weight loss

Obesity and health insurance

Find out what is covered by health funds for weight loss programs, surgeries and more.

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 options online and apply for cover or speak with an adviser

Details Features
Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
Enquire Now More info
Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
Enquire Now 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
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 and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
Enquire Now More info
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
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
Top Hospital Excess
Top Hospital Excess
Comprehensive hospital cover with $250 excess option to reduce the premium you pay.
  • Emergency ambulance cover
  • Pregnancy cover
  • Cancer-related surgery
  • Heart surgery cover
Go to site More info
Top Extras
Top Extras
Top level extras cover with highest percentage back.
  • 60 - 100% back
  • $800 dental annual limit per person
  • $850 physiotherapy annual limit per person
  • $300 optical annual limit per person
Enquire Now More info

What costs will your health fund cover?

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.

How is obesity covered?

Prevention is considered better than a cure, so some private health insurers may include non-surgical treatments such as gym memberships, yoga and pilates classes in 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.

Are obesity related procedures covered by Medicare, private health insurance or both?

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

What type of cover is best for someone looking to lose weight?

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 my 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.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
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
GMHBAGMHBA'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

For a full list of what is covered for weight loss programs by health funds in Australia, please review the table at the bottom of the page.

Conditions and exclusions

HIF

  • Optional materials such as shakers or foodstuffs are not covered by the Healthy Lifestyle benefit.

ahm

To be eligible for weight loss program cover under the Diet and Nutrition benefit, you must provide medical proof of a Body Mass Index rating of 26 or higher. Accepted documents of proof are:

  • A doctors certificate.
  • A completed ahm Health Improvement Benefit Approval Form.
  • A certificate from an ahm approved weight loss provider.

Australian Unity

Your program receipt and a completed claim form needs to be provided to Australian Unity before you receive your joining benefit. To claim your weight goal and weight loss maintenance benefit a signed certificate of goal achievement from your provider must be submitted with your completed claim form.

  • Weight Watchers online programs and at home kits are not covered by the Preventative Health Service's weight loss benefit.

GMHBA

Weight loss program benefits are only payable when they have been deemed by a health practitioner to be necessary to improve or prevent a specific condition. Written referral is required.

When lodging a claim for the weight loss benefit you must also provide either a report from the weight loss provider, photocopy of your membership record of fees paid or membership record of weight loss achieved from your commencement in the program.

      • Meals and exercise components are not covered by GMHBA's weight loss benefit.

HCF and the Healthy Weight for Life program

Healthy Weight for Life is an independent program that offers a free 18 week at home course to eligible HCF members with chronic diseases that includes:

        • Meal replacement weight loss programs.
        • Online tracking to chart your progress.
        • Personal phone and email support.

To be eligible for this program you must of held an HCF hospital cover policy for at least 12 months and be suffering from:

        • Type 2 diabetes.
        • A heart condition.
        • X-ray diagnosed osteoarthritis of the knee or hip.

Additionally you must:

        • Have a body mass index of 28 or more.
        • Not be under medical supervision and have approval from a medical practitioner to participate.
        • Not be allergic or intolerant to KicStart meal replacements.
        • Not be pregnant or breastfeeding, or intending to fall pregnant during the 18 week course.
        • Willing to provide personal and medical data.
        • Have regular internet access and a personal email address.

Make sure 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

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
GMHBAGMHBA'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
phoenix health fund provider linkPhoenix Health Fund's Mid and Top Extras policies will cover approved weight loss programs. 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.

Conditions and exclusions

Bupa

The weight loss program you select will have to meet certain criteria and conditions before the benefit will be paid. You will have to contact Bupa by phone to find out if your program is eligible. Additionally, when claiming you must also provide receipts or account records from your approved weight loss program.

  • Weight loss related foodstuffs, videos, books and medications are not covered by this benefit.

CUA

A CUA Health Management Programs benefit approval form must be filled out by both you and your medical practitioner and submitted before you can claim, and your chosen weight loss provider has to hold an Australian Business Number and specialise in the program recommended by your medical practitioner. Your condition has to of been identified before you start the weight loss program.

  • Weight loss related goods are not covered.
  • Recreational services such as gyms, personal trainers, pilates (unless conducted by a physiotherapist), yoga, weight loss classes and hypnotherapy are not covered.

Health Partners

In order to claim you must provide a completion certificate or confirmation proving you are enrolled in a recognised weight loss program.

Peoplecare

The weight loss program must be registered with the Australian Weight Management Council, and when claiming you must provide a receipt containing your name, details of your weight loss program, date of payment and payment amount.

  • Goods and services that are primarily used for sports, recreation or entertainment purposes (such as sports shoes or gym membership), are not covered by Peoplecare health management benefit.

Phoenix Health Fund

Your approved weight loss program must be part of a health management plan that has been recommended by your medical practitioner, who must sign a completed Healthy Lifestyle treatment plan form in order for the benefit to be paid.

  • Weight loss related foodstuffs are not covered by this benefit.

Queensland Country Health Fund

The healthy living benefit can only be paid if your participation in the approved weight loss program has been recommended as medically necessary by your health practitioner to improve or prevent a specific illness or condition. A Health Management Benefit Approval Form must be completed by you and your doctor and submitted when you claim.

Doctors Health Fund

Eligibility for weight loss program benefit requires written referral from your medical practitioner stating it is medically necessary to treat a specific health condition.

Teachers Health Fund

In order to claim the benefit your weight loss program must be approved by the fund and recommended by your medical practitioner as part of a health management plan designed to treat a specific health condition. The written medical recommendation must be resubmitted every 12 months.

TUH

The weight loss benefit offered by TUH is to assist people suffering from a chronic disease, and therefore requires your weight loss program to have been recommended by a health care professional as a necessary part of your health management plan.

Medibank Integrated Osteoarthritis Management Program

Offered by Medibank on behalf of the Healthy Weight for Life service, a free 18 week at home course to eligible Medibank members suffering from osteoarthritis of the knee or hip and includes:

  • Portion control eating plan (including KicStart and VLCD meal replacements).
  • Physiotherapist-developed strength, balance and mobility exercises.
  • Personalised online symptom, progress and satisfaction tracking.
  • Personal motivation, support and advice via phone, SMS, email, message board and post.

To be eligible for this program you must be a Medibank member and have:

  • Been diagnosed with osteoarthritis of the knee or hip by x-ray, MRI or from an incidental finding from a previous arthroscopy.
  • A body mass index of 28 or more.

Additionally you must also have at least one of the following:

  • Knee or hip symptoms that have, or is likely to require a referral to an orthopaedic surgeon.
  • An existing knee or hip replacement that has developed symptoms that could benefit from weight loss or improved muscle strength and fitness.
  • A scheduled knee or hip joint replacement procedure where weight loss or improved muscle strength and fitness prior to surgery is desirable

Other things to be aware of:

  • You must obtain approval from your medical practitioner to participate in this program.
  • You must be willing to provide progress data, joint pain scores, blood pressure and cholesterol.
  • You must not have participated in this program or any other Healthy Weight for Life program offered by Medibank.

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