Health insurance means fairness for Aussies

4 minute read

Did you know medical history or age don’t influence the price of health insurance?

Unlike risk-based insurance such as car and life insurance, health insurance is based on a system called community rating.

Under this system, factors such as your age, health status or claim history don’t impact your ability to have cover or your premium amount. This means you can be covered with confidence that you’ll be treated fairly.

Why is community rating important for our healthcare system?

Our community rated system ensures equality and fairness for Australians when it comes to protecting their health with insurance. Higher claims don’t mean higher premiums and those who need to claim aren’t disadvantaged because they need to access healthcare services.

This system also helps to take the burden off our public healthcare system by making it accessible for anyone who needs it.

Community rating and private health are important parts of Australia’s world leading dual health system. Currently over 45% of Australians have private hospital cover and 55% have extras or general treatment cover and are protected by the community rating system this insurance is based on.1

But premiums can vary for other reasons, and that’s why you should compare

While health funds can’t charge extra based on your age, health status or claim history, premiums can vary between health funds based on other factors, such as your state or territory and the number of services, or for hospital cover, clinical categories, a policy includes.

Premiums can vary depending on your state or territory simply because the price of private healthcare is different in every state and territory.

When it comes to the level of cover, premiums are generally higher for policies that cover more services. In 2019, the Australian Government introduced tiers to categorise hospital cover: Gold, Silver, Bronze and Basic. While these tiers have standardised the inclusions of hospital cover across the health insurance industry, it’s ultimately up to individual health funds to set the price of these policies. That means a Gold policy with one health fund can have a different premium to a Gold policy with another health fund, even if they cover the same services. So, it always helps to compare and see you’re getting the best value.

Premiums are individual to you (but not your health)

It’s always important to consider your own circumstances when comparing health cover, as there are more factors, such as your income, when you take out private hospital cover, whether you have an excess, and the number of people your policy covers, which can influence the final price of your health insurance premium. The private health insurance rebate, lifetime health cover loading, and age-based discount are initiatives established by the Australian Government to encourage Australians to take up private hospital cover and may be applicable to your premium, depending on your circumstances.

With competitively priced Gold hospital cover, industry leading medical gap cover and no preferred providers for extras, Doctors’ Health Fund is made for doctors, the medical community and their families. Plus, when you join by 8 April, you’ll receive 8 weeks free and skip the two-month waits on extras.^ Contact the team on 1800 226 126 for a tailored comparison with your current cover and to join.

Click here to find out more.

References / disclaimers:

1APRA quarterly private health insurance statistics, September 2023. Accessed at

^Terms and conditions apply. Must join by 8 April 2024 to receive 8 weeks free and two-month waiting periods waived on extras. New members only. Check eligibility in the full terms and conditions at

Private health insurance products are issued by The Doctors’ Health Fund Pty Limited, ABN 68 001 417 527 (Doctors’ Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy, available at

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