Private Health Insurance

Medicare provides access to public healthcare services, but some people choose private health insurance as an additional option. It may help when covering costs that Medicare excludes, avoiding the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) or wanting choice with reduced wait times compared to the public healthcare system.

1. Covers costs that Medicare generally excludes, such as dental, optical, physio, and ambulance services (depending on state).
2. Depending on income and circumstances, holding appropriate hospital cover can help avoid the Medicare Levy Surcharge (MLS) or Lifetime Health Cover (LHC). Visit ato.gov.au and search for ‘Medicare Levy Surcharge’ or ‘Lifetime Health Cover’ to find out more.
3. Private health insurance may allow you to be treated as a private patient in hospital. This can offer more choice in specialists or hospitals and may reduce waiting times for some elective surgeries, compared with public healthcare system.

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Thinking about cost? With an eligible AIA Health policy, you can save on your premium by engaging with AIA Vitality. You can earn up to $760 cashback into your CommBank account every year, plus up to $240 premium credits just for maintaining healthy habits with AIA Vitality.³

Hospital cover contributes towards costs when admitted to a hospital as a private patient, depending on the level of cover and the treatments included.

Hospital cover may provide:

• access to treatment in a private hospital or as a private patient in a public hospital
• greater choice of doctor, subject to availability and provider arrangements
• cover for specific clinical categories, depending on the policy

Extras cover (or general treatment) provides benefits for out-of-hospital services that Medicare generally does not cover, such as dental, optical, physiotherapy, and chiropractic care. Limits, waiting periods and included services vary by policy.

AIA Health Insurance Hospital cover comes in levels from Basic to Silver Plus Family, with each level covering different treatments. For example, cover to be treated in a private hospital for pregnancy is only available under Silver Plus Family Hospital. Extras cover can be taken out on its own as Extras Only or Combined cover (with Hospital), with claimable services depending on the level chosen.

No, AIA Health’s FlexiExtras is an Extras cover designed to give members flexibility to choose how they use their annual Extras limit across different services. This means you can direct more of your benefits towards the services you use most, like dental, physiotherapy or chiropractic. Plus, you are rewarded the longer you hold your cover by receiving a $100 increase every year on your annual limits, for up to five years.

No. AIA Vitality (or AIA Vitality Starter) is only available to customers who purchase Hospital or Combined cover.³

An excess is the upfront amount agreed to pay when submitting a hospital claim.

• Higher Excess = Lower Premium: Pay less on the ongoing premium with a higher upfront cost should you need to make a hospital claim
• Lower Excess = Higher Premium: Pay more on the ongoing premium to avoid a larger upfront amount when submitting a hospital claim

Policy holders typically only pay the excess once per person, per calendar year, regardless of how many times you are admitted.

With AIA Health, customers on eligible policies can use AIA Vitality (or AIA Vitality Starter)³ to receive a Hospital Excess Refund² benefit when both of the following conditions are met:

1. Hold an eligible AIA Health policy: Choose the excess that best suits your situation and hold the policy for at least 6 months.
2. Reach AIA Vitality Silver Status: Engage with the AIA Vitality program (such as completing health assessments, walking and sleep tracking) to reach Silver Status.

Once both conditions above are met, and when admitted to hospital, AIA Health will provide an Excess Refund benefit of up to $500 for eligible hospital admissions. Conditions apply.²

A waiting period is the time you must wait after joining a policy before you can claim benefits. Waiting periods apply to most services, particularly for pre-existing conditions and major procedures. Waiting periods vary by policy and type of service.

If you switch to AIA Health from another fund, AIA Health ensures that any waiting periods you have already served for equivalent cover are recognised, so you don't have to start from scratch.

Many Australians are eligible for the Private Health Insurance Rebate. This is an amount the government contributes towards the cost of private health insurance premiums. Eligibility depends on age and income tier. Depending on circumstances, the rebate is generally claimed either:

• as a reduction in premiums through the health insurer, or
• as a tax offset when lodging a tax return.

The Medicare Levy Surcharge is an additional tax levied by the Australian Government on higher-income earners who do not hold an appropriate level of private hospital cover. It is designed to encourage individuals to take out private health insurance to reduce the strain on the public Medicare system. It's calculated in three tiers for singles and couples/families. Find out more about the MLS on PrivateHealth.gov.au.

A person may be exempt from the surcharge if they have held a valid private hospital insurance policy with a registered health fund for the full financial year. If cover is held for only part of the year, the surcharge may still apply for the period not covered.

LHC loading is a government loading on hospital premiums if you do not take out private hospital cover before 1 July following your 31^st birthday.  

It is designed to encourage people to join early and stay covered. If you join late, you pay more:

• An extra 2% loading applies on top of the premium for every year of age over 30 without cover.
• The loading is capped at 70%.
• The loading may not be permanent. Once hospital cover is held for 10 years continuously, the loading may be removed, and premium returns to the standard rate if the policy is maintained.

Rules around LHC are set by the Australian Government and may change. Learn more about LHC.

AIA Vitality (or AIA Vitality Starter)³ is a science-backed health and wellbeing program available with eligible AIA Health policies. It works on a simple cycle:  

1. Know your health: Complete a range of online and offline assessments to understand your overall health and start your journey to better health.
2. Improve your health: Track your physical activity or complete health checks and more to earn AIA Vitality Points. AIA Vitality helps you on your journey to improving your health with discounts on gym memberships, fitness devices and more.
3. Enjoy the rewards: As you earn points, you increase your AIA Vitality Status (from Bronze through to Platinum). AIA Vitality keeps you motivated with ongoing rewards including Shopping Rewards each time you unlock a new AIA Vitality Status and discounts with retail partners, cashbacks on flights and health insurance premium rewards.³

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Generally, private health insurance Extras cover does not allow claims for a standard gym membership used for general fitness. However, there are two important ways AIA Health supports your fitness costs:

1. Medical Health or Wellness Management programs: If a doctor or health practitioner prescribes a gym or exercise program to treat a specific diagnosed health condition (such as diabetes or heart disease), you may be able to claim this under the Health or Wellness Management category of your Extras cover. You will need your doctor’s letter of recommendation.
2. AIA Vitality: Even if not claiming, AIA Health members with AIA Vitality (or AIA Vitality Starter) can access benefits. AIA Vitality provides up to 40% off memberships with partner gyms like Virgin Active and Fitness First. Plus, by staying active and tracking your gym visits, you can earn weekly Active Benefits rewards (like vouchers or cashback directly into your CommBank account).³