What laws govern private health insurance in Australia?
The Private Health Insurance Act 2007 is the main law that sets out the requirements for private health insurance and health insurers.
Private Health Insurance Rules sit under this law. They provide more detail about different areas of private health insurance.
How Australia’s private health insurance laws affect you
Private health insurance laws govern:
- who can provide private health insurance
- waiting periods
- what your insurance covers and can’t cover
- how and when insurers can increase your premiums
Our private health laws also govern what your insurer must let you know.
What your insurer must let you know
Your insurer must let you know certain things about your policy.
What the policy covers and its features
Your insurer must give you private health information statements. These must tell you what the policy covers and its features.
Learn more from the Commonwealth Ombudsman about private health information statements.
Changes to your cover or premiums
Your insurer must let you know in advance about any changes to your premiums or cover.
They must give you reasonable notice so you can find a different policy if you wish.
Find out more about your options for managing your premiums from the Commonwealth Ombudsman.
If your policy is discontinued
If your insurer wants to discontinue your policy and move you to a new policy, they must tell you clearly how this will affect you.
They must let you know:
- what services are covered under the discontinued policy that won’t be covered under the new policy
- if your excess or co-payments will change
- what waiting periods will apply
- what your new premiums will be
You don’t have to transfer to the new policy your insurer offers you. You can transfer to a new policy of your own choice if you wish.
Learn more about your right to choose.
What you might pay out of pocket for treatment
Your insurer must let you know if you will have to pay any out of pocket costs for a treatment or service you are covered for.
This allows you to give informed financial consent to treatment.