Parliament Building, Canberra, Australia.

Private Health Insurance Act

How is the private health insurance industry regulated in Australia? The Health Insurance Act and the entities that protect consumers.

Although health insurance in Australia has roots dating back to the 1800s, it wasn’t until the second half of the 20th century that commonwealth and state governments increasingly started to turn their attentions to providing access to quality healthcare for all Australians. Following the establishment in 1984 of Medicare – the basis of Australia’s public healthcare system – health policy has consistently been at the forefront of national debate.

Private health insurance is designed to provide cover for the medical and healthcare costs not included in Medicare. Health cover in Australia is governed under the Private Health Insurance Act 2007.

Looking for health insurance? Compare your options with help from an adviser

Private Health Insurance Act 2007

The Private Health Insurance Act 2007 sets out the rules that govern private health insurance and private health funds in Australia. This act represented a huge change in the way health insurance was legislated in Australia, and it contained a number of reforms to help Australians better understand health insurance cover, provided incentives to encourage more people to take out cover, and established rules governing private health insurance products.

To encourage more people to take out cover, the Act:

  • Introduced reductions in premiums for complying health insurance policies.
  • Introduced the Lifetime Health Cover Scheme, which means that Australians who do not take out health insurance at a young age will need to pay higher premiums.

Under the Private Health Insurance Act 2007, only registered health funds are eligible to offer private health insurance in Australia. The act also regulates the individual policies offered by health funds, and ensures that those policies are offered to all Australians in a non-discriminatory way.

What entities enforce the Act?

The Private Health Insurance Act 2007 is enforced by the Australian Prudential Regulation Authority (APRA) and the Private Health Insurance Ombudsman. From July 2015, APRA assumed responsibility for the supervision of private health insurers from the Private Health Insurance Administration Council. APRA’s role is to monitor and regulate insurers, with the aim of creating an efficient and competitive health insurance industry that looks after the needs of consumers.

Meanwhile, the Private Health Insurance Ombudsman’s role is to protect the interests of consumers. It does this in several ways, including:

  • Offering an independent complaints handling service to help consumers resolve disputes with health funds.
  • Identifying problems in the way health funds and healthcare providers operate.
  • Advising the Commonwealth Government and Australian industry about private health insurance issues that affect consumers.
  • Offering advice and guidance to the government and industry about matters relating to private health insurance.

What incentives does the Act provide?

The Private Health Insurance Act 2007 introduced two key initiatives to encourage Australians to take out private health insurance. Not only are these initiatives designed to ensure that more Australians can access the medical care they need, but they also reduce the strain on Australia’s public healthcare system.

Incentives in the Act include:

  • The Australian Government Private Health Insurance Rebate. This rebate is currently available to most Australians who have private health insurance, helping to make private health cover premiums more affordable. The rebate is income tested, and the amount you are entitled to receive increases as you age. However, Australians who earn more than $140,000 a year are not entitled to the rebate.
  • The Lifetime Health Cover (LHC) Scheme. The Lifetime Health Cover Scheme is designed to encourage all Australians to take out private hospital cover earlier in life and maintain their cover. Under the scheme, people who don’t take out an adequate level of cover before they turn 30 will need to pay a premium loading for every year they do not take out cover. The LHC is levied at 2% per year up to a maximum loading of 70%; you can find out more about the scheme and how it works in our explanatory guide.

What are the Australian health funds registered under the Act?

Health fundWho can get health insurance with these funds?Find out more
HIF Logo
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC is available for those temporarily visiting or working in Australia.
More info
health.com.aulogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
ahmMore info
Australian UnityMore info
GMHBA
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
HCF
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC is available for those temporarily visiting or working in Australia.
More info
nib
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC and OSHC are available for those temporarily studying, visiting or working in Australia.
More info
Transport Health Logo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
Bupa
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC and OSHC are available for those temporarily studying, visiting or working in Australia.
More info
cdhlogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
cua
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
Frank
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC is available for those temporarily visiting or working in Australia.
More info
gmflogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
GU Health
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC is available for those temporarily visiting or working in Australia.
More info
HBF
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC is available for those temporarily visiting or working in Australia.
More info
hcilogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
logo health partners
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
latrobehealthlogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
 medibank
  • Open. Any Australian citizen or permanent resident is eligible to join. OVHC and OSHC are available for those temporarily studying, visiting or working in Australia.
More info
mildurahealthfundlogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
onemedifundlogo
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
peoplecare provider page link
  • Open. Any Australian citizen or permanent resident is eligible to join. OSHC is available for those temporarily studying in Australia although it is only extras, not hospital cover.
More info
phoenix health fund provider link
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
queensland country health fund provider link
  • Open. Any Australian citizen or permanent resident who lives in Queensland or the Northern Territory is eligible to join.
More info
St. Lukes Health Logo
  • Open. Any Australian citizen or permanent resident is eligible to join. 
More info
westfund provider link
  • Open. Any Australian citizen or permanent resident is eligible to join.
More info
acahealthlogo
  • Restricted. Open to members of the Seventh-day Adventist Church and present and past employees of affiliated companies, along with the partners/spouses, dependents, siblings, parents and grandchildren of those mentioned previously.
More info
CBHS Health Fund Logo
  • Restricted. Open to employees, contractors and franchisees of Commonwealth Bank of Australia Group as well as their partners and family members, including dependent and non-dependent children, siblings, parents and grandchildren.
More info
defencehealthlogo
  • Restricted. Open to reservists and past members* of the Australian Defence Force, employees of the Department of Defence and Defence suppliers. Extended family as well as the ex-partner/spouse of those previously mentioned are also eligible to join.
More info
navyhealthlogo
  • Restricted. Open to current and former members, reservists and cadets of the ADF, employees of the DoD, Defence suppliers and more. Extended family as well as the ex-partner/spouse of those previously mentioned are also eligible to join.
More info
doctorshealthfundlogo
  • Restricted. Open to registered Medical Practitioners and Health Practitioners (in an eligible category), their employees, extended family and much more. The eligibility criteria for this fund is wide and you can view the full list via the More Info button.
More info
policehealthlogo
  • Restricted. Open to current or former (if retired or resigned after 1 Jan 2001) employees of state, territory and federal police departments/police unions including their partners/spouses, dependants and adult children plus their immediate family.
More info
rthealthlogo
  • Restricted. Open to current or former employees of Government or privately owned transport (air, sea, land) and energy generation/delivery entities, as well as those involved in administering them. Extended family of eligible members can also join.
More info
rbhslogo
  • Restricted. Open to current or former employees of the Reserve Bank of Australia and Note Printing Australia, as well as their current or ex-partner or spouse and their dependant or adult children.
More info
teachers
  • Restricted. Open to current or former members and administrative staff of approved education unions and organisations, along with their extended family. Use the More Info button to the right to view the eligible unions and organisations.
More info
tuh
  • Restricted. Open to current or former union members of any industry along with their current or ex partner/spouse, dependent children, adult children (plus their partner), siblings (plus their partners and dependent children), parents and grandchildren.
More info

Compare policies from Australian health funds

Details Features
High Hospital with $0 / $250/ $500 Excess Options
High Hospital with $0 / $250/ $500 Excess Options
Provides a high level of cover for hospital including pregnancy cover and assisted reproductive services.
  • Cover starting from $36.22 weekly
  • Two month waiting period for wisdom teeth
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
Enquire Now More info
Premier Hospital
Premier Hospital
This top hospital policy covers you for a multitude of services as well as 100% of the cost of hospital accommodation and theatre fees in all HCI agreement hospitals and day surgery facilities.
  • Cover for pregnancy and IVF treatment
  • 100% back on surgically implanted prostheses
  • 100% back on hospital prescriptions
  • Access Gap Cover
Get Quote More info
GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
Get Quote More info
Top hospital 500
Top hospital 500
Top hospital 500 provides cover for a comprehensive range of services from psych to obstetrics to the removal of tonsils.
  • Spinal fusion
  • Weight loss surgery
  • All joint replacements
  • Rehabilitation
Enquire Now More info
Mid Hospital with Pregnancy
Mid Hospital with Pregnancy
Mid Hospital with Pregnancy covers you for pregnancy and related services in addition to what the standard Mid Hospital policy covers.
  • Pregnancy and related services
  • Nine month waiting period for pregnancy in public hospital
  • 12 month waiting period for pregnancy in private hospital
  • Day surgeries
Enquire Now More info
Premium Family Package
Premium Family Package
This is GMHBA's most comprehensive policy and providing a range of benefits including a pregnancy option.
  • Pregnancy and birth related services
  • Assisted reproductive services (IVF)
  • No hospital excess for kids
  • 100% back on optical
Enquire Now More info
Premium Hospital Cover
Premium Hospital Cover
Comprehensive hospital protection with complete cover including pregnancy.
  • No excess for kids
  • No excess for accidents
  • Cover for pregnancy, heart surgery, joint investigations
  • Free access to health and wellbeing programs
Enquire Now More info
Top Hospital Cover
Top Hospital Cover
NIB's premier Hospital protection with cover for pregnancy and birth services, obesity surgery and all other benefits covered across other policies.
  • $250 / $500 excess
  • Pregnancy and birth services cover
  • Infertility Investigations cover
  • Renal dialysis cover
Enquire Now More info
Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
Enquire Now More info

Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

Was this content helpful to you? No  Yes

Related Posts

Ask a Question

You are about to post a question on finder.com.au

  • Do not enter personal information (eg. surname, phone number, bank details) as your question will be made public
  • finder.com.au is a financial comparison and information service, not a bank or product provider
  • We cannot provide you with personal advice or recommendations
  • Your answer might already be waiting – check previous questions below to see if yours has already been asked

Disclaimer: At finder.com.au we provide factual information and general advice. Before you make any decision about a product read the Product Disclosure Statement and consider your own circumstances to decide whether it is appropriate for you.
Rates and fees mentioned in comments are correct at the time of publication.
By submitting this question you agree to the finder.com.au privacy policy, receive follow up emails related to finder.com.au and to create a user account where further replies to your questions will be sent.

Ask a question
feedback