The Private Health Insurance Legislation Amendment Rules (No. 5) 2026 (the Amendment Rules) amend the:
- Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules).
- Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Rules).
- Private Health Insurance (Health Insurance Business) Rules 2018 (the Business Rules).
The Amendment Rules were registered on the Federal Register of Legislation on 26 June 2026.
We administer private health insurance under the Private Health Insurance Act 2007 and associated rules.
The Amendment Rules, commencing 1 July 2026 amend the:
- Benefit Rules to update the minimum benefits payable by private health insurers per night for overnight and same-day accommodation for private patients in private hospitals nationally, and public hospitals in all states and territories.
- Benefit Rules to update the benefits payable by private health insurers per night for nursing-home type patients (NHTP) in public hospitals in the Australian Capital Territory (ACT), Western Australia (WA), and South Australia (SA).
- Complying Product Rules to increase the daily patient contribution payable by a NHTP in public hospitals in the ACT and WA, bringing these jurisdictions into alignment with the contribution amount amended for all other states and territories, and private hospitals nationally, in March 2026.
- Business Rules to amend the fee for processing and assessment of applications by declared private hospitals for inclusion in the second-tier eligible hospitals class to $1,050.
Overnight and Same Day Accommodation Benefit Indexation
Overnight and same-day minimum hospital treatment accommodation benefits payable by insurers for private patients are indexed annually effective 1 July. The indexation figure applied is the percentage change reported by the Australian Bureau of Statistics (abs.gov.au) in the Consumer Price Index (CPI) weighted average of eight capital cities for the twelve months to the March quarter; which for March 2026 is 4.6 per cent.
Total fees and charges for privately insured patients in public hospitals are determined by the state or territory in which the patient is receiving treatment.
Overnight accommodation
The minimum benefits payable by insurers will change from 1 July 2026 for overnight accommodation for private patients in public hospitals in each state and territory, and private hospitals nationally. These changes will be incorporated into the Benefit Rules.
The table below summarises the minimum benefits payable by insurers from 1 July 2026 for private patients’ overnight accommodation, in private hospitals nationally.
| Class of patient | Minimum benefit payable per night |
|---|---|
| Advanced surgical patient | |
| ‑ first 14 days | $565 |
| ‑ over 14 days | $393 |
| Surgical patient or obstetric patient | |
| ‑ first 14 days | $524 |
| ‑ over 14 days | $393 |
| Psychiatric patient | |
| ‑ first 42 days | $524 |
| ‑ 43 – 65 days | $455 |
| ‑ over 65 days | $393 |
| Rehabilitation patient | |
| ‑ first 49 days | $524 |
| ‑ 50 ‑ 65 days | $455 |
| ‑ over 65 days | $393 |
| Other patients | |
| ‑ first 14 days | $455 |
| ‑ over 14 days | $393 |
The tables below summarise the minimum benefits payable by insurers from 1 July 2026 for overnight accommodation for private patients in public hospitals, in each state and territory.
| Class of patient | Minimum benefit payable per night |
|---|---|
| Advanced surgical patient | |
| ‑ first 14 days | $565 |
| ‑ over 14 days | $393 |
| Surgical patient or obstetric patient | |
| ‑ first 14 days | $524 |
| ‑ over 14 days | $393 |
| Psychiatric patient | |
| ‑ first 42 days | $524 |
| ‑ 43 – 65 days | $455 |
| ‑ over 65 days | $393 |
| Rehabilitation patient | |
| ‑ first 49 days | $524 |
| ‑ 50 ‑ 65 days | $455 |
| ‑ over 65 days | $393 |
| Other patients | |
| ‑ first 14 days | $455 |
| ‑ over 14 days | $393 |
| Class of patient | Minimum benefit payable per night |
|---|---|
| Advanced surgical patient | |
| ‑ first 14 days | $565 |
| ‑ over 14 days | $393 |
| Surgical patient or obstetric patient | |
| ‑ first 14 days | $524 |
| ‑ over 14 days | $393 |
| Psychiatric patient | |
| ‑ first 42 days | $524 |
| ‑ 43 – 65 days | $455 |
| ‑ over 65 days | $393 |
| Rehabilitation patient | |
| ‑ first 49 days | $524 |
| ‑ 50 ‑ 65 days | $455 |
| ‑ over 65 days | $393 |
| Other patients | |
| ‑ first 14 days | $455 |
| ‑ over 14 days | $393 |
| State/Territory | Minimum benefit payable per night |
|---|---|
| Australian Capital Territory | $467 |
| New South Wales | $467 |
| Northern Territory | $467 |
| Queensland | $479 |
| South Australia | $467 |
| Western Australia | $467 |
Same day accommodation
The minimum benefits payable by insurers will change from 1 July 2026 for same day accommodation for private patients in public hospitals in each state and territory, and private hospitals nationally. These changes will be incorporated into the Benefit Rules.
The table below summarises the minimum benefits payable by insurers from 1 July 2026 for same day accommodation for private patients in public hospitals in each state and territory.
| Public hospitals | Band 1 | Band 2 | Band 3 | Band 4 |
|---|---|---|---|---|
| New South Wales | $339 | $377 | $416 | $467 |
| Australian Capital Territory | $339 | $377 | $416 | $467 |
| Northern Territory | $339 | $389 | $448 | $467 |
| Queensland | $345 | $391 | $428 | $479 |
| South Australia | $339 | $389 | $427 | $467 |
| Tasmania | $328 | $392 | $452 | $524 |
| Victoria | $333 | $393 | $456 | $524 |
| Western Australia | $385 | $385 | $385 | $385 |
The table below summarises the minimum benefits payable by insurers from 1 July 2026 for same day accommodation for private patients in private hospitals nationally.
| Private hospitals | Band 1 | Band 2 | Band 3 | Band 4 |
|---|---|---|---|---|
| All States and Territories | $294 | $368 | $448 | $524 |
Nursing‑Home Type Patient accommodation adjustments
NHTP contributions and minimum insurer benefits are indexed by the Commonwealth twice annually, on 20 March and 20 September. Jurisdictions are consulted on changes to rates in public hospitals. Total fees and charges for privately insured NHTPs in public hospitals are determined by the state or territory in which the patient is receiving treatment. Some jurisdictions apply changes from July or September, annually.
Benefit payable by private health insurers for NHTP
The benefit payable per night by private health insurers for NHTP in hospitals, was previously adjusted from 20 March 2026 by New South Wales (NSW), Tasmania (Tas) and Vic, will be implemented from 1 July 2026 for private patients in public hospitals in the ACT, SA and WA.
The table below summarises the minimum benefits payable by insurers from 1 July 2026 for private NHTP in public hospitals.
| State/Territory | Minimum benefit payable per night |
|---|---|
| Australian Capital Territory | $159.85 |
| New South Wales | $197.35 |
| Northern Territory | $162.75 |
| Queensland | $150.75 |
| South Australia | $157.00 |
| Tasmania | $197.95 |
| Victoria | $175.39 |
| Western Australia | $156.70 |
Although there is no change to the NHTP benefit for private patients at private hospitals, it is included in the Amendment Rules to update the table format.
The table below summarises the minimum benefits payable by insurers from 1 July 2026 for private NHTP in private hospitals nationally.
| Private Hospitals | Minimum benefit payable per night |
|---|---|
| All States and Territories | $28.60 |
Patient contribution
The daily patient contribution payable by a NHTP in hospital was adjusted from 20 March 2026 in NSW, the NT, Qld, SA, Tas, and Vic. Changes will be implemented from 1 July 2026 for patients in public hospitals in the ACT and WA.
The table below summarises the daily patient contribution payable by a NHTP in public hospitals from 1 July 2026.
| State/Territory | Daily NHTP contribution |
|---|---|
| Australian Capital Territory | $82.50 |
| New South Wales | $82.50 |
| Northern Territory | $82.50 |
| Queensland | $82.50 |
| South Australia | $82.50 |
| Tasmania | $82.50 |
| Victoria | $82.50 |
| Western Australia | $82.50 |
Second-tier benefits eligibility application fee indexation
The activities and tasks that make up the assessment for second tier default benefits eligibility have been reviewed and updated. Government policy to index charges annually has resulted in an increase in the application fee of $40, to $1,050 from 1 July 2026.
Find out more in our Cost Recovery Implementation Statement.
More information
Further details on amendments are included in the Explanatory Statement accompanying each set of Amendment Rules available on the Federal Register of Legislation website by searching ‘Private Health Insurance Legislation Amendment Rules (No. 5) 2026.’
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