Private health insurance

Page last updated: 02 July 2019

New private health insurance information

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.

Access to the waiting period exemption for psychiatric care benefits has been available since 1 April 2018. Further information on the waiting period exemption can be accessed on the Supporting Mental Health — waiting period exemption for higher benefits web page.

Private Health Insurance — Prostheses

Private Health Insurance — Prostheses formerly known as Schedule 5 — Benefits payable in respect of surgically implanted prostheses, human tissue items and other medical devices.

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

These documents have now been finalised and are available on a new Second Tier Default Benefits web page.