Lifetime Health Cover

Are you over 31, or about to turn 31 and don’t have private health insurance? Under the Government’s Lifetime Health Cover initiative, you may be required to pay a loading when you take out private health cover for the first time.

With Lifetime Health Cover, the earlier you take out cover, the better off you’ll be: if you’re over 31, the sooner you join, the smaller the loading you will pay. Or if you’re under 31 and you join now, you may be able to avoid the loading altogether.

So it pays to take out private health cover now!

Here’s how it works

A 2% loading applies for every year you delay taking out private health cover over the age of 31. Under Lifetime Health Cover, this is based on your age on 1 July prior to taking out cover for the first time (this is sometimes referred to as your Certified Age at Entry or your Lifetime Health Cover age). The loading increases each year until it reaches 70%. Check out the table below to see how you could be impacted.

Your age on 1 July prior to joining	Lifetime Health Cover loading
30	0%
31	2%
32	4%
33	6%
34	8%
35	10%
36	12%
37	14%
38	16%
39	18%
40	20%
41	22%
42	24%
43	26%
44	28%
45	30%
46	32%
47	34%
48	36%
49	38%
50	40%
51	42%
52	44%
53	46%
54	48%
55	50%
56	52%
57	54%
58	56%
59	58%
60	60%
61	62%
62	64%
63	66%
64	68%
65+	70% maximum

How is the loading applied?

If you have a loading, you will be required to pay this on top of the ‘base rate’ premium, or standard premium payable for your hospital cover. The Lifetime Health Cover loading does not apply to extras cover premiums.

How to avoid or reduce the loading

Take out hospital cover before you turn 31 and maintain it without a break (or any break less than three years).
Or, if you are over 31, take out hospital cover as soon as possible to minimise the loading you will pay. Each year you delay, your loading will increase by 2%, up to a maximum of 70%.

Where the loading doesn’t apply

There are some situations where you won’t have to pay the loading. These include if you:

Had hospital cover on 1 July 2000 and have maintained it since then;
Were born on or before 1 July 1934;
Turned 31 on or before 1 July 2000 and were overseas on 1 July 2000; or
Are the subject of a determination under Clause 10 of Schedule 2 in the National Health Act 1953 (Cth)

Lifetime Health Cover does not apply to overseas visitors covers.

Also, once you’ve had private hospital cover with the loading for 10 consecutive years, you won’t have to pay the loading any longer.

Why Lifetime Health Cover?

The Lifetime Health Cover initiative was introduced by the Government on 1 July 2000.

Lifetime Health Cover recognises the length of time that a person has had private health insurance hospital cover. It is designed to encourage people to take out private health insurance earlier in life, and to maintain their cover. People who join early in life will pay lower premiums relative to people who join later. For example, someone joining before the age of 30 will pay lower health insurance premiums throughout their years of membership compared with someone who joins for the first time at 50 years of age.

What else do I need to know?

Lifetime Health Cover Terms Explained

Term	Explanation
Certified Age at Entry (or Lifetime Health Cover Age)	Your age on the 1 July before the day on which you take out private hospital cover.
Base rate	The 'base rate' for private hospital cover is the standard premium payable for the cover if no loading applies.
Loading	The 'loading' will be 2% per year, representing the adjustment to the base rate for each year by which the Certified Age at Entry is above 30. For example, if you join at age 40, you will pay an additional 20% on the base rate premium.
Maximum loading	The maximum loading allowed on top of the base rate is 70%. This translates to the maximum loading for an entry age of 65 and above. However, once you have held private health insurance hospital cover for a continuous period of 10 years your loading will be removed.

Can I change my level of cover under Lifetime Health Cover?

Yes. You can still upgrade or downgrade your hospital and extras covers under Lifetime Health Cover. The usual waiting periods and applicable pre-existing condition rules will still apply.

However, because Lifetime Health Cover only applies to hospital cover, if you decide to drop your hospital cover and only maintain your extras cover, your Certified Age at Entry may be affected.

What happens to the Government Rebate under Lifetime Health Cover?

If you are eligible for the Government Rebate, this will apply to the whole premium, including any applicable Lifetime Health Cover loadings on top of the base rate premium.

Does Lifetime Health Cover affect premiums for extras cover and ambulance cover?

Lifetime Health Cover does not apply to extras cover and ambulance cover. It only applies to hospital cover.

What happens if someone is unemployed, goes overseas or simply chooses to drop out for a while?

The Government recognises that there are going to be times when people need to drop their hospital cover. For example, if people are travelling overseas for extended periods of time, or in the case of unemployment. To cater for this, people can drop their hospital cover for up to 1,094 days without having to pay an additional Lifetime Health Cover loading when they are ready to take out hospital cover again. Please note that certain days are not counted, such as days spent overseas that are part of a continuous period of being overseas for more than one year.

How does Lifetime Health Cover affect people if they wish to switch between funds?

Under Lifetime Health Cover, people are still able to transfer their private health cover between funds as they always have. All health funds are obliged to recognise the Certified Age at Entry of any new contributor transferring from another fund.

Check out our Lifetime Health Cover calculator to see how you may be impacted

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