Membership and Coverage

Membership and Coverage Image

Release Date:
May 2015
Next Release:
August 2015
Notes on Statistics
Membership and Coverage Image
This report details by State the number of insured people with hospital treatment and general treatment and the proportion of the population these persons represent.

Note: Statistics are released approximately six weeks after the end of the quarter.

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These statistics may be used freely, however the source must be acknowledged.

SOURCE: Private Health Insurance Administration Council 2015

To obtain statistics older than those published online, contact us.

  1. The population figures used to calculate coverage are derived from the Australian Bureau of Statistics publication, "Australian Demographic Statistics" Catalogue number 3101.0. ACT population is included in NSW prior to December 2009 (see note (p)). Until 31 March 2007 NT policies and coverage were understated as some funds reported NT in other States. From 1 April 2007 the numbers reported in each state reflect the actual policies and insured persons in those states (see note (g)).
  2. The figures on Gold Card Holders, used to adjust the population base by excluding Gold Card Holders, are obtained from the Department of Veterans Affairs.
  3. Minor discrepancies between sums of components and totals are due to rounding.
  4. P = Preliminary.
  5. R = Revised. Revisions in the percent of the population covered occur when the Australian Bureau of Statistics revise the estimated resident population.
  6. Statistics are sourced from data collected from Private Health Insurers that are or were registered under the Private Health Insurance Act 2007 or the National Health Act 1953.
  7. Until the December quarter 1995 "State" meant State of registration of the fund, not necessarily the State of residence of the policy holder. Restricted membership organisations reported for States in which 5% or more of their policies resided. From the December quarter 1995 funds were required to submit membership data for reinsurance purposes where 500 or more single equivalent units reside in a State. From 1 April 2007 insurers were required to report in every state for risk equalisation purposes.
  8. Care should be exercised when analysing trends because of the effects of changes eg. introduction of separate policy and coverage reporting for the Northern Territory (see (a) above).
  9. Persons with hospital cover by age group has only been collected since September 1997.
  10. Persons with general treatment cover (see note (n)) by age group has only been collected since September 2002.
  11. Ambulance Only General Treatment policies and insured persons was first collected in the September quarter 1999 under the category of ancillary.
  12. Lifetime Health Cover, from 1 July 2000, imposes a penalty on policy holders joining a health benefits organisation for hospital cover after reaching the age of 30. The penalty is 2% above the base rate for each year over the age of 30 in which the policy holder was not a member of a health benefits fund.
  13. Starting from 1 April 2007, the family policies include two more categories: 2+ persons, no adults – a policy where two or more persons are insured none of whom is an adult and 3+ adults – a policy that covers at least three adults.
  14. Starting from 1 April 2007 general treatment policies replaced ancillary policies. General treatment policies cover treatment similar to that previously known as ancillary (eg. dental) but can also cover hospital-substitute treatment, Chronic Disease Management Programs and hospital-linked ambulance coverage. Many hospital treatment only policies were reclassified as hospital and general treatment combined policies, causing an artificial increase in the series.
  15. In the March quarter 2009 PHIAC began collecting general treatment policies and persons covering ancillary/other services (eg. Dental) separately from those general treatment policies and persons that are not covered for ancillary services. Table 7 shows persons with general treatment ancillary cover by age. Data between March 2007 and March 2009 has been estimated.
  16. Data for the ACT was included with NSW data until the December quarter 2009 when PHIAC began collecting ACT data separately. Analysis of NSW data should be viewed with caution due to the break in the NSW data series between September 2009 and December 2009.