Private Health Insurance Administration Council
The Operations of Private Health Insurers Annual R...
This circular is to advise the release of The Operati...
The consumer section provides information about private health insurance and insurers, types and levels of cover, waiting times, government surcharge and rebate, consumer rights and responsibilities.
As the regulator of the private health insurance industry, PHIAC plays a key role in protecting consumers. PHIAC’s primary responsibility is to ensure the industry is competitive, efficient and financially sound. PHIAC regularly review insurers’ finances and develops actuarial modelling to ensure insurers have enough funds to pay claims now and in the future. PHIAC also develops rules to ensure insurers are managed appropriately and take into account the interests of consumers.
The industry section provides information about the regulatory framework in place, industry statistics, industry education programs and other industry related information.
As the regulator of the private health insurance industry, PHIAC plays a key role in supervising the industry. PHIAC closely monitors industry risks and ensures the controls in place are effective in managing those risks. To ensure the industry fully understands the consequences of growth, capital adequacy standards and prudential standards, PHIAC runs education programs and provides guidance to insurers. PHIAC also has the power to ensure best practices are implemented.
A report that details key membership, utilisation, benefit and financial statistics on a quarterly basis.
Membership and Coverage
Provides details by State of the number of insured persons for hospital treatment and general treatment and the proportion of the population...
Provides data on in-hospital medical services. The proportion of services for which there was no gap or known gap and the average gap...
Hospital Treatment Chart
Distribution of the costs for a stay in hospital. The major cost items are Medical Specialists, Prostheses and Accommodation (accommodation...
Distribution of the major costs for ancillary (non-hospital) items. The major ancillary items are dental, optical, physiotherapy and chiropractic.
Hospital Benefits and Out of Pocket per person...
Hospital costs – who pays. The major costs are met by the private health insurer. Depending on the type of policy held by the health...
Health Funds List
Find details of private health funds registered in Australia
If your health fund isn't here please click here for more info
Information about the health system, services and issues in community languages
Find information about support available for communities, for private health insurance visa requirements for overseas visitors.
How can I be sure my fund is registered in Australia?
If your fund is not on the list, it may mean that:
- Your fund may have several brand names
A registered insurer may have several brand names under which they operate. For example, Frank is not an insurer. It is a brand from GMHBA, which is a registered insurer in Australia. AHM is also a brand from Medibank.
- Your fund is not registered in Australia
Your insurance policy was issued outside of Australia or by a fund that is not registered in Australia. For example, you have purchased a travel insurance policy to provide medical cover for your stay in Australia. These policies are generally risk rated, that is, the premium that you pay is dependent on your risk profile including age, sex, health condition, claiming history, or nationality. These insurance policies are not recognised for Medicare Levy Surcharge or Lifetime Health Cover purpose, thus you may therefore be liable for government surcharges.
Only health funds listed on PHIAC’s website can issue private health insurance for the purposes of Medicare Levy Surcharge or Lifetime Health Cover.
You can check whether your fund is registered by:
- Checking on their website, or
- Contacting your fund directly