You are financially responsible for any health care debts you incur in Australia. We may need to consider any outstanding health debts you have if you apply for a visa in future.
Medicare is Australia's universal insurance scheme. In most cases, visitors to Australia are not eligible for Medicare, and are responsible for all costs incurred during their stay. This includes, but is not limited to, care provided in both a public and private hospital setting.
To be eligible for Medicare, for a service rendered in Australia you must be:
- an Australian citizen
- an Australian permanent resident
- a New Zealand citizen who is lawfully present in Australia
- a Resident Return visa holder
- an applicant for permanent residency (conditions apply)
- a temporary visa holder covered by a
Ministerial Order; or
- a citizen or permanent resident of Norfolk Island, Cocos (Keeling) Islands, Christmas Island or Low Howe Island.
Ministerial Orders made under section 6(1) of the
Health Insurance Act 1973 extend Medicare eligibility to specified classess of persons. This includes holders of particular temporary visas.
You may also be eligible for Medicare if you are visiting from a Reciprocal Health Care Agreement country (RHCA). More information on RHCAs is available below.
We strongly recommend that all visitors to Australia who are not eligible for Medicare get private health insurance (regardless of whether it is a condition of their visa). This ensures they are covered for any health care costs they may incur while they are in Australia.
A person who is not eligible for Medicare will be considered a private patient when receiving health care in Australia. The private patient must pay any costs they incur that are not covered by private health insurance at the time of treatment. This will apply whether a person receives health care in the public system, or the private health care system in Australia. For routine health care, an appointment with a general practitioner (GP) is normally the most cost-effective solution.
For overseas visitors, Overseas Visitor Health Cover (OVHC) products commonly provide the minimum level of private health insurance recommended. For overseas students, Overseas Student Health Cover (OSHC) products commonly provide the minimum level of private health insurance recommended. The level of cover provided by OVHC and OSHC products can vary. Visitors and students are therefore strongly encouraged to carefully review private health insurance products to determine what is and what is not covered. This ensures that the product they select meets the minimum level of cover and their individual health care needs.
For more information, see the Australian Government website,
Overseas Visitors & Overseas Students.
OSHC and OVHC products may include information notices stating whether the level of cover selected is sufficient to satisfy visa condition 8501. Condition 8501 requires that the holder must maintain adequate arrangements for health insurance while the holder is in Australia.
See
Visas subject to condition 8501.
Out of pocket expenses
Your healthcare costs in Australia are unlikely to be covered completely by private health insurance. Where your health care costs are not completely covered by your private health insurance, you will be liable to pay the balance of your healthcare costs. Before receiving any health care in Australia, we recommended that you get an estimate of:
- costs so that you understand what the costs are
- what your private health insurance covers
- any out-of-pocket costs (gap fees) you must pay.
This is called informed financial consent.
Find out more about
out-of-pocket costs.
Reciprocal Health Care Agreements
Find out more about RHCAs on the Services Australia website.
Evidence of adequate health insurance
Some Australian visas, as part of the criteria for grant, require applicants to have provided evidence of adequate arrangements for health insurance during the period of their intended stay in Australia. Applicants for these visas will need to provide a copy of a current private health insurance policy held with an Australian registered private health insurer for you and any additional applicants applying for the visa with them.
Based on the OSHC base cover product requirements, it is recommended that your private health insurance policy covers the equivalent to:
- out-of-hospital medical services, such as visits to the doctor (GP)
- in-hospital treatment delivered in a public or private hospital
- surgery, including surgically implanted medical devices and human tissue products
- blood tests and x-rays
- pharmaceuticals, including prescription medicines
- ambulance services, including inter-hospital transfers and emergency treatment
We recommend that visitors to Australia visit the
Private Health website. You will find information about private health insurance while in Australia to help you understand the requirements and available options.
We encourage prospective visitors to Australia to shop around to get the best value private health insurance product for their time in Australia. Private health insurance provided by Australian or overseas health insurance companies may be acceptable.
The
Private Health website also provides a list of private health insurers operating in Australia to help consumers choose an insurer for the uptake of cover.
Minimum level of cover
To satisfy the adequate health insurance requirement, you should purchase cover that provides benefits at least equivalent to the following and consider, based on your needs, whether a higher level of cover may be more appropriate than the minimum level of cover we suggest.
The following benefits guide is our recommended minimum level of cover for all visitors to Australia. It is based on the
OSHC base product requirements. The Australian Government regulates OSHC through the
OSHC Deed. This sets out the detailed requirements for the benefits insurers must provide under OSHC products.
Hospital treatment in a public or private hospital
For medical assessments and treatments provided by a medical professional while admitted to hospital.
For public hospitals this should cover a benefit equal to the state and territory health authority gazetted rates for Medicare ineligible patients for:
- overnight and day only hospital accommodation (all costs including: all theatre, intensive care, labour wards, ward drugs)
- emergency department fees
- admitted patient care and postoperative services that are a continuation of care associated with an early discharge from hospital.
For private hospitals this should cover a benefit of at least the amounts specified in the
Benefit Requirement Rules, or the contract if one is in place between the insurer and hospital.
This includes all admitted treatments covered by the Medicare Benefit Schedule (MBS).
Waiting periods
A waiting period is a set amount of time you must wait after starting your health insurance policy before you can claim certain benefits. Your insurance policy will set out the waiting periods for your selected product.
We suggest you purchase a product that has maximum waiting periods no higher than those set by the Australian Government for OSHC products. These maximum waiting periods, from the policy start date, include:
- 12 months for pregnancy and birth related treatments (obstetrics) and 0 months for policies of 2 years duration or more,
- 12 months for pre-existing conditions,
- 2 months for psychiatric treatments, rehabilitation or palliative care, even for a pre-existing condition,
- 2 months for all other treatments.
Medical devices and human tissue products
For medical devices and human tissue products listed in the
Private Health Insurance (Medical Devices and Human Tissue Products) Rules, a benefit at least equal to 100 per cent of the minimum benefit amount listed.
Pharmacy
For all Pharmaceutical Benefits Schedule (PBS)-listed drugs, prescribed according to PBS-approved indications, that are administered during and form part of an admitted episode of care, a benefit equal to the PBS-listed price in excess of the patient contribution.
This includes the cost of PBS-listed drugs administered post-discharge if they form part of the admitted episode of care.
Note that OSHC products are only required to provide limited cover of pharmaceuticals. If you purchase a product like OSHC, you may face significant out-of-pocket costs if you need treatment with pharmaceuticals. If you are likely to require pharmaceuticals you may wish to explore increasing the cover above that provided under an OSHC, or similar, product.
Medical Services
For in-hospital medical services with a Medical Benefits Schedule (MBS) item number, at least 100 per cent of the MBS fee or less if the patient is charged less.
Ambulance services
100 per cent of the charge not otherwise covered by third-party arrangements for transport by ambulance provided by, or under an arrangement with, a government-approved ambulance service when medically necessary for admission to hospital, emergency treatment onsite, or inter-hospital transfer for emergency treatment.
This includes inter-hospital transfers that are necessary because the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences.
Informed financial consent
Your private health insurer will allow hospitals to check your private health insurance cover. This is so you will know what your out of pockets costs will be and are able to give informed financial consent before you are admitted to hospital for medical treatment.
Excluded services and treatments
Australian registered private health insurers are unable to cover some services and treatments, including:
- elective cosmetic treatments
- treatments and services that are experimental, unproven, or not listed on the MBS;certain natural remedies (including aromatherapy, homeopathy, Buteyko, and reflexology)
- OSHC products do not cover services and treatments provided outside Australia, including treatment provided whilst travelling to or from Australia (exceptions apply)
- services and treatment that is not medically necessary
- treatment arranged in advance of the insured's arrival in Australia (OSHC-specific products may cover prearranged treatment)
- services and treatment where the medical expenses are for a compensable injury or illness for which the insurer has accepted liability.
Carefully check the terms of your private health insurance policy to determine which services and treatments are covered and which are excluded.
Global annual benefit limits
To comply with the minimum level of health insurance, the per-person, per-annum benefit payable under your private health insurance policy must not be less than AUD1,000,000.
Out-of-hospital cover
Out-of-hospital medical services are those provided by a medical professional such as a physician at a clinic and/or general practice and do not involve hospital admission. Out-of-hospital treatment is the most effective way to treat many conditions and health insurance for out-of-hospital medical services is recommended for all visitors.
There may be instances where medical services and treatment is undertaken in a hospital environment by a treating physician, such as in an outpatient department. Providing that the patient is not admitted to hospital, the services performed are still considered to be out-of-hospital medical services.
For out-of-hospital services that have an MBS item number and for which a benefit is payable, cover should include benefits up to the benefit listed in the MBS.
Subject to some conditions, an Australian registered private health insurer can determine whether it provides cover for out-of-hospital treatments and, as such, consumers may choose to purchase additional cover to meet their individual health care needs while in Australia.
Higher Level Cover
You can choose to purchase cover above the minimum we suggest. Higher levels of cover are more expensive and usually include all the services listed above, plus additional services such as:
- dental
- physiotherapy
- optical
- private psychology
- counselling
- repatriation
Each insurer offers different services under their higher level cover, so it is a good idea to check the services included in your insurance package and compare with other insurance providers.
Excess, co-payment or patient contribution
An excess, co-payment, and patient contribution are out-of-pocket costs. An excess is a one-off lump sum paid per hospital stay or year. A co-payment is a daily fee for each day in hospital. A patient contribution broadly refers to any personal share of medical costs
Australian registered private health insurers may apply an excess, co-payment or patient contribution to their product offerings. We recommend that visitors choose products that do not have an excess to ensure they can access treatment when they need it. We recommend visitors take note of any excess, co-payment and patient contributions that may apply.
Private health insurers generally have agreements with a number of private hospitals; and these hospitals generally charge lower or no out-of-pocket expenses. Without a contractual arrangement in place, an insurer is unable to advise what hospital costs will be covered, resulting in possible unexpected out-of-pocket costs.
You should check with your insurer which hospitals they have agreements with before presenting at a hospital for non-emergency treatment. Before presenting at a hospital that your insurer does not have an agreement with, be sure to seek written confirmation about your likely out-of-pocket costs.
Find out more about
out-of-pocket costs.
Portability
Australian registered private health insurers are required to recognise previous length of membership on a domestic or OSHC policy held with another Australian private health insurer when determining whether the waiting period may apply in certain circumstances, specifically:
- when transferring between Australian-based insurers where the customer has been a member of the previous fund for more than 12 months, waiting periods of no longer than 12 months will apply to the higher level of benefits
- when transferring between Australian-based insurers where the customer has been a member of the previous fund for less than 12 months, any unserved waiting periods must be completed with the new fund. If increasing the level of cover or benefits, further waiting periods of no longer than 12 months will apply to the higher level of benefits. These waiting periods are to be served concurrently.
Australian registered private health insurers are also required for domestic policies to:
- grant a member who transfers between Australia-based insurers continuity of cover for up to 30 days from the date they leave their previous insurer
- provide members who terminate their policy with a clearance certificate within 14 days of the termination date or the date they were notified of the termination, whichever is later.
We suggest when transferring between private health insurers that you ensure your new cover provides the above portability requirements.
Buy-out clauses
To comply with requirement to hold adequate health insurance, your insurance policy cannot contain a buy-out clause that would have the effect of terminating an Australian registered private health insurer’s liability under the policy in exchange for a predetermined lump sum payment.
In the event of a buy-out, the visa holder would no longer hold adequate health insurance (in the absence of purchasing another appropriate policy) and be in breach of condition 8501.
Membership Arrears
Membership arrears occur when your payments for your Private Health Insurance Policy are not up to date.
The Australian registered private health insurer will generally allow the insured person 60 days from the last financial date of membership to pay a premium without terminating the membership.
Australian registered private health insurers are not required to pay for any treatment received during a period of arrears until and or unless the period of arrears is paid for in relation to the relevant period. In order to continue to meet the requirement for maintaining adequate health insurance you must ensure that you pay any arrears within the period permitted under your insurance policy.
