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Frequently Asked Questions

Health Insurance 101

Private health insurance offers  additional healthcare options and services not covered by Medicare. There are two types of health insurance: hospital and extras cover. Hospital is classified into Gold, Silver, Bronze, or Basic tier. Extras helps cover the cost of health services not covered by Medicare.

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To make private health more affordable, the Australian Government contributes towards the cost of your private health insurance premiums. You can receive this rebate as either:

  1. A reduction in the cost of your health insurance premium.
  2. A rebate claimed in your annual tax return.
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Lifetime Health Cover (LHC) loading is a penalty that we are obliged to apply for late entry into hospital cover after the age of 31, designed by the Government to encourage early insurance adoption.  The loading is an additional 2% of the base premium for every year delayed after the age of 30, up to a maximum of 70%.

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The Medicare Levy funds public healthcare in Australia. Those earning above a $97,000 a year (or $194,000 for couples and families) have to pay the Medicare Levy Surcharge (MLS) unless they have private hospital cover. The surcharge amount varies based on income and is designed to incentivise those with higher incomes totake out private healthcare.

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The Medicare Benefits Schedule (MBS) is a list of medical services and fees set by the Australian Government. Patients can claim a rebate from Medicare for services provided out of hospital, but may have to pay an additional "gap fee" if the service provider charges more than the schedule fee.

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The Medicare Safety Net in Australia helps individuals and families with high medical costs by reducing their out-of-pocket expenses for out-of-hospital services. When an individual or family's gap payments exceed a certain threshold amount in a calendar year, Medicare reimburses 100% of the MBS fee for out-of-hospital services.

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Join selected hospital covers before 30 and get up to 10% off the full cost of the hospital component of certain policies. As long as you retain an eligible policy the discount applies until you turn 41, then decreases by 2% per year.

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The Pharmaceutical Benefits Scheme (PBS) subsidises prescription medicines for Australians with a Medicare card.  If a medicine is subsidised, the government pays for most of the cost and the patient pays a lower price. If your insurance covers pharmaceuticals, you can claim the amount above the PBS patient co-payment up to the benefit amount. 

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Since 1 April 2018, policyholders have been able to upgrade from a policy which offers restricted benefits for hospital psychiatric services, to a policy which fully covers psychiatric services, without having to serve the normal two-month waiting period.

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Useful Definitions

Health insurance has it's own language and we're here to help you understand key terms related to your cover.