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The guide · receipt 04 of 06

Comparing policies on privatehealth.gov.au

Every private health policy sold in Australia has a Private Health Information Statement, a standard summary of what it covers, and privatehealth.gov.au holds one for every policy from every registered insurer. Its Compare Policies search narrows them down by who is covered, where you live and the cover you want.

What a statement is for

Health insurers are required by law to provide a Private Health Information Statement for every policy, so you can review the one you hold or compare others. privatehealth.gov.au, an Australian Government site managed by the Private Health Insurance Ombudsman, carries a statement for every policy from every registered insurer.

There are three types: hospital, general treatment (extras) and combined. A hospital statement describes the clinical categories covered, which are restricted, the waiting periods and any excesses, co-payments and gaps. An extras statement describes the services covered, waiting periods, benefit limits and example benefits.

Reading one, line by line

A simplified, made-up statement to show where things sit. It is not the official layout and describes no real policy.

1. 1The tier: Gold, Silver, Bronze or Basic, explained on privatehealth.gov.au’s product tiers page.
2. 2Each clinical category, marked covered or restricted, explained on privatehealth.gov.au’s clinical categories page.
3. 3“Other services (see insurer for detail)”. This means more services than the ones listed may be restricted or not covered, and only the insurer can say which.
4. 4Excess and co-payment. An excess is a set amount you pay towards a hospital stay before benefits are paid; a co-payment is a set amount for each day in hospital. Both lower the premium.
5. 5The premium. The statement shows the full monthly premium and the premium with the Standard Rebate taken off. It leaves out any Lifetime Health Cover loading and any discounts, and your own rebate may differ with your income and age. The dollar amounts are for comparison only and are not a quote.
6. 6Status. A policy is Available or Closed. A closed policy is no longer sold but still covers existing members. An ‘Available From’ date appears only when a policy can’t be bought until a future date.
7. 7The PolicyID, the unique identifier of that particular statement.

Extras statements add their own lines: example maximum benefits for common treatments in each service, and ‘Special features’ text, flagged with an asterisk, where a service has extra information. ‘Other features’ is where insurers put anything that doesn’t fit the format, such as discounts, bonus schemes or programs.

Two cautions from the Ombudsman’s site: the words on a statement may not match the ones your insurer uses, and the statement is a summary, so the full policy information is worth reading before you sign up.

Using Compare Policies

The search on privatehealth.gov.au starts with three things: who is covered, where you live and the type of cover you want. Choosing specific hospital services or extras gives more tailored results but takes longer, and a personal key lets you reuse the answers from an earlier search.

Where you live matters because a policy is offered at a set price within one state. Who is covered matters too: under changes passed in 2021, the law lets insurers cover dependants up to 31, though each insurer can set its own age range.

privatehealth.gov.au also lists restricted insurers, which cover people in a particular industry or group, sometimes with their families. The Ombudsman’s site suggests checking whether you qualify for any of them.

The tools beside the statement

• Health insurers: each registered insurer’s policies, contact details and performance. The annual performance report for each insurer in each state is on its page.
• Agreement hospitals: the private hospitals that have an agreement with a given insurer, which affects what you pay for hospital charges.
• Gap cover doctors: shows where to find each insurer’s gap cover arrangements. The gap receipt shows what those arrangements do to a bill.
• Medical Costs Finder: typical costs for common specialist procedures in different places.

The statement for the policy you already hold

Your insurer must send you a statement at least once a year, and again each time your policy changes. Insurers can also send a customised version with more detail. Because every policy on the market has one, reading yours beside the statements for other policies is a like-for-like comparison.

The cheapest policy may not be the right one. The Ombudsman’s site suggests weighing how comprehensive a policy is, and how its excesses, co-payments and benefit limits would affect the total cost of treatment, alongside the premium.

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