weight loss

Obesity and health insurance

Do health funds cover weight loss programs or surgeries? Find out.

Obesity is the term used to describe being excessively overweight. There are multiple procedures available to people who are obese to assist with weight loss, such as gastric bypass or banding surgery, which Medicare can provide cover for if you meet pre-approval requirements. Private health insurance may also cover weight reduction programs and surgeries too. While some elective procedures are covered by Medicare and most private health insurers, liposuction is covered by some but not all private health funds.

Compare your health insurance options from 30+ Australian funds

What obesity related costs are covered by your health fund?

Weight loss programs are covered on a case-by-case basis by extras insurance. You must visit a physician for a face-to-face consultation before you can go ahead with weight loss surgery or enrol in a program. Private insurance will generally cover bariatric (weight loss) surgery, and your insurer will help pay for physician consultations, accommodation in a private or public hospital, anesthetists fees and post-op doctors’ fees. As well as an excess, you will also pay any out-of-pocket expenses that may arise from your weight loss surgery. Your physician(s) will discuss these fees with you before the procedure.

What obesity related service can you claim on private health?

Prevention is better than cure, which is why some private health insurers include cover for non-surgical treatments such as gym memberships, yoga and pilates classes on their extras policies. Private health insurers provide refunds for bariatric treatments such as gastric banding, gastric bypass and gastrectomy procedures, though these operations are covered by comprehensive policies only. In all cases, you must have a face-to-face consultation with your doctor first so that the best treatment can be recommended for your situation.

What obesity related procedure costs can you claim on Medicare or private health insurance?

Not all obesity related procedures are covered by private health insurance or Medicare, but you can get a rebate for bariatric surgery if you hold a mid- or top-tier insurance policy. Here are some of the procedures covered by funds in Australia:

Ahm Bupa nib
Gastric banding
  • Yes (Top Hospital Cover)
  • Yes (Standard Hospital Cover and above)
  • Yes (Top Hospital Cover only)
Sleeve gastrectomy
  • Information not provided
  • Yes (Standard Hospital Cover and above)
  • No
Gastric bypass
  • Information not provided
  • Yes (Standard Hospital Cover and above)
  • Yes (Top Hospital Cover only)
Liposuction
  • No
  • Yes (Lipectomy - Standard Hospital Cover and above)
  • No
Living well benefits
  • Yes (Basic Extras Cover and above)
  • Yes (Bronze Extras Cover and above)
  • Yes (Top Extras Cover only)
Diet & nutrition
  • Yes (Basic Extras Cover and above)
  • Yes (Silver Extras Cover and above)
  • Yes (Top Extras Cover only)

Medicare benefits for obesity related services

Medicare can provide a benefit for some procedures, these rebates are limited, which means you will either need to have private health insurance to help out or be able to foot the bill yourself. Procedures that you can receive a rebate for may include:

  • Duodenal switch
  • Gastric banding
  • Gastric bypass
  • Gastric sleeve (sleeve gastrectomy)
  • Reversal of Gastric Banding/Lap Band

Looking to lose weight? What type of cover do you need?

Most health funds in Australia have a 12-month waiting period for preexisting conditions, so if you plan on claiming a bariatric procedure such as gastric banding through your insurance, your doctor may recommend diet and exercise in the months before the surgery. Liposuction is elective surgery. Liposuction is not a magic bullet solution and must be combined with diet and exercise to be an effective lasting treatment. Private health extras cover can reduce the cost of non-surgical treatments for obesity conditions. Most private health insurers provide some form of living well benefit (such as cover for a gym membership) as well as cover for consultations with a nutritionist and dietitian. The waiting period before you can claim a benefit is only two months.

How do you claim weight loss treatment on your health insurance?

Claims procedures can vary different depending on your weight loss procedure. You must have the appropriate level of insurance and meet the waiting period requirements before you can claim a benefit for weight loss treatment. You’re also required to attend a consultation with your physician so you can be sure about the best procedure or course of action for your condition. Also be sure to check that your weight loss program provider is covered by your insurer. You may be able to submit a request to claim online, however, in some cases you and your physician will need to complete paperwork and return it to the insurer before you get your refund.

Weight loss programs covered by insurance providers in the finder.com.au panel

Health fundPolicies that include cover for weight loss servicesFind out more
HIF LogoHIF Saver, Special, Super and Premium extras cover policies offer cover for recognised weight loss programs. HIF approved providers include Weight Watchers, Jenny Craig, Michelle Bridges' 12 Week Body Transformation Program and more. Exclusions can be found below this table.More info
Health.com.auHealth.com.au Extras 50, Basic Extras, Middle Extras and High Extras policies include a benefit that covers weight loss management services. Be aware that Basic, Middle and High Extras can only be purchased as a combined policy with hospital cover.More info
ahm health fundahm includes a benefit towards the cost of weight loss programs in the Basic, Lifestyle, Family and Super extras cover policies. The weight loss program has to be undertaken with an ahm recognised provider, which are Weight Watchers, Jenny Craig, Fernwood and Slimplicity. Further conditions can be found below this table.More info
Australian UnityAustralian Unity offers a benefit on weight loss programs, which is available through the Smart Combination, Smart Essentials and Smart Start combined hospital and extras policies. Programs approved by Australian Unity are Weight Watchers, Jenny Craig, Sure Slim, Curves Complete and Ultralite. Conditions and exclusions can be found below this table.More info
GMHBA health fundGMHBA's Gold Extras policy provides cover for Weight Management Council of Australia member programs which include Weight Watchers, Jenny Craig Weight Loss Centres, Fernwood and Simplicity Weight Loss. Conditions and exclusions can be found below this table.More info
HCFHCF Silver Plus, Gold and Platinum Extras policies provide a benefit for weight loss programs taken through an approved provider and may cover some of the expenses of weight loss medication. HCF members with chronic ailments may also be able to access the Healthy Weight for Life program. More information on this can be found below this table.More info
nibnib Top and Core Wellbeing Extras policies include a benefit that pays towards weight loss management programs that are approved by the health fund, which include Jenny Craig and Weight Watchers. Further conditions can be found below.More info
Transport Health LogoFamily By Design Combined Cover allows policyholders to claim for weight loss programs.More info

Full list of health funds that offer cover for weight loss programs

Health fundPolicies that include cover for weight loss servicesFind out more
ahmahm includes a benefit towards the cost of weight loss programs in the Basic, Lifestyle, Family and Super extras cover policies. The weight loss program has to be undertaken with an ahm recognised provider, which are Weight Watchers, Jenny Craig, Fernwood and Slimplicity. Further conditions can be found below this table.More info
Australian UnityAustralian Unity offers a benefit on weight loss programs, which is available through the Smart Combination, Smart Essentials and Smart Start combined hospital and extras policies. Programs approved by Australian Unity are Weight Watchers, Jenny Craig, Sure Slim, Curves Complete and Ultralite. Conditions and exclusions can be found below this table.More info
BupaBupa pays a benefit towards the cost of weight management programs which is included in the Bronze, Silver, Gold and Platinum Extras policies. The Your Choice Extras policy allows you to mix and match so if you require this benefit you will have to select it. Conditions and exclusions can be found below this table.More info
cdhlogoCUA's Gold and Silver Extras Cover policies will pay a benefit towards the costs of entering into a weight management program. Conditions and exclusions can be found below this table.More info
cuaGMHBA's Gold Extras policy provides cover for Weight Management Council of Australia member programs which include Weight Watchers, Jenny Craig Weight Loss Centres, Fernwood and Simplicity Weight Loss. Conditions and exclusions can be found below this table.More info
GMHBA health fundGMHBA's Gold Extras policy provides cover for Weight Management Council of Australia member programs which include Weight Watchers, Jenny Craig Weight Loss Centres, Fernwood and Simplicity Weight Loss. Conditions and exclusions can be found below this table.More info
HBFHBF Flexi Extras allows you to select up to 10 cover options of your choice, one of which is a healthy living programs benefit, which pays towards the cost of a number of services including HBF approved weight management programs.More info
HCFHCF Silver Plus, Gold and Platinum Extras policies provide a benefit for weight loss programs taken through an approved provider and may cover some of the expenses of weight loss medication. HCF members with chronic ailments may also be able to access the Healthy Weight for Life program. More information on this can be found below this table.More info
health.com.aulogoHealth.com.au Extras 50, Basic Extras, Middle Extras and High Extras policies include a benefit that covers weight loss management services. Be aware that Basic, Middle and High Extras can only be purchased as a combined policy with hospital cover.More info
hcilogoBenefits for weight loss programs are included in Health Care Insurance's Premier, Essential and Select Extras cover. The programs must be approved by the fund before a benefit will be paid. The pharmacy benefit in these extras policies can also pay towards the cost of weight loss medication.More info
logo health partnersHealth Partners offers benefits for weight management programs in the Gold and Silver Extras cover if participation in such a program is deemed medically necessary. Additional conditions can be found below this table.More info
HIF LogoHIF Saver, Special, Super and Premium extras cover policies offer cover for recognised weight loss programs under the Healthy Lifestyle benefit. HIF approved providers include Weight Watchers, Jenny Craig, Michelle Bridges' 12 Week Body Transformation Program and more. Exclusions can be found below this table.More info
medibankMedibank's Integrated Osteoarthritis Management program is offered to eligible members who suffer from osteoarthritis. Run by the Healthy Weight for Life team on behalf of Medibank, this at home 18 weeks course provides healthy meal delivery, support and services at no cost. Eligibility requirements for this program can be found below this table.More info
nibnib Top and Core Wellbeing Extras policies include a benefit that pays towards weight loss management programs that are approved by the health fund, which include Jenny Craig and Weight Watchers. Further conditions can be found below.More info
peoplecare provider page linkA health management benefit of varying amounts is included across the whole range of Peoplecare's extras policies, and covers membership fees for approved weight loss programs which are Weight Watchers (including Weight Watchers Online) and the Fernwood Weight Loss program. Conditions and exclusions can be found below this table.More info
queensland country health fund provider linkA healthy living benefit is included in all Queensland Country Health Fund extras policies, which pays towards the cost of participating in weight loss programs or gym membership. The benefit amount will vary depending on the level of extras cover you choose. Conditions can be found below this table.More info
Transport Health LogoFamily By Design Combined Cover allows policyholders to claim for weight loss programs.More info
westfund provider linkWestfund Gold and Platinum Extras policies will pay a benefit towards the cost of you joining a weight loss program. Please note that cover extends to membership and joining fees only.More info
CBHS Health Fund LogoRestricted fund*CBHS Essential, Intermediate and Top Extras cover include a weight loss program benefit. To be eligible for cover the weight loss program must be taken through Fernwood Slimplicity, Jenny Craig, Weight Watchers, BodyTrim or Michelle Bridges' 12WBT.More info
doctorshealthfundlogoRestricted Fund*Doctors Health Fund includes a health management benefit that covers weight loss programs in their Total Extras policy. Further conditions can be found below this table.More info
teachersRestricted fund*Teachers Health Fund offers a benefit for weight loss programs in the Top and Essential Extras policies. The weight loss program must be approved by Teachers Health Fund. Further conditions can be found below this table.More info
tuhRestricted fund*Benefits for weight loss programs can be accessed through TUH's Mid range, Healthy Options and Comprehensive Extras cover. Eligibility and claiming conditions can be found below.More info

*Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.

Why should you check the fine print?

Be sure to read the policy document so you’re aware of the conditions relating to your cover. Qualifications for cover can be based on the following:

  • Waiting period. If you want to claim on surgery, you must wait 12 months from when you purchased the insurance policy before you are eligible for cover. Non-surgical treatments such as living well benefits only have a waiting period of two months.
  • Pre and post-op medication. Unless you’ve been prescribed medication by your doctor, you insurer won’t pay for any weight loss medication.
  • Partner hospitals. Some policies let you choose whichever public or private hospital that is most convenient. While you can generally choose any public hospital, if you choose a non-partner private hospital, you may be entitled to restricted benefits only.

What happens to loyalty limits when I change health funds?

Private health insurers provide a rollover period of about two months when you change policies. You will continue to receive cover for treatments common to your old policy and your new policy without having to serve the waiting periods again. If you have accrued loyalty benefits — additional perks such as reduced excesses when you hold a policy for a certain number of years — you forfeit these perks if you change insurers.

Compare policies with the help of an adviser

Picture: Shutterstock

Richard Laycock

Richard is the insurance editor at finder.com.au. He is on a mission to make insurance easier to understand.

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