Insure? Not Sure?

Topics in this Section

Introduction

Contents

General Information

Surcharges and Incentives

About Private Health Insurance

Types of Cover

Questions You Should Ask

Common Terms

Insurer Contact Details

About Private Health Insurance

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Private health insurance is provided through private health insurers registered under the Private Health Insurance Act 2007. The financial performance of registered private health insurers is monitored by PHIAC, an independent Australian Government body, to ensure solvency and capital adequacy requirements are met.

A health insurer is registered either as:

• an open membership organisation (anyone can apply to join), or

• a restricted membership organisation (available only through specific employment groups, professional associations or unions).

Health insurers follow a principle known as `community rating'. Under this principle, the premiums charged by the insurers do not vary according to your age (other than age at entry for Lifetime Health Cover), gender, state of health, or the size of your family. For example, a single, healthy 20 year-old and a single, unwell 60 year-old will both pay the same premium for the same cover. However, the cost of premiums for similar cover may vary between insurers.

Private health insurance is different from trauma and disability insurance. These insurances are 'risk-rated' rather than ‘community-rated’ and generally offer lump-sum payments in the event of specific illness or loss. They are not a substitute for private health insurance.

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Insured groups

The insured groups provided for under the Private Health Insurance Act 2007 are:

(a) for policies other than a non-student policy or a policy referred to in paragraph (c), the insured groups are:

I. only one person

II. 2 adults (and no-one else)

III. 2 or more people, none of whom is an adult

IV. 2 or more people, only one of whom is an adult

V. 3 or more people, only 2 of whom are adults

VI. 3 or more people, at least 3 of whom are adults

(b) for policies that are a dependent child/non-student policy, the insured groups are:

I. 2 or more people, only one of whom is an adult

II. 3 or more people, only 2 of whom are adults

(c) for policies that before 31 December 2008 cover a dependent child non-student which have as conditions of the policy that the non-student is not covered for general treatment, other than hospital-substitute treatment, and must have his or her own policy with the same insurer covering general treatment (other than hospital-substitute treatment), the insured groups are:

I. 2 or more people, only one of whom is an adult

II. 3 or more people, only 2 of whom are adults.

‘Dependent child' is defined in the Private Health Insurance Act 2007 as a person:

(a) who is:

I. aged under 18 or

II. a dependent child under the rules of the private health insurer that insures the person; and

(b) who is not aged over 25 or over; and

(c) who does not have a partner.

‘Dependent child non-student' means a person who:

(a) is aged between 18 and 24 (inclusive) and was born before 1991; and

(b) is a dependent child under the rules of the private health insurer that insures the person as referred to in subparagraph (a) (ii) of the definition of ‘dependent child’ in the Private Health Insurance Act 2007, whether or not the person is wholly or substantially dependent on an adult insured under the same health insurance policy; and

(c) does not have a partner; and

(d) is not receiving full-time education at a school, college or university.

Note: A ‘dependent child non-student' is therefore a ‘dependent child’ as defined in the Private Health Insurance Act 2007.

Health insurers are not required to offer all types of cover to all categories of insured groups.

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Private Health Insurance Administration Council

Suite 16, Level 1, 71 Leichhardt Street, KINGSTON ACT 2604
Telephone 02 6215 7900 | Facsimile 02 6215 7977 | Email phiac@phiac.gov.au

Last modified: 22 July, 2005