Iaso

Income-based government subsidy tiers for the Private Health Insurance (PHI) rebate. Rates for under-65s from 1 April 2026 to 31 March 2027, with 2026–27 income thresholds:

• Base Tier — singles up to $105,000, families up to $210,000 → 24.118% rebate
• Tier 1 — singles $105,001–$123,000, families $210,001–$246,000 → 16.079%
• Tier 2 — singles $123,001–$164,000, families $246,001–$328,000 → 8.038%
• Tier 3 — singles $164,001 or more, families $328,001 or more → 0%

Single parents and couples use the family thresholds, which rise by $1,500 for each dependent child after the first. If the oldest person on the policy is 65–69, the Base, Tier 1 and Tier 2 rates are 28.139%, 20.098% and 12.058%; at 70 or over they are 32.158%, 24.118% and 16.079%.

Higher tier = lower rebate. The tier applies both to the premium rebate and to the Medicare Levy Surcharge (MLS) threshold. Sources: PHI Circular 12/26 (rates), privatehealth.gov.au (thresholds).

The amount you pay upfront per admission before your fund pays hospital benefits. Common amounts: $250, $500, $750, $1,000.

• Higher excess = lower premium
• For couples, excess is per-person but is often capped (e.g. one excess per policy per calendar year for the same hospital stay)
• Some funds waive excess for day procedures, accidents, or children
• AIA Vitality members at Silver status can receive a $500 excess refund annually

Check your fund’s PDS for the exact definition — “per day”, “per admission”, and per-person caps vary significantly.

The Bronze / Silver / Gold classification of hospital services covered. Defined by Ministerial Rules.

• Gold — all clinical categories covered, including pregnancy, weight-loss surgery, and joint replacements
• Silver — most services covered; excludes at least pregnancy and some weight-loss categories
• Bronze — minimum required services (accidents, psychiatric, rehabilitation, palliative care); excludes most elective
• Basic — hospital cover only for accidents and public hospital upgrades
• “Plus” variants (e.g. Silver Plus) — fund-specific additions of specific clinical categories above the tier minimum

Your tier is printed on your policy certificate and on your PHIS document from privatehealth.gov.au.

Covers out-of-hospital (“general treatment”) services: dental, optical, physiotherapy, chiropractic, psychology, orthodontic, and more.

• Listed as a percentage benefit (e.g. 60–70% back) up to an annual dollar limit per service category
• Annual limits reset on 1 January each year (or policy anniversary — check with your fund)
• Waiting periods apply: typically 2 months general dental, 12 months major dental / orthodontic
• No government tier classification — coverage varies widely; compare specific dollar limits, not just percentage back

A 1–1.5% tax surcharge on taxable income for high earners who do not hold private hospital cover. For 2026–27:

• Singles over $105,000 income → 1% MLS (rises to 1.25% and 1.5% at the Tier 2 and Tier 3 thresholds)
• Families / couples over $210,000 combined → 1% MLS (rises to 1.25% and 1.5% at higher thresholds)

Holding any compliant hospital cover (even Basic tier) removes the surcharge entirely. If MLS applies to you, buying hospital cover often costs less than paying the tax. Use the ATO MLS calculator to verify.

If you didn’t hold hospital cover by the 1 July after your 31st birthday, your fund adds 2% for each year of age over 30 when you take it out (your age on the 1 July before you join), capped at 70%.

• Example: first taking out hospital cover at age 40 → 20% LHC loading
• Capped at 70% maximum loading regardless of age
• Loading is removed after 10 continuous years of hospital cover
• Couples and families pay the average of each adult’s loading
• Use the LHC calculator on the Ethical Top 3 page to estimate your adjusted premium

Loading applies to the hospital premium component only, never extras, and the government rebate doesn’t apply to it. Source: privatehealth.gov.au — Lifetime Health Cover.

Mandatory periods after joining before you can claim for certain services. Government-set maximums:

• 2 months — general hospital treatment, general extras (dental check-ups, optical)
• 12 months — pre-existing conditions (hospital), major dental, orthodontics, obstetrics / pregnancy

Waiting periods are served once per insurer. Transferring between funds: if you held equivalent or higher cover, waiting periods for the same service don’t restart (portability rules). Upgrading cover restarts waiting periods only for the newly covered services.

The difference between what a doctor charges and what Medicare + your fund pays combined.

• Zero-gap / no-gap — your doctor charges at or below the agreed schedule fee; you pay nothing out of pocket
• Known-gap — a small agreed gap (usually under $500) disclosed to you in advance
• Unexpected / out-of-contract gap — your doctor charges above the schedule fee and is not in your fund’s gap cover arrangement; can be thousands of dollars

Always ask your surgeon, anaesthetist, and assistant surgeon whether they participate in your fund’s gap cover scheme before booking elective procedures.

Total insurance claims paid ÷ total premiums collected (APRA annual statistics, FY2024–25). Expressed as a percentage.

• Industry average: approximately 84%
• Higher % = more of your premium returned as benefits
• HCF FY24–25: 87.85% — best of the NFP funds scored here, above most for-profits
• GMHBA: 81.94%  ·  HBF: 82.24%  ·  Medibank: 85.60%  ·  Bupa: 82.37%  ·  AIA: 90.41%

NFP status alone does not guarantee a higher payout ratio — only HCF consistently outperforms the major for-profits. Source: APRA Operations of Private Health Insurers FY24–25.

A mutual or member-owned fund. Surplus is reinvested into member benefits, reserves, or community programs rather than distributed to external shareholders.

• APRA registers NFP insurers as “registered health benefits organisations” — verify via the AHSA member list
• NFP status is one factor in our ethical ranking but does not automatically produce higher payout ratios (see Benefit Payout Ratio above)

For-profit funds (Bupa, Medibank, nib, AIA) distribute surplus to shareholders; premiums carry a shareholder return component.

A hospital with a contracted agreement with your fund. In an agreement hospital your fund covers the full accommodation and theatre fees up to the agreed schedule. In a non-agreement hospital, cover is typically limited to a default daily benefit (often far below actual charges) — potentially leaving you with thousands in out-of-pocket costs.

Always confirm that your local hospitals are agreement hospitals before choosing a fund. For ACT residents, key hospitals to check: Calvary John James and National Capital Private.

The government body that handles complaints and disputes about private health insurers in Australia.

• PHIO publishes annual complaint ratios per fund in the State of the Health Funds report
• Our ethical ranking uses complaint share vs. market share: a fund with proportionally fewer complaints scores higher
• HBF FY24–25: 4.8/5.0 (best performer)  ·  GMHBA: 4.5/5.0  ·  HCF: 4.2/5.0

Lodge a complaint or browse fund reports at: ombudsman.gov.au

Iaso (Ἰασώ) — daughter of Asclepius, goddess of recuperation and recovery from illness. Her name comes from the Greek iasis (ἴασις), meaning "healing" or "cure". She represents the process of getting better — not just treatment, but the journey back to health.