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Guides
Guide

Private Health Insurance

Reviewed and updated 9 May 2025

In this Guide, we provide an overview of Private Health Insurance in Australia, as well as answer your most common questions.

This Guide explains:

  • how Private Health Insurance works
  • how to work out whether you need Private Health Insurance and the best type of cover for you
  • some key concepts underlying Private Health Insurance:
  • how to manage your Private Health Insurance and how to make a claim.

Private health insurance explained

What is private health insurance?
Is private health insurance community rated or risk rated?
How does private health insurance work?
Do I need private health insurance?
Why don’t private health insurers cover the entire cost of treatments?
Will I get treatment faster if I have private health insurance?
What happens if I don’t have private health insurance?
What are private health insurance incentives?
What are private health insurance surcharges?
How much tax will I save with private health insurance?
What is the best way to compare private health insurance policies?

Managing your private health insurance

How to choose Private Health Insurance
What is a Private Health Information Statement (PHIS)?
What are private health insurance premiums?
What are private health insurance waiting periods?
Do waiting periods apply if I change health insurers?
What is an excess?
What is a co-payment?
What are out-of-pocket costs?
Do I have to pay out-of-pocket fees for treatments outside of hospital?
How can I avoid out-of-pocket costs?
How to make a private health insurance claim
What is informed financial consent?
What is a Medical Gap?
What is a Hospital Gap?
What is the Medical Gap Cover Scheme?
When does Private Health Insurance reset?
How do I know if I have a combined policy or separate policies?
What can I do if I have a problem with my Private Health Insurance?
How do I change to a different private health insurer?
How do I cancel my Private Health Insurance?
What is a Private Health Insurance Statement?

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