The Private Health Insurance Legislation Amendment Rules (No. 6) 2025 (the Amendment Rules) amend the Private Health Insurance (Benefit Requirements) Rules 2011 (the Benefit Rules), the Private Health Insurance (Complying Product) Rules 2015 (the Complying Product Rules) and the Private Health Insurance (Health Insurance Business) Rules 2018 (the Business Rules Rules).
The Amendment Rules were registered on the Federal Register of Legislation on 25 June 2025, to commence 1 July 2025. Emailed notification is also provided direct to the sector.
The Australian Government Department of Health, Disability and Ageing administers private health insurance under the Private Health Insurance Act 2007 and associated Rules.
The Amendment Rules 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 benefits payable by insurers for private nursing-home type patients (NHTPs) in public hospitals in the Australian Capital Territory (ACT) and South Australia (SA).
- Complying Product Rules to increase the daily patient contribution payable by a NHTP in public hospitals in the ACT.
- 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 $1,010.
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 2025 is 2.4 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 public hospital treatment.
Overnight accommodation
The table below summarises the minimum benefits payable by insurers from 1 July 2025 for overnight accommodation as described in the Amendment Rules, for private patients in private hospitals in all states and territories and shared ward accommodation for private patients in public hospitals in Victoria and Tasmania. These changes will be incorporated into updates to the Benefit Rules.
| Class of patient | Minimum benefit payable per night |
|---|---|
| Advanced surgical patient | |
| ‑ first 14 days | $540 |
| ‑ over 14 days | $376 |
| Surgical patient or obstetric patient | |
| ‑ first 14 days | $501 |
| ‑ over 14 days | $376 |
| Psychiatric patient | |
| ‑ first 42 days | $501 |
| ‑ 43 – 65 days | $435 |
| ‑ over 65 days | $376 |
| Rehabilitation patient | |
| ‑ first 49 days | $501 |
| ‑ 50 ‑ 65 days | $435 |
| ‑ over 65 days | $376 |
| Other patients | |
| ‑ first 14 days | $435 |
| ‑ over 14 days | $376 |
| Public hospitals | Minimum benefit payable per night |
|---|---|
| Australian Capital Territory | $446 |
| New South Wales | $446 |
| Northern Territory | $446 |
| Queensland | $458 |
| South Australia | $446 |
| Western Australia | $446 |
Same day accommodation
The tables below provide the minimum benefits payable by insurers from 1 July 2025 for same day accommodation as described in the Amendment Rules. These changes will be incorporated into updates to the Benefit Rules.
| Public hospitals | Band 1 | Band 2 | Band 3 | Band 4 |
|---|---|---|---|---|
| New South Wales | $324 | $360 | $398 | $446 |
| Australian Capital Territory | $324 | $360 | $398 | $446 |
| Northern Territory | $324 | $372 | $428 | $446 |
| Queensland | $330 | $374 | $409 | $458 |
| South Australia | $324 | $372 | $408 | $446 |
| Tasmania | $314 | $375 | $432 | $501 |
| Victoria | $318 | $376 | $436 | $501 |
| Western Australia | $368 | $368 | $368 | $368 |
| Private hospitals | Band 1 | Band 2 | Band 3 | Band 4 |
| Private hospitals all states and territories | $281 | $352 | $428 | $501 |
Nursing‑Home Type Patient (NHTP) accommodation indexation
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. Some jurisdictions apply the changes from July or September, annually.
The ACT will implement the 20 March 2025 indexation to the daily patient contribution rate payable by NHTP at hospitals in the ACT from 1 July 2025.
Patient contribution
The Complying Product Rules Part 2 – 8A(3) Benefit requirement – nursing-home type patients, establish the statutory minimum daily patient contribution rate payable by a NHTP in hospital.
The table below shows the daily patient contribution payable by a NHTP in hospital from 1 July 2025 described in the Amendment Rules and will be incorporated into the Complying Product Rules.
| Public hospitals | Minimum patient contribution for each day a NHTP |
|---|---|
| Australian Capital Territory | $78.95 |
| New South Wales | $78.95 NO CHANGE – amended March |
| Northern Territory | $78.95 NO CHANGE – amended March |
| Queensland | $78.95 NO CHANGE – amended March |
| South Australia | $78.95 NO CHANGE – amended March |
| Tasmania | $78.95 NO CHANGE – amended March |
| Victoria | $78.95 NO CHANGE – amended March |
| Western Australia | $78.95 NO CHANGE – amended March |
| Private hospitals | Minimum patient contribution for each day a NHTP |
| Private hospitals all states and territories | $78.95 NO CHANGE – amended March |
Minimum benefit payable by private health insurers for NHTP
The Benefits Rules Schedule 4 – Nursing-home type patient accommodation: hospitals in all States/Territories, Part 6 establish the minimum benefit payable per night by private health insurers for NHTP in hospitals.
Rates were updated from 20 March 2025 for private patients in private hospitals nationally, and for private patients in public hospitals in New South Wales, Tasmania, Victoria and Western Australia.
From 1 July 2025 updated rates will be implemented by the ACT and SA. Rates in Queensland and the Northern Territory remain unchanged.
The table below shows the minimum benefit payable by insurers for NHTP from 1 July 2025 as described in the Amendment Rules and will be incorporated into the Benefits Rules.
| Public hospitals | Minimum benefit per night |
|---|---|
| Australian Capital Territory | $152.25 |
| New South Wales | $183.40 NO CHANGE – amended March |
| Northern Territory | $155.59 NO CHANGE |
| Queensland | $145.80 NO CHANGE |
| South Australia | $150.00 |
| Tasmania | $189.50 NO CHANGE – amended March |
| Victoria | $166.72 NO CHANGE – amended March |
| Western Australia | $153.15 NO CHANGE – amended March |
| Private hospitals | Minimum benefit per night |
| Private hospitals all states and territories | $32.15 NO CHANGE – amended March |
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 $25, to $1,010 from 1 July 2025.
Find out more in our Cost Recovery Implementation Statement.
More information
Further details on the amendments are included in the Explanatory Statement accompanying the Amendment Rules available on the Federal Register of Legislation at www.legislation.gov.au by searching ‘Private Health Insurance Legislation Amendment Rules (No. 6) 2025’ or unique ID ‘F2025L00743.’
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