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Lifetime Health Cover - Frequently Asked Questions

This page contains frequently asked questions by consumers on Lifetime Health Cover.

Private Health Insurance - For Consumers

Private Health Insurance - For Health Professionals


How does Lifetime Health Cover affect me if I am unable to maintain my hospital cover for certain periods of time?

If you purchase hospital cover at any time on or after 1 July following your 31st birthday, you establish what is called your certified age at entry. Your certified age at entry is what your insurer will use to determine your LHC loading.

Once you are covered by a hospital cover policy, your certified age at entry and therefore any applicable LHC loading will remain the same as long as you remain covered.

There is always the possibility that you may not be able to maintain your hospital cover for various reasons. For these situations Lifetime Health Cover allows for permitted days without hospital cover.

These are any of the following days that occur after a person ceases to have hospital cover provided they have established their certified age at entry:
  • days on which your insurer has agreed to 'suspend' your hospital cover. Suspending your cover will protect you from incurring a LHC loading (or from further increases to your LHC loading, if you already have one), however the duration of any suspension will be up to the discretion of your insurer;
  • not including days on which your cover is suspended by your insurer, days on which you are overseas that form part of a continuous period overseas of more than one year; and
  • not including the previous two types of permitted days without cover, the first 1,094 days (1 day less than 3 years) that you are without hospital cover will not be subject to any increase in LHC loading. Once you have used your 1,094 days however, you will become liable for increases to your LHC loading. This means that on the 1,095th day, your LHC loading would increase by 2%, and would continue to increase by 2% for each year you are without hospital cover from that point onwards. Remember that you only have one set of 1,094 days to use throughout your lifetime.

How can I find out how many of my permitted days without hospital cover I have used?

Your insurer is required to provide you with an annual statement showing how many of your permitted days without hospital cover you have used as well as any additional amount you may be paying on your hospital cover premium under Lifetime Health Cover.

Your health insurer can also confirm this information upon request, either over the phone or in writing.
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Can I change the level of my hospital cover without affecting my LHC loading?

Yes. You are able to upgrade or downgrade your hospital cover policy without affecting your LHC loading. Remember that you may be required to observe new waiting periods at the discretion of your health insurer.

The only circumstances under which your LHC loading would be affected by a variation to your private health insurance cover would be if you changed from a policy that includes hospital cover to a policy that does not. In this case, permitted days without hospital cover would apply. That is, your LHC loading would be unaffected for the first 1,094 days that you were without hospital cover. On the 1,095th day, your LHC loading would increase by 2%, and would continue to increase by 2% for each year you are without hospital cover from that point onwards.

How is my LHC loading affected if I want to change from a single policy to a family or couple’s policy?

The LHC loading applicable to a family or couple’s policy (that includes hospital cover) is dependant upon the certified age at entry of each adult covered by the policy.

Your certified age at entry will not change if you change to a family or couple’s policy, but you may find that the LHC loading that you are paying will change.

This is because the LHC loading applicable to hospital cover that covers more than one adult is determined by the average of LHC loadings payable by each adult covered.

So, if two adults decide to purchase a family hospital cover policy and both are liable to pay a LHC loading, then their health insurer will determine the applicable LHC loading by adding the two LHC loadings together and then dividing the result by 2.

For example, if Shari has a LHC loading of 4%, and Isaac has a LHC loading of 12%, then the applicable LHC loading if they were to purchase family hospital cover together would be 8%. This is because 4% plus 12% divided by 2 adults covered equals 8%.

The same would apply if only one of the adults covered by the same family hospital cover policy had a LHC loading.

For example, if the LHC loading payable by one adult is 40%, whereas the other adult covered by the policy does not pay a LHC loading, then the applicable LHC loading would be 20%.
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Are there any other provisions for special circumstances relating to Lifetime Health Cover?

If you are an Australian citizen or permanent resident who is overseas on 1 July following your 31st birthday, you will not pay a LHC loading if you purchase hospital cover before the first anniversary of the day you return to Australia. So no matter how long you remain overseas, you will be entitled to a 12 month period starting from the day that you return in which you are able to purchase a hospital cover policy without paying a LHC loading.

You are also able to return to Australia for periods of up to 90 consecutive days and are still considered to be overseas.

Time spent on Norfolk Island is classified as time spent overseas.

If you are a member of the Australian Defence Forces (ADF) your medical services are provided by the ADF, so you are considered to have hospital cover. If you are discharged from the ADF after the 1 July following your 31st birthday, then you are considered to be using your 1,094 permitted days without hospital cover.

If you are discharged from the ADF before the 1 July following your 31st birthday, then the normal rules apply.

If you hold a Department of Veterans’ Affairs (DVA) Gold Card you are considered to have hospital cover. If you have held a Gold Card at any time since 1 July 1999, and the card was subsequently withdrawn by the DVA, you may claim the period you held the card as a period with hospital cover.

If you were born on or before 1 July 1934, you are exempt from the LHC loading. You can purchase hospital cover at any time in the future and pay the base rate premium.

Can I apply for an exemption from my LHC loading?

No. There is no means by which the Minister or the Department of Health and Ageing can reduce or remove a correctly calculated LHC loading.

According to the current legislation, the only means by which a person may have their LHC loading removed is by paying their LHC loading for a continuous period of ten (10) years.

Following the introduction of Lifetime Health Cover in July 2000, it was possible for people to obtain an exemption from the general rules providing they met specific conditions.

It was acknowledged that individuals’ financial or other circumstances may have precluded them from purchasing hospital cover by the requisite date, and in this context, a hardship provision was incorporated into the legislation which gave authority to Lifetime Health Cover at the time.

This provision allowed a delegate of the Minister for Health and Ageing to approve exemptions from the general Lifetime Health Cover rules for successful applicants.

The deadline for all hardship applications was 1 July 2002. There is no longer any discretionary power within the legislation to allow for any further exemptions.
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