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Private health insurance explained

Understand private health insurance, from the Pharmaceutical Benefit Scheme to Lifetime Health Cover Loading.


Understanding private health insurance

Families and individuals who are eligible for Medicare and pay private health insurance contributions on an appropriate hospital or extras cover may be eligible for the Australian Government Rebate on Private Health Insurance. The rebate can help to reduce your contributions. You can read more about the rebate in our fact sheet.

The level of rebate that you're entitled to claim is based on the age of the oldest person covered by the policy and by your annual earnings. These are set out in tiers depending on whether you are a single or a couple/family.
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Income thresholds effective from 1 July 2022

Base tierTier 1Tier 2Tier 3
Singles<$90,000$90,001 - $105,000 $105,001 - $140,000>$140,001
Families<$180,000$180,001 - $210,000$210,001 - $280,000>$280,001

Please note: Single parents and couples (including de facto couples) are subject to the family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first.

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Rebate % by age group effective from 1 April 2022 to 31 March 2023

Base TierTier 1Tier 2Tier 3
Aged under 6524.608%16.405%8.202%0.000%
Aged 65 to 6928.710%20.507%12.303%0.000%
Ages 70+32.812%24.608%16.405%0.000%

Please note: Single parents and couples (including de facto couples) are subject to the family tiers. For families with children, the thresholds are increased by $1,500 for each child after the first. Rebate levels are adjusted annually on 1 April based on the Rebate Adjustment Factor.

Australian Government Rebate FAQs

What are Private Health Insurance Statements (PHIS)?

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What are Private Health Insurance Statements (PHIS)?

So you can understand and easily compare your cover, GU Health provides you with a Private Health Insurance Statement (PHIS) every year and every time you make a change to your cover.

You don’t need to take any action when you receive your PHIS but we do encourage you to review your current level of cover to ensure it will meet your needs into the future.


What is the Medicare Levy Surcharge?

If you're earning over $90,000 as a single or over $180,000 as a couple, family or single-parent family, you could be affected by the Medicare Levy Surcharge if you don't hold private hospital cover for the full financial year.

Would the Medicare Levy Surcharge apply to me?

To find out if the MLS applies to you, as well as the surcharge rate you may have to pay, please visit the ATO’s Medicare Levy Surcharge Income Calculator.

Need more info? Please refer to privatehealth.gov.au for further information about the Medicare Levy Surcharge in relation to private health insurance.

What is the Pharmaceutical Benefit Scheme?

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The Pharmaceutical Benefit Scheme (PBS) gives all Australians and eligible overseas visitors access to more than 2,600 prescription medicines at a government-subsidised price. The scheme aims to increase the accessibility of medications for Australians.

All you need when you visit the pharmacy is your:

  • Medicare card

  • Services Australia or Department of Veterans’ Affairs’ (DVA) concession card (if you have one)

  • PBS Safety Net card (if you have one)

Once you or your family reach your Safety Net threshold, you can get a PBS Safety Net card from your pharmacist. This means your PBS-listed medicine will be cheaper, or free, for the rest of the calendar year.


Health care for non-Australians

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Individuals who have an Australian working (subclass 482) visa are subject to conditions that require them, and their accompanying family members, to maintain adequate health insurance arrangements for as long as they’re in Australia. All GU Health overseas visitor Hospital covers meet visa requirements. Visit our overseas visitors page for more information.

If you’re from a country which has a Reciprocal Health Care Agreement (RHCA) with Australia, you may be eligible to access Medicare. For further information you should refer to Services Australia for information about RHCA countries.

We offer non-resident RHCA health cover designed to ensure you can apply for exemption from the Medicare Levy Surcharge without the need to purchase additional cover components.