Private Health Insurance Frequently Asked Questions

Learn more about the different aspects of private health insurance, from hospital and extras cover, to waiting periods, rebates and surcharges.
Family sitting together in living room

Health Insurance

What is private health insurance?

What does private health insurance cover?

How does private health insurance work?

Which health insurance is the best?

Why should I take out private health insurance?

Who offers health insurance in Australia?

How many Australians have health insurance?

Public vs. private health insurance comparison

Can I check how Australian health funds are performing?

Is private health insurance worth it?

What happens if I don't have health insurance?

Why is health insurance important?

What impacts the cost of health insurance?

Can I claim health aides (Eg: orthotics) and health improvement services on private health insurance?

What is a Private Health Information Statement (PHIS)?

What are Fund Rules?

What is a recognised provider?

Hospital Cover

How does hospital cover work?

Why should I get Hospital Cover?

What are the private health insurance product tiers?

What is an excess and a co-payment?

Am I likely to pay an out-of-pocket cost above my excess or co-payment for medical costs?

What does ‘no gap’ mean in health insurance?

Do I have to wait to claim? What is a pre-existing condition in health insurance?

What is an excess?

Does health insurance cover home nursing?

Does hospital cover provide coverage for rehab and chemo at home?

Can I claim weight loss surgery on private health insurance?

Does private health cover insulin pumps?

Does private health insurance cover X-rays, ultrasounds, and other preventative tests?

Does private health insurance cover out patients specialists’ consultations?

Are youth discounts available for those aged 18-29?

What’s the Private Patients Hospital Charter?

Extras Cover

How does Extras cover work?

What's the difference between routine, complex and major dental?

Are braces covered by health insurance?

Is Invisalign covered by private health insurance?

Are veneers and teeth whitening covered by private health?

Are dental implants covered by private health insurance?

Does Medicare cover dental treatment?

Does Medicare cover wisdom tooth removal?

What is gap free preventative dental?

Can I claim pharmacy with my health insurance?

Can I claim wellness programs and gym membership with my health insurance?

Does private health insurance cover hearing aids?

Health Insurance Waiting Periods

What is a waiting period?

How can I avoid health insurance waiting periods?

Do I have to reserve waiting periods if I switch funds?

How long will I have to wait before I'm eligible for dental/optical/chiro/physio services?


Should I buy private health insurance for pregnancy?

What is the waiting period for pregnancy cover?

Which type of health insurance covers pregnancies?

Is my baby also covered under a pregnancy policy?

If I'm planning a family, when do I need to take out health insurance for pregnancy?

Does private health insurance cover IVF treatments?

The Medicare Levy Surcharge (MLS)^

What is the Medicare Levy Surcharge?

Do I have to pay the Medicare Levy Surcharge?

What is the difference between Medicare Levy and Medicare Levy Surcharge?

How can I avoid the risk of paying the Medicare Levy Surcharge?

^This should be treated as general information only, for specific tax advice it’s recommended you speak with an accountant or financial advisor.

Lifetime Health Cover Loading (LHC)

What is Lifetime Health Cover Loading?

Is the private health insurance rebate applicable to the Lifetime Health Cover (LHC) loading on health insurance premiums?

I've just turned 30; do I have to purchase private health insurance?

I've just become a permanent resident; can I purchase private hospital cover without Lifetime Health Cover loading?

I’ve just received a letter about Lifetime Health Cover. What do I need to do?

Health Insurance and Tax

What is the Medicare levy?

Is private health insurance tax deductible?

How can I claim the Australian Government Rebate on private health insurance?

What happens if I nominate an incorrect rebate tier?

Do I need to let my health fund know what my income is to determine my rebate tier?

What happens if my or my family’s income changes from one tier to another during the financial year?

What's Savings Provision Entitlement?

What is a Medicare levy exemption?

What is a Medicare entitlement statement?

What is the Private Health Insurance Australian Government Rebate?

Who should claim a private health insurance Australian Government Rebate?

Ambulance Cover

What is ambulance cover?

What insurance covers ambulance?

How can I get the Ambulance Levy Exemption?

Does Medicare cover ambulances? If not, how am I covered?