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An independent guide to private health cover in Australia. Not an insurer, broker or comparison service.
Independent guide · not a health fund
Two kinds of cover, four tiers of hospital cover, and the government rules that change what you pay. Each one explained in plain words, from the official sources, so the card in your wallet makes sense.
An enlarged card, drawn for this guide. It belongs to no fund and holds no one’s details.
The back of the card
Hospital treatments are grouped into standard categories, such as ‘bone, joint and muscle’ or ‘heart and vascular system’. A policy that covers a category must cover everything listed in it. The full table of categories by tier.
Since 1 April 2020 every hospital policy is classified as Gold, Silver, Bronze or Basic, by the minimum categories it covers. How the tiers are built.
The government caps hospital waiting periods at two months in most circumstances, including psychiatric care, rehabilitation and palliative care, even for a pre-existing condition. Waiting periods, explained.
The cap is twelve months for pre-existing conditions and for pregnancy and birth. Extras waiting periods are set by each insurer. What counts as pre-existing.
Front of the card
Private health insurance is generally divided into hospital cover, general treatment cover (also called extras or ancillary cover) and ambulance cover. You can hold them separately or as a combined policy.
Helps with the costs of treatment as a private patient in hospital.
Helps with the cost of out-of-hospital health services that Medicare does not cover.
The colour bands
Each bar below has 38 cells, one for each clinical category on the official tier table. The filled cells are the categories a policy must cover to carry that tier’s name. A policy that covers more than its minimum can be called ‘Plus’, such as Bronze Plus.
Gold 38
Must cover all 38 clinical categories, including pregnancy and birth, joint replacements, cataracts, dialysis and weight loss surgery.
Silver 29
Everything Bronze must cover, plus eight more, including heart and vascular system, back, neck and spine, lung and chest, and dental surgery.
Bronze 21
Everything Basic must cover, plus eighteen more, including bone, joint and muscle, chemotherapy for cancer, digestive system and gynaecology.
Basic 3
Must cover rehabilitation, hospital psychiatric services and palliative care, and may do so on a restricted basis.
Every category, tier by tier, and what ‘restricted’ means on a Basic policy.
What changes the price
The rebate, Lifetime Health Cover and age-based discounts affect what you pay for private health insurance; the Medicare levy surcharge affects people above an income threshold who do not hold private hospital cover. The figures below are as at October 2026.
2% a year
Added to your hospital premium for every year you are aged over 30 when you take out hospital cover, if you did not hold it on your base day, up to 70%. It stops after 10 years of continuous hospital cover.
As at October 2026 · privatehealth.gov.au
1–1.5%
For 2026–27, paid by singles with income for MLS purposes above $105,000 and families above $210,000 who do not hold an appropriate level of private hospital cover.
As at October 2026 · ato.gov.au
24.118%
The base-tier rebate for policies where the oldest person covered is under 65, from 1 July 2026 to 31 March 2027. It falls as income rises and is nil at Tier 3.
As at October 2026 · ato.gov.au
The guide
What each one pays towards, and what neither covers.
The four hospital tiers and the 38 clinical categories behind them.
The government maximums for hospital cover, and the exceptions.
The 2% a year rule, your base day, and how the loading ends.
Who pays it at tax time, and which cover avoids it.
The income tiers, the age bands, and two ways to claim.
Where to check