Quarterly Private Health Insurance Statistics

March 2020 (released 19 May 2020)

 Disclaimer and Copyright
While APRA endeavours to ensure the quality of this publication, it does not accept any
responsibility for the accuracy, completeness or currency of the material included in this
publication and will not be liable for any loss or damage arising out of any use of, or
reliance on, this publication.

© Australian Prudential Regulation Authority (APRA)

This work is licensed under the Creative Commons Attribution 3.0 Australia Licence
(CCBY 3.0). This licence allows you to copy, distribute and adapt this work, provided you
attribute the work and do not suggest that APRA endorses you or your work. To view a full
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AUSTRALIAN PRUDENTIAL REGULATION AUTHORITY 2

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Contents

Snapshot of the industry.…….…….………………..…… 2

Membership and coverage…….……….……………..…… 3

Benefits paid…..…….…….……………….………………… 5

Service utilisation………..…….…………………………… 8

Out-of-pocket payments…….……………………………… 9

Financial information……………………………………… 10

Notes on statistics…………………………………………… 12

Related publications…………….………………………… 13

Copyright
© Australian Prudential Regulation Authority (APRA)

This work is licensed under the Creative Commons Attribution 3.0 Australia Licence (CCBY 3.0).
This licence allows you to copy, distribute and adapt this work, provided you attribute the
work and do not suggest that APRA endorses you or your work. To view a full copy of the terms of this licence, visit:
www.creativecommons.org/licenses/by/3.0/au/

Disclaimer

While APRA endeavours to ensure the quality of this publication, APRA does not accept any responsibility
for the accuracy, completeness or currency of the material included in this publication, and will not be liable
for any loss or damage arising out of any use, or reliance on, this publication.

Forthcoming issues

This publication will be released according to the timetable published on the APRA website.

Revisions

This publication will include revisions to previously published statistics if better source data becomes available
or if compilation errors are uncovered.

APRA regularly analyses past revisions to identify potential improvements to the source data and statistical
compilation techniques, in order to minimise the frequency and scale of any future revisions.

Rounding

Details on tables may not add up to totals due to rounding of figures.

Enquiries

For more information about the statistics in this publication:

DataAnalytics@apra.gov.au

Manager, External Data and Reporting

Australian Prudential Regulation Authority
GPO Box 9836
Sydney NSW 2001

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Key metrics
Hospital treatment membership
5,490,748
Policies
5,497,976
43.8% of population at 31 March 2020
↓ -0.2% percentage points from 31 Dec 2019
11,223,363 ↓ -9,760 insured persons over the quarter
Insured persons
11,256,108

31 March 2020 31 March 2019

General treatment membership

6,703,324 53.2% of population at 31 March 2020
Policies
6,672,915 ↓ -0.2% percentage points from 31 Dec 2019
↑ 5,200 insured persons over the quarter
13,634,405
Insured persons
13,612,007

31 March 2020 31 March 2019

Hospital treatment episodes

↑ 0.5% over the 12 months to March 2020 4,716,206

↓ -3.1% compared to the December 2019 quarter 4,693,934

12 months to 31 March 2020 12 months to 31 March 2019

General treatment services (ancillary)

↓ -3.6% over the 12 months to March 2020
93,069,841
↓ -4.4% compared to the December 2019 quarter
96,539,113

12 months to 31 March 2020 12 months to 31 March 2019

Benefits (millions)
↑ 3.4% over the 12 months to March 2020
Hospital treatment $15,925 ↑ 2.8% compared to the March 2019 quarter
(Including HST) $15,395

General treatment $39

(CDMP) $53
↑ 0.9% over the 12 months to March 2020
General treatment $5,346
(ancillary) $5,296 ↓ -3.4% compared to the March 2019 quarter

12 months to 31 March 2020 12 months to 31 March 2019

Out-of-pocket per episode/service

$324.04
↑ 2.5% over the 12 months to March 2020 Hospital treatment
$316.13

General treatment $50.46

↑ 6.2% over the 12 months to March 2020 (ancillary) $47.51

31 March 2020 31 March 2019

Financial
(millions)

Premium $24,996
↑ 2.5% over the 12 months to March 2020
revenue $24,397

$21,509 ↑ 3.7% over the 12 months to March 2020

Benefits
$20,747

Profit before tax

$1,312 ↓ -26.9% over the 12 months to March 2020
$1,796

12 months to 31 March 2020 12 months to 31 March 2019

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Membership and coverage as at 31 March 2020

Hospital Treatment
At 31 March 2020, 11,223,363 people, or
43.8% of the population, were covered by
hospital treatment cover. There was a 0.2 Net quarterly change in insured persons
percentage point decrease in the percentage 30,000
of the population covered compared to the
25,000 Actual change
December 2019 quarter.
20,000 Net Change
There was a decrease in coverage of 9,760 15,000
insured people in the March 2020 quarter.
10,000
Single policies decreased by 683 and family
policies by 4,375 during the quarter. This 5,000
resulted in an overall decrease of 914 hospital 0
policies. For the 12 months to 31 March 2020,
-5,000
the number of insured people with hospital
treatment cover has increased by 1,355 -10,000
policies. -15,000

10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85–89
90–94
0–4
5–9

95+
The largest decrease in coverage during the
quarter was 9,565 for people aged between 30
and 34. The largest net decrease (taking into
account movement between age groups) was
for the age group between 25 and 29, with a
drop of 11,176 people.

Number of persons insured by age

Lifetime health cover

The majority of adults with hospital cover 90–94

(89.1%) have a certified age of entry of 30,
with no penalty loading; a 0.1 percentage 80–84
points increase compared to December 2019. 70–74

At the end of the March 2020 quarter, there 60–64

were 882,791 people with a certified age of 50–54
entry of more than 30 and subject to a Lifetime
Health Cover loading; a net decrease in people 40–44
paying a penalty over the preceding 12 months 30–34
of 54,484. There was a net increase in people
with a certified age of entry of 30 (with no 20–24
penalty) over the year of 28,111.
10–14
0–4
600 400 200 0 200 400 600
Persons '000 Female Male

Hospital treatment tables

Aust. 43.8% 56.2% Aust. 5,427,457 5,795,906 Aust. 48.2% 51.8%

NSW 45.2% 54.8% NSW 1,789,864 1,902,902 NSW 48.2% 51.8%

VIC 40.2% 59.8% VIC 1,296,316 1,396,594 VIC 50.5% 49.5%

QLD 40.5% 59.5% QLD 1,006,394 1,083,217 QLD 46.1% 53.9%

SA 44.0% 56.0% SA 371,893 404,195 SA 48.4% 51.6%

WA 53.6% 46.4% WA 698,090 720,620 WA 46.7% 53.3%

TAS 42.1% 57.9% TAS 107,492 119,119 TAS 48.5% 51.5%

ACT 53.8% 46.2% ACT 110,910 120,960 ACT 48.5% 51.5%

NT 38.7% 61.3% NT 46,498 48,299 NT 47.9% 52.1%

Insured persons Non insured persons Male Female Single policies Family policies

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General Treatment
At 31 March 2020, 13,634,405 people or
53.2% of the population had some form of
general treatment cover. There was a increase Net quarterly change in insured persons (ancillary)
of 5200 people when compared to the
December 2019 quarter. 30,000
25,000
The increase was mainly driven by single Actual change
20,000
policies (up 7,348). For the 12 months to 31 Net change
March 2020, the number of insured persons 15,000
with general treatment cover has increased by 10,000
22,398.
5,000

There was a decrease of 13,894 people with 0

general treatment (ancillary) coverage in the -5,000
March 2020 quarter. The largest net decrease -10,000
in coverage, after accounting for movements
-15,000
across age groups, was 9,888 for people in

95+
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85–89
90–94
the 25 to 29 age group.

Number of persons insured by age (ancillary)

90–94
80–84
70–74
60–64
50–54
40–44
30–34
20–24
10–14
0–4
600 400 200 0 200 400 600
Persons '000 Female Male

General treatment tables (ancillary)

Aust. 53.2% 46.8% Aust. 5,926,041 6,385,138 Aust. 49.2% 50.8%

NSW 55.6% 44.4% NSW 1,993,776 2,125,348 NSW 48.7% 51.3%

VIC 47.2% 52.8% VIC 1,283,210 1,389,647 VIC 51.3% 48.7%

QLD 47.0% 53.0% QLD 1,054,569 1,155,980 QLD 47.7% 52.3%

SA 58.5% 41.5% SA 459,146 505,031 SA 49.3% 50.7%

WA 68.7% 31.3% WA 852,509 898,062 WA 48.5% 51.5%

TAS 49.7% 50.3% TAS 116,070 130,030 TAS 49.9% 50.1%

ACT 65.9% 34.1% ACT 118,706 130,531 ACT 49.5% 50.5%

NT 43.1% 56.9% NT 48,055 50,509 NT 49.1% 50.9%

Insured persons Not insured persons Male Female Single policies Family policies

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Benefits Paid
Hospital treatment

Benefits per episode/service Hospital treatment benefits paid by age

12 months to 31 March 2020
Change
from
December
90–94
March 2020 2019
80–84
Hospital Treatment
Acute $2,374 -4.2% 70–74
Medical $60 -3.8% 60–64
Prostheses  $668 -1.7%
Cardiac $3,932 -2.1% 50–54
Hip $1,681 -3.5%
40–44
Knee $1,773 -1.5%
Total benefits and growth rate 30–34
Hospital $ 3,805,565,414 -7.9%
General $1,371,713,283 -1.7% 20–24

10–14

During the March 2020 quarter, insurers paid 0–4

$3,806 million in hospital treatment benefits, a 1,000,000 500,000 0 500,000 1,000,000
decrease of 7.9% compared to the December
2019 quarter. Hospital treatment benefits were $'000 Female Male
comprised of:

◊ $2,710 million for hospital services such as

accommodation and nursing Hospital treatment benefits per person covered and percentage of
benefits paid by age cohort
◊ $575 million for medical services
$7,000 16%
◊ $521 million for prostheses items.
$6,000 14%
12%
$5,000
10%
The age group for which most hospital benefits $4,000
8%
are paid is between 60 and 84 (top chart). Total $3,000
benefits by age group is affected by the average 6%
benefits paid per person (displayed in the second $2,000
4%
chart) and the number of people in each age
$1,000 2%
group. Older age groups have a higher claiming
rate. The rise in benefits in the 20–39 age $0 0%
95+
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85–89
90–94

cohorts is due to increases in female benefits

associated with child bearing.
Average hospital benefits per person increased
Benefits per person % benefits
from $1,368 for the year ending March 2019 to
$1,419 for the year ending March 2020. The
largest amount of benefits per person was spent
on hospital accommodation and nursing, Hospital treatment benefits per person
followed by medical and prostheses benefits.

12 months to Mar 2019 $1,367.74

Medical
$217.23
Hospital
12 months to Mar 2020
$1,005.84
Prostheses
$195.86

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General treatment

Benefits per service General treatment benefits paid by age

12 months to 31 March 2020 (ancillary)
Change
from
March 2020 December
2019 90–94

80–84
Dental $68 5.0%
Chiropractic $34 10.7% 70–74
Physiotherapy $39 8.1%
Optical $76 2.1% 60–64

50–54

40–44
During the March 2020 quarter, insurers paid
$1,363 million in general treatment (ancillary) 30–34
benefits. This was a decrease of 1.6% 20–24
compared to the December 2019 quarter.
Ancillary benefits for the March 2020 quarter 10–14
included the major categories of:
0–4
◊ Dental $705 million 450,000 300,000 150,000 0 150,000 300,000

$'000 Female Male

◊ Optical $252 million

◊ Physiotherapy $109 million

◊ Chiropractic $79 million. General treatment benefits per person covered and
percentage of benefits paid by age cohort (ancillary)

There is a marked difference between the $700 10%

distribution of benefits over age groups between 9%
$600
hospital benefits and ancillary benefits. The 8%
major difference is the higher claiming rate in $500 7%
older age groups for hospital benefits while
$400 6%
benefits per person for ancillary benefits are 5%
more evenly spread over the age groups. $300 4%
$200 3%
General treatment (ancillary) benefits per
person during the year to March 2020 were 2%
$100
$434, increasing from $430 for the year to 1%
March 2019. The largest component of ancillary $0 0%
95+
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
65–69
70–74
75–79
80–84
85–89
90–94

benefits is dental, for which $231 was paid per

insured.
Benefits per person % benefits

General treatment benefits per person (ancillary)

12 months to Mar 2019 $430.27

$430.27 Optical Chiropractic

$75.17 $23.86
Dental Other
12 months to Mar 2020 $69.40
$231.00

Physiotherapy
$34.81

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Medical benefits Prostheses benefits

Total benefits for medical services decreased
8.2% during the March quarter 2020, driven
largely by a 3.6% decrease in the number of
services.
The change in medical benefits paid per
service was calculated over a range of
medical services and does not mean medical
services overall decreased or increased in
cost. The average benefits paid reflects the
type of medical services utilised during the
quarter as well as the volume of services. The
medical service for which the greatest amount
of benefits was paid was anaesthetics,
comprising 24.0% of all medical benefits and
totalling $138 million.
Total benefits paid for prostheses decreased
by 10.9% in the March quarter 2020 compared
to the December quarter 2019. Similar to
medical services, the change in benefits paid
for prostheses was calculated over a range of
prosthetics (see chart) and does not mean
prostheses overall changed in cost. The
change in benefits paid may reflect a change
in the type of prosthetics utilised, or a change
in the overall utilisation of prosthetics. The
prosthetic group for which the greatest amount
of benefits were paid was cardiac, comprising
17.2% of all prosthetic benefits and totalling
$90 million.

Medical benefits by Speciality group

General Surgical
Pathology 5% Ophthalmology
Obstetrics 7% 5% Cardiothoracic
5% 5%
Orthopaedic Assist
7% at operations
3%
Other Urology
Specialties 3%
Smaller Groups 5%
Specialist
39% ICU
10%
2%
Neuro
surgical
Diagnostic 2%
6% Plastic/
Colorectal reconstructive
Anaesthesia 4% ENT 2%
24% 2%
Vascular
1%

Benefits paid for prostheses

Other Cardiac
12% 17%

Plastic/ General Knee

ENT reconstructive Miscellaneous 12%
2% 1% 13%

Hip
Cardiothoracic
10%
1%
Urogenital
1% Neurosurgical
3% Orthopaedic
Spinal 12%
Vascular 8%
3%
Ophthalmic
4%

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Service utilisation

Episodes/Services by type

Change from Hospital utilisation is distributed over four

December categories of hospital—public, private, day only
March 2020 2019 facilities and hospital-substitute. During the
March 2020 quarter, hospital episodes were
distributed as follows:
Hospital Episodes 1,141,509 -3.1%
Hospital Days 2,988,019 -3.3%
Medical Services 9,574,984 -4.5% ◊ public hospitals 193,916 episodes
Prostheses Items  779,616 -9.4% ◊ private hospitals 754,215 episodes
Specialist Orthopaedic 142,547 -7.6% ◊ day hospital facilities 144,181 episodes
Ophthalmic 82,920 -11.5% ◊ hospital substitute 49,197 episodes.
Spinal 53,057 -11.3%
General Treatment 22,839,322 -4.4%
Dental 10,338,800 -8.6%
Chiropractic 2,321,874 12.2%
Physiotherapy 2,783,058 4.3%
Optical 3,313,800 -10.4%

During the March 2020 quarter, insurers paid benefits

for 2.99 million days in hospital, arising from 1.14
million hospital episodes of care. Quarter Year
change change

◊ public hospitals ↑ 1.1% ↓ -2.5%

◊ private hospitals ↓ -3.7% ↑ 1.8%
◊ day hospital facilities ↓ -6.9% ↓ -2.3%
◊ hospital-substitute ↑ 2.2% ↑ 0.2%

Day-only episodes in the four categories of

hospital totalled 759,533, a decrease of 3.0%
compared to the December 2019 quarter.

Hospital treatment services per 1,000 insured persons General treatment services (ancillary) per 1,000
insured persons

1000 1000
900 900
800 800
700 700
600 600
500 500
400 400
300 300
200 200
100 100
0 0
Jun-17

Jun-18

Jun-19
Dec-17

Dec-18

Dec-19
Sep-17

Sep-18

Sep-19
Mar-17

Mar-18

Mar-19

Mar-20

Jun-17

Jun-18

Jun-19
Dec-17

Dec-18

Dec-19
Sep-17

Sep-18

Sep-19
Mar-17

Mar-18

Mar-19

Mar-20

Acute episodes Acute days Dental Optical

Medical services Prostheses items Physiotherapy Chiropractic

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Out-of-pocket payments
Average out-of-pocket per episode/service
Change The out-of-pocket payments for hospital
from Dec Change episodes increased by 2.5% compared to the
March 2020 19 from Mar 19 same quarter for the previous year.
Out-of-pocket payments for medical services
Hospital treatment $324.04 8.1% 2.5% were $193 where an out-of-pocket payment
Hospital-substitute treatment $9.81 -6.2% -10.8% was payable. The amount of gap for medical
General treatment ancillary $50.46 -0.4% 6.2% services varies depending on the specialty
Medical gap where gap was group. The specialty group with the largest
paid $193.42 0.4% 24.4% out-of-pocket payment was
plastic/reconstructive with an average gap of
$414. Gap incurred for the various medical
services is displayed in the first chart.
The average out-of-pocket (gap) payment for a hospital episode Medical gap also varies by state and territory
was $324 in the March 2020 quarter. This included out-of-pocket and these differences are shown in the
payments for medical services, in addition to any excess or co- bottom chart.
payment amounts relating to hospital accommodation.

Medical benefits and out-of-pocket by specialty group

1%

3%
2%
6%
1%

6%

11%
9%
11%

11%
15%
15%
17%
17%

24%
27%

29%

38%
99%
99%

98%

97%
94%

94%
91%

89%
89%

89%
85%
85%
83%
83%

76%
73%

71%

62%

Assist at operations

Diagnostic

Pathology
Specialist consultants

Colorectal
Anaesthesia

Cardiothoracic

Neurosurgical

ENT

Orthopaedic

Other
General surgical

Plastic/reconstruct
Obstetrics

Vascular
ICU

Ophthalmology
Urology

Gap % of charge Benefits % of charge

Proportion of services and average out-of-pocket payments

90.0% $193.46
Aust. Aust.
7.5% $19.41

90.7% $243.60
NSW NSW
6.3% $22.54

89.2% $143.95
Vic. Vic.
8.8% $15.61

90.9% $227.47
Qld Qld
6.1% $20.79

91.5% $110.56
SA SA
7.9% $9.41

87.1% $145.37
WA WA
10.0% $18.73

91.0% $166.32
Tas. Tas.
7.5% $15.04

79.9% $282.04
ACT ACT
13.2% $56.78

87.9% $237.32
NT NT
8.8% $28.71

Proportion of services with no gap Average gap payment where gap was paid

Proportion of services with known gap Average gap payment across all services

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Financial information

Financial Performance

12 months to 12 months to Health Insurance Business (HIB) premium

All Figures $'000 March 2020 March 2019 revenue was up 2.5% for the year March
Revenue 2020, while total fund benefits increased
HIB premium revenue 24,995,955 24,397,186 by 3.7%. As a result, gross margin
Net investment income 94,734 415,861 decreased from 13.0% to 14.0%.
Net HRB revenue 116,743 137,526
Net other operational revenue 185,314 69,362 Net investment income decreased from
Total revenue 25,392,747 25,019,936 $416 million in the year ending March
Benefits 2019 to $95 million in the year ending
Fund benefits 21,509,050 20,746,593 March 2020.
State ambulance levies 237,994 231,702
Total fund benefits 21,747,044 20,978,295 HIB expenses as a percentage of revenue
Expenses remained stable at 9.0% and net margin
HIB expenses 1,844,175 1,799,911 decreased from 5.0% to 3.96%.
HIB claims handling 414,619 399,024
Non-operating expenses 74,451 46,825 Net profit after tax decreased to $0.97
Total expenses 2,333,245 2,245,760 billion for the year ended March 2020
Profit of the industry compared to $1.359 billlion for the year
Profit/(loss) before tax ended 31 March 2019.
1,312,458 1,795,881
Taxation expense 339,284 435,957
Profit/(loss) after tax 973,174 1,359,924
Margins
Gross margin 13.00% 14.01%
HIB expenses 9.04% 9.01%
Net margin 3.96% 5.00%

Health Benefits Fund Profit After Tax Breakdown for 12 months to March 2020

$24,996 $21,747
$95 $117 $185
(millions)

$1,844
$415 $74 $973
$339
Fund benefits
operational

HIB expenses
Net investment

Non-operating
HIB claims
Net HRB

Taxation expense
HIB premium

Net other

Profit/(loss) after
revenue

revenue

handling

expenses
revenue

income

tax

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Prudential Position

March December March The industry held total assets of $15.4

All figures $'000 2020 2019 2019 billion as at 31 March 2020.

Assets Total assets have increased by $405

Cash 1,675,697 1,216,958 1,204,782 million in the last 12 months.
Investments
Equities 1,447,593 1,671,006 1,680,580 Total liabilities reported by the industry
Interest bearing assets 8,041,924 7,772,708 8,182,336 have increased by $265 million over the
Property 746,884 739,259 709,269 year.
Subsidiary and associated
296,563 288,051 289,237
entities Total net assets increased from $8.4 billion
Loans 34,481 38,960 38,277 in March 2019 to $8.5 billion in March
Receivables 65,717 55,567 63,442 2020.
Intangibles DAC and FITBS 1,093,598 1,075,189 902,070
Pre-paid expenses 72,149 72,556 63,582
Other* 1,885,444 1,714,320 1,821,354
Total assets 15,360,051 14,644,575 14,954,930
Liabilities
Unearned premium liabilities 3,382,257 2,572,150 3,316,687
Unpresented & outstanding
2,233,134 2,034,425 2,097,970
claims
Other fund liabilities 164,560 149,112 177,091
Interest bearing liabilities 2,390 926 3,953
Payables, provisions &
1,054,256 1,065,858 975,664
other liabilities
Total liabilities 6,836,597 5,822,472 6,571,364
Total assets minus total liabilities 8,523,454 8,822,103 8,383,566

Capital Adequacy Requirement

March December March

All figures $'000 2020 2019 2019
Total Liabiliities 6,836,597 5,822,472 6,571,364
Liability risk charges 338,263 446,990 -296,305
Loss risk charges 1,254,369 1,107,765 1,111,297
Operational risk charges 166,336 172,908 174,204
Other capital charges 88,609 85,378 85,378
Less subordinated debt 4,479 4,414 4,414
Total Capital Adequacy Requirement# 8,679,695 7,631,098 7,641,523

* includes health insurance equipment and other assets

# Does not include Capital Management Policy target levels (refer to glossary)

Health Benefits Fund Assets vs Liabilities as at March 2020

Cash

Equities

12% 11% Interest bearing assets

Property
8% 10%
Subsidiary and associated entities
2% 45%
Loans, premiums receivable, prepayments and intangibles
5%
Other

Balance sheet liabilities

Liability risk charges

52% Loss risk charges

Operational risk charges

1% 8% 2%
Other capital charges

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Notes on statistics
Source of data

On 1 July 2015, supervisory responsibilities were transferred from the Private Health Insurance Administration
Council (PHIAC) to APRA under the Private Health Insurance (Prudential Supervision) Act 2015 .

This publication is compiled primarily from regulatory returns submitted to APRA under the Financial Sector
(Collection of Data) Act 2001 by authorised Private Health Insurance companies.
Prior to 1 July 2015, PHIAC collected data from Private Health Insurers.

The population figures used to calculate coverage are derived from:

Australian Bureau of Statistics, Australian Demographic Statistics, ABS cat no. 3101.0, ABS, Canberra.
The June 2019 quarterly release of Australian Demographic Statistics contains the most recent estimates of
the resident populations (ERP) of Australia and the states and territories based on the results of the 2019
Census of Population and Housing held on 9 August 2016. For more information refer to the publication at the
ABS website.

Net change by five year age group is the actual change adjusted for the number of people moving into the
cohort and out of the cohort due to ageing. The calculation makes the simplifying assumption that the number
of people are evenly distributed over each year within the five year age group.

Lifetime Health Cover is a financial loading (LHC loading) that can be payable in addition to the premium for
your private health insurance hospital cover (hospital cover). LHC loadings apply only to hospital cover. The
loading is 2% above the base rate for each year over the age of 30 in which the policy holder did not have
private health insurance hospital cover. After ten years of paying the loading the loading is removed.

Starting from 1 April 2007, general treatment policies replaced ancillary policies. General treatment policies
cover treatment similar to that previously known as ancillary (eg. dental) but can also cover hospital-substitute
treatment and Chronic Disease Management Programs.

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Related Publications

Quarterly publications

A number of related quarterly publicatons are available from:

https://www.apra.gov.au/publications

These include:

Quarterly Statistics

The Quarterly Statistics are principal release of statistics with summaries for the key financial
and membership statistics of the Private Health Insurance industry.

Membership Statistics

A publication which details by State the number of insured persons for hospital treatment and general
treatment and the proportion of the population these persons represent. The tables are shown on both a
quarterly and an annual basis and include hospital treatment by age cohort.

Medical Gap Information

A publication on in-hospital medical services. The proportion of services for which there was no gap or
known gap and the average gap payment are shown for each state.

Private Health Insurance Membership and Benefits (formerly PHIAC A)

A publication detailing by State, the membership and benefits paid by private health insurers for the
period. These State reports are available both in PDF format and Excel.

Prostheses Report

A report providing data on prosthetic benefits paid by private health insurers by major prosthetic
category

Medical Services Report

A report providing data on services, benefits paid and gap payments by MBS Specialty Block
Groupings for medical services paid by private health insurers.

Statistical Trends - Quarterly Statistical trends in membership and benefits paid

These are two separate publications detailing trends since September 1997 in the number of insured
persons and benefits paid for hospital and general treatment.

Annual publications

APRA will continue to produce an Annual Report on the Operations of the Private Health
Insurance Industry. This report contains an industry overview and tables of statistics by
individual fund. Current and historical versions are available at:

https://www.apra.gov.au/publications/operations-private-health-insurers-annual-report

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