Days of Absence starts again, which means your period of absence is reset, and you can use the remaining days of absence as allowed under the rule.
New Migrants to Australia
For new migrants to Australia, the Lifetime Health Cover (LHC) loading rules are slightly different when you first gain access to Medicare. Your LHC base day, which is the deadline by which you must take out hospital cover to avoid LHC loading, will be whichever of the following dates is later:
The 1st July after your 31st birthday, or
The first anniversary of your full Medicare registration.
This gives you time until your LHC base day to take out hospital cover without incurring the LHC loading, which applies a 2% penalty for each year you delay getting hospital insurance after that date.
Example: New Migrant
Take the case of Diya, a new migrant to Australia:
- Diya registered for full Medicare benefits on June 15, 2023, and turned 31 on February 20, 2024.
- Diya’s LHC base day would be July 1, 2024, since it’s the later of the two dates (his 31st birthday and his Medicare registration).
If Diya doesn’t take out hospital cover by July 1, 2024, he will incur LHC loading at a rate of 2% for each year he delays taking out private hospital insurance after this base day.
For example, if Diya waits until 2029 at age 36 to take out hospital cover, he will be subject to a 12% LHC loading (2% for each of the 6 years of delay). If he chooses a policy like the nib Silver Hospital with a base premium of $182.66 per month, the 12% loading would add an additional $21.92 per month, or $263.01 per year, amounting to an extra $2,630.10 over the 10-year LHC loading period.
Migrants Returning from Overseas
For new migrants who are overseas on their LHC base day and return to Australia after the deadline has passed, the rules are a little different. In this case, they have 12 months from the date of their first return (for a stay of 90 days or more) to take out hospital cover and avoid LHC loading. This means their first long-term return anniversary becomes their new LHC base day.
Example: Migrant Returning from Overseas
If Diya was overseas on his LHC base day and returned to Australia on August 5, 2025, his new LHC base day would be August 5, 2026. Diya would have until August 5, 2026 to take out hospital cover and avoid LHC loading. If he meets this deadline, he won’t incur the additional premium costs from LHC loading.
Summary
Overseas travel for more than 12 months doesn’t count towards the 1,094 Days of Absence rule, but upon returning to Australia and staying for 90 days or more, your absence period resets.
For new migrants, your LHC base day depends on whether it’s the 1st July after your 31st birthday or the first anniversary of your Medicare registration, whichever is later. Delaying cover past your base day incurs a 2% LHC loading per year of delay.
Migrants returning from overseas also have 12 months from their return date to take out hospital cover and avoid LHC loading.
LHC Loading Removal
Once LHC loading is applied to your hospital cover premium, it doesn’t last forever. LHC loading is removed after 10 continuous years of holding hospital cover. However, if you have any breaks in coverage during that time, it can reset or extend the period you’ll need to pay the loading. Here are three scenarios to explain how this works in different situations:
1. Example: 10 Years of Continuous Cover
Sarah takes out hospital cover at 35 and incurs a 10% LHC loading. She keeps her hospital cover for 10 years without any breaks in between.
Premium Details:
- Sarah’s base premium is $150 per month.
- The 10% LHC loading adds $15 per month, making her total premium $165 per month.
After 10 years of continuous hospital cover, Sarah’s LHC loading is removed, and she now only pays the base premium of $150 per month.
2. Example: Break in Cover After 5 Years
David takes out hospital cover at 35 and incurs a 10% LHC loading. He keeps his cover for 5 years, but then he decides to take a 1-year break from health insurance. After that, he takes out hospital cover again for 6 years.
How the Loading Period Works:
- After 5 years, David has completed half of the 10-year loading period.
- When he drops his coverage for 1 year, he uses part of the 1,094 Days of Absence rule (approximately three years) without penalty.
- After rejoining, the remaining 6 years of coverage count towards the 10-year period to remove the loading.
Conclusion:
- David will have to pay the 10% LHC loading for 11 years total due to his 1-year break in cover, meaning it will take an extra year for his loading to be removed.
3. Example: Longer Break in Cover
Emily incurs a 10% LHC loading when she takes out hospital cover at 35. She keeps her cover for 8 years, but then she drops her coverage for 4 years and exceeds the allowed 1,094 days of absence.
How the Loading Period Works:
- After 8 years, Emily is well on her way to completing the 10-year LHC loading period.
- However, her 4-year break in coverage exceeds the allowed absence period.
- When Emily reactivates her hospital cover after the break, her LHC loading period resets because the absence was too long.
- The 8 years of coverage she previously had will no longer count towards removing the LHC loading.
Conclusion:
- Emily will now need to maintain 10 continuous years of hospital cover again to remove the 10% LHC loading. This means she will pay the loading for an additional 10 years, adding significant costs to her premiums.
Summary:
- Continuous coverage for 10 years is needed to remove LHC loading, but breaks in coverage can interrupt this process.
- Short breaks (such as 1 year) can add extra years to your loading period.
- Long breaks (over 1,094 days) reset the loading period entirely, and you’ll need to start from scratch.
Frequently Asked Questions (FAQs)
Does LHC Loading Apply to Extras Cover?
No, LHC loading does not apply to extras cover. LHC loading is only tied to hospital cover. Even if you have extras cover (which includes services like dental, optical, or physiotherapy), it will not help you avoid LHC loading. To avoid the loading, you must have private hospital cover (or a combined hospital and extras policy) before your LHC base day, which is generally the 1st of July following your 31st birthday. Having only extras cover will not affect your LHC status.
Will I Still Pay LHC Loading If I Cancel My Hospital Cover?
Yes, if you cancel or drop your hospital cover for an extended period, you will be subject to LHC loading when you rejoin. The government allows a 1,094-day gap (approximately 3 years) over your lifetime, meaning you can be without hospital coverage for this period without penalty. However, if you exceed this gap, LHC loading will apply when you re-join your cover. It’s important to keep track of how many days you’ve been without hospital insurance because exceeding the limit will reset the LHC loading. This will result in an extra 2% charge for each additional year without cover.
How Does LHC Loading Work for Couples?
For couples, the LHC loading is calculated separately for each individual and then averaged for the couple’s joint policy. For example:
- Layla has had hospital cover since she was 28, so her LHC loading is 0%.
- John, who is 41 and has never had hospital cover, has a 22% LHC loading (2% per year for 11 years).
When Layla and John take out a couples’ hospital policy, their combined LHC loading will be the average of their individual loadings. In this case, the average loading is 11% (which is the middle ground between 0% and 22%). This 11% loading will be applied to their joint premiums.
New Migrants to Australia and LHC
New migrants to Australia need to be aware of LHC loading, which applies from their LHC base day. The base day for new migrants is the later of:
- The 1st of July following your 31st birthday, or
- The first anniversary of your full Medicare registration (the date you are granted full or interim Medicare benefits with a blue or green Medicare card).
For example:
- If you register for full Medicare on 15 June 2024 and you are over 31, your base day would be 1 July 2025. You would need to have hospital cover before this date to avoid LHC loading. If you don’t take out hospital cover by this date, you’ll incur 2% loading for each year after your base day until you join a hospital cover policy.
How Compare Your Health Can Help
In Australia, there are over 50 different health funds offering a wide range of policies to help you avoid paying the LHC loading, each with unique benefits and coverage options. At Compare Your Health, we make navigating these choices easier. Our comparison tool is designed to help you find the best health fund policy that suits your needs and budget.
By using our tool, you can potentially save thousands of dollars that you would otherwise spend on LHC loading. The goal is to help you choose a health fund that not only helps you avoid unnecessary extra costs but also provides the coverage you need for your health and well-being.
In this article, we’ll guide you through everything you need to know about hospital-only cover, the advantages of getting the right health cover, and more. Let’s dive in!
Compare Now
In summary, LHC loading is an additional expense that can be easily reduced or avoided if you plan ahead. All you need to do is get and maintain hospital cover. To help you with this, Compare Your Health offers a powerful health insurance comparison tool. With this tool, you can compare policies, costs, and providers to find the best plan for your needs.
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Frequently Asked Questions
Depending on the policy, private health insurance can help cover the cost of your medical treatments in or out-of-hospital that Medicare sometimes won’t cover. Out of hospital treatment can include services such as Dental, optical, physiotherapy or even remedial massage
Private health insurance can help cover medical treatment received when hospitalised. Therefore, it is important to select the right level of cover for the clinical categories that are necessary to you.
Your private health insurance should change as often as needed to ensure you are covered at all the different stages of your life.
Also, private health insurance gives you the ability to choose your own doctor and avoid any public waiting lists for categories covered by your policy.
There are many top competing health funds, however you want to find one that is best suited to your individual health requirements and not just a health fund that is the best in the market.
This can sometimes be a difficult task for individuals, therefore companies like Health.Compare can offer comparisons of different health insurance policies to help you choose a policy that is catered to your health circumstances and budget.
Excess is the amount you pay upfront to cover some of the hospitalisation expenses if you ever get hospitalised. The higher the excess, the lower your private health insurance premiums will be. This usually applies to people with relatively lower health concerns who do not see themselves being in hospital anytime soon and in the event that they are hospitalised, they can agree to pay a higher excess, ultimately reducing their regular premiums.
Please be aware that excess amounts do vary depending on the health insurance provider, so it may be beneficial for you to consider your individual health and financial circumstances at the time of buying the insurance policy before agreeing to the Excess amount.
In Australia, health insurance is not tax deductible however you can receive rebates for your private health insurance. When taking out Private Health Insurance you choose whether or not to claim a rebate from the government. The government rebate is dependent on a number of factors including age and taxable income.
This can be applied to Hospital, Extras or combined products.
According to a recent report by APRA, 55.2% of Australians have extra cover, and 45.2% have hospital cover. These are the verified figures as of June 2022.
While the average cost of private health insurance adds up to $160 per month per person, your premiums may go up or down depending on the type of cover you choose or the excess amount you agree upon.
The starting point for many, is to look at your individual needs, preferences and financial circumstances.
We will help guide you through this conversation by first understanding and then matching your needs to a tailored level of cover. Ultimately, what’s best for you and your situation will be completely different to many others who are eligible for Private Health Insurance.
Yes you can have a private hospital insurance policy with one health fund and extras cover with another. This can be helpful as some funds might have a hospital policy you like, but not the extras cover you require for the specific out-of-hospital treatments.
Private health insurance provides many benefits to its members giving them access to a wide choice of health providers, faster access to medical services and the ability to avoid long wait times experienced in the public hospital system. In this FAQ we will answer some of the common questions about private health insurance.
What are the benefits of having private health insurance?
- Access to private hospitals and faster treatment times
- A wider range of treatment options
- Ability to choose your own doctor and hospital
- Reduced out-of-pocket expenses
- Access to many health services and treatments not covered by the public system
Can I choose my own doctor and hospital if I have private health insurance?
Yes, with private health insurance you have the ability to choose your own doctor and hospital, giving you greater control over your health care to achieve a better overall health outcome.
How can I choose the right private health policy for me?
When choosing private health insurance, there are a few factors to consider:
type of cover required (hospital or extras)
- your budget
- your age and pre-existing medical conditions
- the level of cover required
- the range of health services you need to be covered for
Why should I get extras cover?
extras cover will give you further coverage on a range of treatments such as dental, optical, chiropractic, massage and physiotherapy.
some extras health policies also include further natural therapies such as acupuncture and Chinese medicine
How much does private health insurance cost?
The cost of a health policy in Australia varies depending on what type of cover you choose, your age, if you have any dependents and any pre-existing conditions. On average, the cost of private health insurance is around $2,000 per year for an individual and $4,000 per year for a family.#
In Australia, private health insurance is available to provide financial protection and contribution to medical expenses, but not all medical expenses are covered by your private health policy. In this FAQ we will explain the questions you have around what is typically covered and what’s not covered with private health insurance.
What is not covered by standard private health insurance?
The most common exclusions from private health insurance policies in Australia include:
- Elective cosmetic operations, such as cosmetic surgery and cosmetic dentistry
- Weight loss surgery, unless it is deemed medically necessary
- Infertility treatments, such as IVF
- Alternative therapies, such as homeopathy, aromatherapy, kinesiology, reflexology and iridology
- Mental health services, such as counseling and psychotherapy, unless they are part of a hospital treatment plan
- Non-medical services, such as transportation and accommodation for medical treatment
- International travel for medical treatment
- Experimental treatments or procedures that are not yet widely accepted or covered by Medicare
Does private health insurance cover dental services?
No, private health insurance does not generally cover routine dental services, such as check-ups, cleanings, and fillings. However, some private health insurance policies may offer coverage for more extensive dental procedures, such as orthodontics and oral surgery, that are performed in a hospital setting.
Does private health insurance cover optometry services?
Similar to dental, optometry services are not covered by private health insurance such as eye examinations although prescription glasses and contact lenses are covered by private health extras policies.
Am I covered for ambulance services?
Not all private health policies cover individuals for ambulance services. However, some states in Australia automatically cover policy holders through their state or territory.
Will my private health policy cover prescription drugs?
No, private health insurance policies in Australia do not cover prescription drugs. Prescription drugs are covered by the Pharmaceutical Benefits Scheme (PBS), which is a government-funded program.
In conclusion, it’s important to understand what is not covered under your policy to avoid any surprises when you need to make a claim. While most health insurance policies provide coverage for a wide range of medical expenses, there are still some things that are not covered, and it is important to understand these exclusions.
So, you have private health insurance and want to know how much you might have to pay for medical treatments out of your own pocket? We’ve got you covered with our easy guide FAQ.
What does ‘no gap’ mean when it comes to private health insurance?
Basically, it means that you won’t have to pay anything out of your own pocket for certain medical services, these are covered by your private health insurance. It’s the difference between what your doctor or hospital charges and what Medicare and your private health fund will pay and it’s known as the ‘gap’. With a ‘no gap’ arrangement, your insurance will cover the full cost of the service.
So, I won’t have to pay anything extra?
That’s right! With the ‘no gap’ arrangement, you won’t be left with any unexpected bills to pay. Your private health insurance will cover the full cost of the medical service, so you can focus on your health and recovery.
How does it work?
To be eligible for a ‘no gap’ service, you’ll need to use a provider who is part of your private health insurance provider’s ‘preferred provider’ network. This means that the provider agrees to charge you a set fee for a particular medical service, and your private health insurance will cover this fee in full. This way, you can be sure that you won’t have to pay anything out of your own pocket.
Can I get ‘no gap’ for any medical procedure?
Unfortunately, ‘no gap’ is only available for some medical services, and only if you use a provider who is part of your private health insurance provider’s ‘preferred provider’ network.
Is ‘no gap’ the same as ‘bulk billing’?
No, they’re not the same thing. ‘Bulk billing’ is when medical providers bill Medicare directly for their services, so you don’t have to pay anything out of your own pocket. ‘No gap’ is a service that’s offered by private health insurance providers, and it covers the full cost of certain medical services.
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