The government has approved a 4.41% average health insurance premium rise for 2026 – the highest increase in 9 years. Every year, health insurers must apply to the Minister for Health and Ageing to raise premiums. Last year’s average increase was 3.73%, while the 2017 average was 4.84%. Policyholders will be advised of their premium change over the coming weeks, with new premiums effective from 1 April. The Private Health Insurance Rebate will also be reduced from 1 April...
Increased out-of-pocket costs for specialists are leading many Australians to delay or cancel specialist care, a recent study has found. A survey of 4,000 people by Private Healthcare Australia – peak body for the health insurance industry – found that 55% of people received a higher specialist bill than expected in the past 3 years, and almost one in 3 people had delayed or cancelled specialist care due to costs. The survey – which included 2,300 people...
The Australian Medical Association (AMA), an advocacy group for doctors, says private health insurance no longer provides value for money, and wants the government to overhaul the industry. The association’s annual Private Health Insurance Report Card, released today, found premium prices had doubled over the past 16 years, outstripping health inflation.“Australians are paying more for their...
Increased claim costs are putting health insurers under pressure, new data shows. The latest figures from industry regulator, the Australian Prudential Regulation Authority (APRA), show $5.2 million was paid for hospital treatment claims in the September 2025 quarter – an 8.0% increase compared with the same quarter last year and much higher than the growth in...
Specialist fees for private hospital care in Australia have increased dramatically – in some cases, by as much as 9 times, new data shows. Figures from Private Healthcare Australia, the peak body for the health insurance industry, found that average out-of-pocket fees charged for treating private patients have surged by staggering amounts between 2018-19 and 2023-24. Average...
The Minister of Health has warned health insurers to focus on providing value to customers when they apply to increase their premiums over the next few weeks. Private health insurers are allowed to raise premiums once a year only, subject to government approval. Insurer applications for 2026 premium increases are due in November, with approved prices...
Some ACT residents are being hit with shock bills for public hospital treatment, new figures show. Following news this week that health insurance premiums for ACT residents may rise by at least $180 next year, an analysis of billing records has revealed the high Gaps being paid for Canberra hospital treatment. Data from Private Healthcare Australia...
With public hospitals under strain, health insurers are paying out greater sums for private patient treatment, new data shows. Quarterly health insurance statistics released by the Australian Prudential Regulation Authority, which regulates the industry, showed a significant increase in the amount paid for Hospital Cover claims in the June 2025 quarter. Health insurers paid $4.98 billion...
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The Members Health Fund Alliance is the industry body for health insurers that are not-for-profit or part of a member-owned group.It differs from industry body Private Healthcare Australia, because it claims its members all share a common objective – putting members’ health and wellbeing before profits.It currently represents 24 private health insurers that provide more...
Private Healthcare Australia is an industry body representing private health insurers.It currently represents 22 private health insurers that cover 98% (14.8 million) of people in Australia who hold private health insurance: No. Insurer 1. AIA Health Insurance 2. Australian Unity 3. Bupa Health Insurance 4. CBHS Corporate 5. CBHS Health 6. Defence Health 7. GMHBA...
The Private Health Insurance Ombudsman (PHIO) is part of the Office of the Commonwealth Ombudsman.The Commonwealth Ombudsman protects the community when dealing with the Australian government, particularly resolving complaints about the Australian government.The Commonwealth Ombudsman also oversees some private sector organisations, including private health insurers.The Commonwealth Ombudsman protects private health insurance consumers by:
No. In Australia, private health insurers cannot increase their premiums whenever they choose.Instead, they have to apply to the Australian government for permission to increase premiums and must provide supporting evidence explaining why the increase is necessary.Insurers can apply to increase premiums for their private health insurance policies only once a year.The process works like...
The Australian government regulates private health insurers in Australia.The government regulates:Private health insurance laws also cover what your insurer must let you know about your policy:
In Australia, many private health insurers are mutuals.A mutual is a member-owned organisation where people come together to help achieve their shared purposes. Its objective is to help members and/or the community by providing goods or services rather than returning profits to investors.The underlying concept behind a mutual is that a group of people acting together...
About not-for-profit insurers A not-for-profit health insurer uses its revenue to:In Australia, not-for-profit health insurers are mutual organisations rather than corporations.Most not-for-profits claim to be focused on people rather than profits.Most of the restricted insurers are not-for-profit insurers.How many not-for-profit health insurers are there in Australia? In Australia, 22 private health insurers operate on a not-for-profit basis....
About for-profit insurersA for-profit insurer focuses on returning profits to shareholders from premiums paid by members after it has:How many for-profit health insurers are there in Australia? In Australia, there are 8 private health insurers that operate on a for-profit basis. Insurer Status ahm (a subsidiary of Medibank) Open 1. AIA Health Insurance Open 2. Australian...