Private Health Insurance in Australia

What is Private Health Insurance?

Private health insurance covers costs that Medicare doesn’t cover. It helps pay for private hospital treatment, specialist visits, and extras like dental and physiotherapy.

Medicare vs Private Health Insurance

Medicare covers:

• Public hospital treatment
• GP visits
• Pathology and diagnostic imaging
• Prescription medicines

Private health insurance covers:

• Private hospital treatment
• Extras (dental, physio, glasses)
• Specialist consultations (depending on cover)
• Some services Medicare doesn’t cover

Types of Private Health Insurance

Hospital Cover:

• Covers private hospital admission
• Different levels of cover (basic to comprehensive)

Extras Cover:

• Covers dental, physiotherapy, optical, etc.
• Not connected to hospital treatment

Combined Cover:

• Includes both hospital and extras

Your Rights

When claiming:

• You have the right to transparent information
• Insurer must respond to complaints
• If unhappy, you can go to AFCA (Australian Financial Complaints Authority)

Before canceling:

• You may lose your Lifetime Health Cover loading
• Coverage gaps can result in waiting periods

Important Dates

• Lifetime Health Cover loading starts at age 30 and increases with age
• Annual renewal date for your policy
• Medicare levy surcharge applies if not insured at certain income levels

When to Get Professional Help

If your claim is denied or you’re unhappy with the outcome, contact AFCA or seek legal advice.

Resources

• Private Health Insurance Ombudsman: phio.org.au
• AFCA: afca.org.au
• Health Insurance Providers Council: hipc.org.au