Private health insurance policies and inclusions you can offer

The policies you offer as a private health insurer must comply with Australian private health insurance laws.

Who you can insure

Private health insurance is community rated. This means you must:

  • insure anyone who wants a policy
  • charge everyone the same price for the same policy
  • guarantee everyone the right to renew their policies.

If you are a restricted insurer you can only offer insurance to people in certain industries, companies or groups.

Cover you can offer

You can offer:

  • hospital treatment cover
  • general treatment cover, or extras
  • a mix of hospital and extras cover
  • ambulance cover.

Hospital cover must meet the minimum requirements of one of four hospital product tiers:

  • Basic
  • Bronze
  • Silver
  • Gold.

If you offer more than the minimum requirements of a product tier, you can promote the policy as:

  • Basic Plus (+)
  • Bronze Plus (+)
  • Silver Plus (+).

You can offer:

  • restricted cover that pays part of the costs of hospital cover
  • unrestricted cover that pays all costs of hospital cover, other than any agreed excess or co-payments.

Cover you cannot offer

You cannot offer cover for most services covered by Medicare if the services are provided out of hospital.

We list Medicare services in the Medicare Benefits Schedule at MBS Online.

Waiting periods you can apply

For hospital treatment, you can apply waiting periods of up to:

  • 12 months for pregnancy and birth-related services
  • 2 months for psychiatric care, rehabilitation or palliative care (even if it’s for a pre-existing condition)
  • 2 months for all other services.

For hospital treatment of a pre-existing condition other than psychiatric care, rehabilitation or palliative care, you can apply a waiting period of up to 12 months.

For extras cover, you can apply any waiting period.

Read more about waiting periods.

Last updated: 
21 October 2020

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