How is my premium calculated?

To calculate a premium, we use claims and service cost data from previous years to estimate the amount we’ll need to spend in the coming year. Premiums are then adjusted for each type of cover so we can safely cover those predicted costs.

Premium increases aren’t calculated at an individual member level. Your premium change just depends on the kind of cover you have. Community rating applies to private health insurance, it means everyone with the same cover will have the same premium change.

Your final premium amount each year will be a combination of the cover's premium change, any discounts that you have, your Lifetime Health Cover loading, and, if applicable (and in addition) your Australian Government Rebate on Private Health Insurance.

Calculation of premium increases is subject to external scrutiny. To obtain a premium increase an application must be submitted to the Australian Government Minister for Health. The Department of Health and the Australian Prudential Regulation Authority (APRA), the independent health insurance financial regulator, assess all applications to increase premiums before these are passed to the Minister of Health to consider. A health fund needs to provide sufficient information to demonstrate to the Minister of Health that the increase is necessary. If an increase is regarded as contrary to the public interest it will not be approved.