Hooray! Our private health insurance information for the general public (including the new reforms) has been updated. It’s now available on our beta website. It won’t be exactly the same — in fact, we hope it’s easier to find and understand.
We’re also changing the way our website looks and works so it’s beta to use.
Information for the private health industry and health professionals remains on this page.
Supporting Mental Health — waiting period exemption for higher benefits
Patients with limited cover for psychiatric benefits can now upgrade without serving a waiting period. The waiting period exemption for psychiatric care benefits can only be accessed by a person once in their lifetime, and is only available after a person has served their initial 2 month waiting period for any psychiatric benefits.
Under the Private Health Insurance Act 2007, private health insurers are required to pay benefits for a range of prostheses that are provided as part of an episode of hospital treatment or hospital substitute treatment for which a patient has cover and for which a Medicare benefit is payable for the associated professional service.
Prostheses List (PL) Cost Recovery Implementation Statement (CRIS)
The PL CRIS provides information on how the Department of Health implements cost recovery for the Administration of the Prostheses List.
Private Health Insurance Premiums
Private health insurers are required to apply to the Minister for Health for premium increases.
Private Health Insurance Circulars
Our private health insurance circulars contain important information related to legislation which governs the operation of private health insurance and the licensing of new private hospitals and day hospital facilities in Australia.
Circulars can be accessed here and are distributed to:
Australian registered health insurance funds
Australian licensed private hospitals and day hospital facilities
Australian state and territory health authorities
other Australian health organisations
health service providers
National Joint Replacement Registry (NJRR) Cost Recovery Implementation Statement (CRIS)
The NJRR CRIS provides information on how we implement cost recovery for the National Joint Replacement Registry (NJRR). The NJRR CRIS reports financial and non-financial performance information.
Second-tier default benefits
We have considered feedback from the private health insurance and private hospital sectors on:
draft guidelines for administration of second-tier default benefits eligibility
a draft application form for hospitals applying for second tier default eligibility
draft categorisation of hospitals for second-tier default benefits purposes