Each year the Minister for Health, Ageing, Disability and the NDIS reviews and approves new private health insurance premiums across the industry, to take effect from 1 April.
If you're an Emergency Services Health member, you'll receive personalised information from us about how you're affected, usually by the first week of March..
For general questions about the premium increase we have developed this list of FAQs.
Why do premiums go up?
Annual Private Health Insurance premium changes are necessary to ensure health funds have adequate capital and income to pay for what they will be expected to fund in the next 12 months. The amount needed to cover costs continues to climb due to a number of factors, including:
- The increased cost of an episode of hospital treatment
- The increasing cost of a service provided by health professionals which may be reflected as higher benefits paid for services
- Increases in the number of services claimed against an insurer relative to the number of policies
- Introduction of new medical technology and equipment
- Consumer expectations (e.g. seeking better quality care, more thorough testing etc.)
- Ageing population
- Other factors that may impact your premium include changes to the Australian Government Rebate on private health insurance and the application of the Lifetime Health Cover Loading (LHC).
How does my increase compare to the Industry Average increase?
The average percentages reported in the media aren’t very helpful to you, because the average includes all levels and types of cover not just the top level cover you’re on with us. Because we only offer gold/top level cover options, to get a true comparison of our increase compared to other funds it’s important to look closely at the average increases in Gold cover specifically.
How will changes to the Australian Government Rebate on private health insurance (Rebate) affect the cost of my health insurance?
If eligible, the Rebate is a contribution the Government makes towards the cost of your private health insurance to make it more affordable and accessible.
The Australian Government Rebate on private health insurance (PHI) is annually indexed on 1 April by a Rebate Adjustment Factor (RAF) representing the difference between the Consumer Price Index (CPI) and the industry weighted average increase in premiums. The RAF calculation is set out in the Private Health Insurance (Incentives) Rules 2012 (No. 2).
View the current PHI Rebate tiers
Why is the premium increase different to the increase in Consumer Price Index (CPI)?
It’s a common misconception that CPI is related to health insurance costs. Health insurance increases are not directly correlated with increases in CPI because the two figures are indicative of different things:
CPI is reflective of price increases for a wide range of goods (with healthcare being a subset), and the CPI does not take into account frequency of use; while
Changes in health insurance premiums usually reflect the increased cost of healthcare (which traditionally runs above the rate of CPI), as well as any increased frequency of use.
Why is my premium increase different to Emergency Services Health’s average increase?
Premium increases differ between policies based on the type of cover, how many people are insured on a policy and in what state or territory a policy is purchased.
The figure quoted as Emergency Services Health’s average premium increase by the Department of Health and Aged Care is an average increase across all policies, and so it will, in most cases, be different to the increase applied to your situation.
Who authorises an increase in premiums?
The Board of Police Health Limited, who operate Emergency Services Health, considers and applies for proposed changes to premiums. Under the Private Health Insurance Act 2007, private health insurers must obtain approval from the Minister for Health, Ageing, Disability and the NDIS before applying a rate increase.
If the private health insurer does not provide sufficient information to the Minister to demonstrate that an increase is necessary, then approval is not given. Likewise the Minister has the power to increase premiums beyond what is requested if it is believed that the private health insurer does not have enough funds in reserve to pay the required amount of member benefits.
In the submissions to the Minister, private health insurers must provide detailed financial information and cost and benefit projections to justify any increases. An independent review of this information must also be undertaken by an Appointed Actuary prior to submission.
The proposed increases are examined by the Department of Health and Aged Care and by the Australian Prudential Regulation Authority (APRA).
I haven’t received my premium change notification. How do I get it?
An important policy update, which includes details of your updated premium effective from 1 April 2026, will be sent to you by email or post (depending on your preference) as soon as possible - usually by early March.