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Health insurers criticised for using ‘loophole’ to raise prices

Australian private health insurers have been criticised for using a loophole to raise the prices of Gold Cover policies. This week the Commonwealth Ombudsman found evidence some insurers have been raising prices through ‘product phoenixing’ – closing existing policies to new customers, and creating almost identical policies at a higher price. As a result, new...

Aussies hit with higher out-of-pocket payments

Australians with Private Health Insurance are paying higher out-of-pocket payments for hospital treatment than a year ago, new data shows. The latest statistics from Australian Prudential Regulation Authority (APRA), which regulates the health insurance industry, show out-of-pocket fees for private hospital treatment increased by 8% in the 12 months from October 2023 to September 2024....

Aussies warned about ‘double dipping’ by medical specialists

If you’ve used health insurance to pay for surgery in a private hospital or clinic, check your bill to make sure you haven’t been charged a Gap incorrectly. That’s the advice from Private Healthcare Australia, the peak body for the health insurance industry, after allegations that some specialists (including surgeons and anaesthetists) have been ‘double...

NSW residents may face higher bill for health cover next year

A ‘health tax’ passed by NSW government last week means NSW residents could face higher premiums for health insurance in 2025. The new legislation means the state government can increase its existing tax on private health insurance if insurers do not agree to pay a higher ‘bed rate’ of $892 for private patients in public...

Premiums predicted to rise by $114 a year

Hospital Cover premiums could be set to rise, due to a ‘health tax’ introduced in NSW this week. The NSW Government has introduced laws to force private health insurers to pay the correct rate for single rooms in public hospitals. The government says some private health insurers have not been paying the correct rate, with...

Claims for private hospital procedures rise, APRA report finds

More and more Australians are seeking private hospital treatment, new data has shown. The latest statistics from industry regulator Australian Prudential Regulation Authority (APRA) revealed a 5.1% increase in hospital treatment episodes claimed on health insurance in the 12 months from July 2023 to June 2024. Health insurers paid more than $18 million in claims...

Aussies parents paying large Gaps for obstetric care

Australian women who choose to have their baby delivered by an obstetrician at a private hospital are paying alarmingly high out-of-pocket fees, it’s been revealed. According to Private Healthcare Australia (PHA), the peak body for the health insurance industry, obstetricians are charging as much as $650 for first consultations, a significantly higher fee than that...

Health insurers respond to Ozempic’s popularity

One private health insurer has reduced its cover for Ozempic amid a surge of popularity for the weight-loss drug. Last month, HBF, the largest health insurer in Western Australia, announced it was reducing rebates for Ozempic, saying the rise in claims had become unsustainable. So far, no other insurers have changed their position on the...

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Explore Overview

Guides Overview

Australian Health System (25 articles) Health Insurance Prices (20 articles) Private Health Insurance (31 articles) Private Health Insurers (15 articles) Medicare (28 articles) Medicare Benefits Schedule (MBS) (6 articles) Pharmaceutical Benefits Scheme (PBS) (8 articles) Public Hospitals (6 articles) Private Hospitals (6 articles) Medicare Levy (7 articles) Private Health Insurance Rebate (7 articles) Age-based Discount (5 articles) Lifetime Health Cover Loading (11 articles)

Hospital Cover (9 articles) Extras Cover (5 articles) Ambulance Cover (5 articles) Excluded Treatments

Insurers Overview

AAMI Health Insurance

AIA Health Insurance

Allianz Care Australia

APIA Health Insurance

Astute Simplicity Health

Australian Unity

Bupa Health Insurance

Emergency Services Health

Health Partners

Hunter Health Insurance (by CDH Benefits Fund)

ING Health Insurance

Latrobe Health Services

Mildura Health Fund

Nurses and Midwives Health

Phoenix Health Fund

Priceline Health Insurance

Qantas Insurance

Queensland Country Health Fund

Real Health Insurance

Reserve Bank Health Society (RBHS)

Seniors Health Insurance

St Lukes Health

Suncorp Health Insurance

Teachers Health

Territory Health Fund

Transport Health

Westfund

Health insurers criticised for using ‘loophole’ to raise prices Aussies hit with higher out-of-pocket payments Aussies warned about ‘double dipping’ by medical specialists NSW residents may face higher bill for health cover next year Premiums predicted to rise by $114 a year Claims for private hospital procedures rise, APRA report finds Aussies parents paying large Gaps for obstetric care Health insurers respond to Ozempic’s popularity

Compare Overview

Calculate Cheapest Policy Search for a new policy based on your health cover needs and budget. We compare every insurer and every policy.

Compare Existing Policy Compare your existing policy with similar policies to meet your current health cover needs and budget. Compare every insurer and every policy.

compare existing policy

Calculate Rebate Discount & Loading Check if your health insurance premium decreases or increases by calculating your Government Rebate, Age-based Discount and Lifetime Health Cover Loading.

About Us Overview

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Our Contributors Overview

Stephen Treacey

Sophie Bartho

Vladimir Kundrat

Trudie McConnochie

Peter Kawecki

Loren Jaffe

Loren Jaffe Customer Engagement Australia

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Home Explore Guides Pharmaceutical Benefits Scheme (PBS)

Pharmaceutical Benefits Scheme (PBS)

Guide

How to claim a refund through the Pharmaceutical Benefits Scheme (PBS)

Reviewed and updated 3 April 2024

How do I claim a PBS refund if I have my Medicare Card?

If you have your Medicare Card, you can claim your PBS refund when you collect your medicines from the pharmacy with the prescriptions from your general practitioner (GP).

How do I get a PBS refund if I don’t have my Medicare Card?

You can claim a refund from the PBS even if you don’t have your Medicare or Concession Card when you buy a PBS medicine at the pharmacy.

Step 1:

Ask your pharmacist for an official receipt to claim a refund.

Step 2:

Download and complete the Patient Claim for Refund Pharmaceutical Benefits Scheme (PBS) form.

NEXT What is the Pharmaceutical Benefits Scheme (PBS) Safety Net?

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