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Lifetime Health Cover Frequently Asked Questions


Here are answers to frequently asked questions about Lifetime Health Cover...

Do people under the age of 30 pay less for health insurance under Lifetime Health Cover?
Can I vary the level of my private health insurance cover without affecting my Lifetime Health Cover Loading?
Do premiums for dental/ancillary (extras) products and ambulance cover count towards Lifetime Health Cover?
What if I take out private health insurance after the age of 30?
How can I find out how much of my period of absence I have used?
How can I find out how much loading I am paying?
How is my Lifetime Health Cover premium affected if I want to change from a single policy to a family or couples policy?
Why doesn't my health insurance policy overseas count towards Lifetime Health Cover?
What is the base rate premium?
Where can I get more information about Lifetime Health Cover?


Do people under the age of 30 pay less for health insurance under Lifetime Health Cover?

No. A person who is aged under 30 when they take out hospital cover will pay the same premium as a person who first takes out hospital cover at age 30. That is, they will pay the base rate premium.

Can I vary the level of my private health insurance cover without affecting my premium under Lifetime Health Cover?

Yes. You are able to upgrade or downgrade your hospital policy under Lifetime Health Cover without affecting your certified age at entry. The usual waiting periods and applicable pre-existing ailment rules will still apply.

The only circumstances under which your certified age at entry would be affected by a variation to your private health insurance cover would be if you changed from a policy that includes hospital cover to a policy that does not. In this case the period of absence rules would apply. That is, your certified age at entry would be unaffected for the first 24 months that you were without hospital cover, and would then increase by one year (2%) for every additional 365 days you did not have hospital cover.

Do premiums for dental/ancillary (extras) products and ambulance cover count towards Lifetime Health Cover?

No. Lifetime Health Cover does not apply to ancillary products or ambulance cover.

Therefore, you need to take out a private health insurance policy that includes hospital cover in order to be assigned a certified age at entry and lock in lower premiums for the rest of your life.

What if I take out private health insurance after the age of 30?

People who purchase hospital cover for the first time after the 1 July following their 31st birthday will pay a Lifetime Health Cover Loading. This loading is based on the person's Lifetime Health Cover Age. The loading equals 2% for each year the persons Lifetime Health Cover age is over 30.

How can I find out how much of my period of absence I have used?

The Government understands that there are various reasons members may need to drop their membership for brief periods. Therefore, the Lifetime Health Cover rules provide members of health insurance who need to drop their membership, for whatever reason, a cumulative period of 24 months absence through their lifetime without affecting their certified age at entry. If you want to find out how much of your period of absence you have used, you should contact your fund.

How can I find out how much loading I am paying?

If you are unsure how much loading you are paying, contact HICA on 1300 732 757, your health fund or refer to the annual statement that your health fund sends you detailing your Lifetime Health Cover status.

How is my Lifetime Health Cover premium affected if I want to change from a single policy to a family or couples policy?

If in the future you decide to take up family or couples cover, there is no problem doing so.

The premium that you pay for your family/couples cover will take into account your certified age at entry as well as you spouse's certified age at entry. The couple or family premium is calculated by dividing the base rate premium by the number of adults on the policy and applying each adult's loading to their proportion of the premium.

So the loading you were paying on your singles cover will now be applied to your proportion of your new couple or family policy. For example, if you joined hospital cover before or during the grace period there would be no loading applied to your half of the family premium. Let's say your spouse, on the other hand, has never had health insurance in the past and has a lifetime health cover age of 40. They would pay a 20 per cent loading on their half of the family premium. If the premium for family cover is $1000, the health fund will put your half, $500, and your spouse's half, now $600 ($500 plus 20 per cent of $500 = $600) together and the premium for your family cover would be $1100.

Why doesn't my health insurance policy overseas count towards Lifetime Health Cover?

Private health insurance overseas does not count towards Lifetime Health Cover. This is because any health insurance held overseas does not contribute to the support of community rating, as Australian private health insurance is required to do.

Community rating requires Australian private health insurance funds to charge everyone the same premium regardless of health status and claims history. This ensures that health funds can not charge the elderly and the chronically ill a higher premium.

What is the base rate premium?

The base rate premium is the price a person joining at the age of 30 would pay for hospital cover. This premium is set by individual health funds. The base rate premium will vary between different health fund products and between different health funds and may increase over time as a result of cost pressures such as new, expensive health technologies and the ageing of the population.

Where can I get more information about Lifetime Health Cover?

Information is available by calling HICA on 1300 732 757, the Department of Health and Ageing on 1800 020 103 or from all registered private health funds and Medicare offices.

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