Private Health Insurance
About Private Health Insurance
Private health insurance, extras or ancillary cover in particular, can contribute to some allied health and support services such as physiotherapy, psychology and occupational therapy. It pays up to annual limits set by the policy, and those limits vary a lot between insurers and cover levels.
It is a different system from the NDIS, aged care or DVA. There is no formal eligibility assessment. The money comes from a policy the person already holds, and claims go directly to the insurer, often on the spot at the session. Only the insurer can say what a policy covers and how much of the annual limit is left.
At a glance
- Extras cover can contribute to physiotherapy, psychology, occupational therapy and similar.
- Annual limits are set by the policy.
- Claims go to the insurer, often at the time of the session.
- Only your insurer can confirm what your policy covers.
This is general information, not financial or funding advice. Program names, amounts and eligibility rules change over time. Always confirm current detail with the relevant official body before relying on it.
How to prepare before arranging support
- Ask your insurer what your policy covers for the service you need.
- Ask how much of your annual limit is left.
- Claim through the insurer, often at the session itself.
Information and records to have ready
- Policy, membership or claim details
- Referral, approval or case-manager correspondence
- Written quote and explanation of likely gaps
- Invoices, receipts and benefit statements
Questions to ask a provider
- Do you bill this scheme directly, or must the person pay and claim?
- Is a referral, approval number or case-manager authority required?
- What is the total fee and likely out-of-pocket amount?
- Are there annual limits, waiting periods, approved-provider rules or session caps?
- What happens if the claim is delayed, reduced or declined?
Common mistakes to avoid
- Assuming a service is covered because it was covered before
- Confusing a rebate with full payment
- Starting before required written approval
- Failing to check annual limits, waiting periods or provider eligibility
Frequently asked questions
Who can tell me what my policy covers?
Only your insurer. Annual limits vary a lot between insurers and cover levels, so also ask how much of your annual limit is left.
Who can confirm what Private Health Insurance means for me?
Ask the responsible insurer, scheme or program. A provider can explain its services and billing, but it cannot make a binding funding decision for the responsible body.
Does a provider listing prove it accepts private health insurance?
No. A directory or public-register listing describes a provider and the supports it lists. Confirm the funding arrangement, approval and current availability with the provider before booking.
What if the rules or my circumstances change?
Check the current guidance with the responsible insurer, scheme or program, tell your providers promptly and update written agreements or approvals before relying on the changed arrangement.
Official sources
Other Other Funding topics
Browse providers or explore other funding topics.
Helpful reading
- NDIS jargon explained: the terms you will hear and what they mean: Plans, supports, coordinators, managers, registered providers: a plain-language glossary of the words that come up most often.
- NDIS or My Aged Care: which system supports you?: Two government systems support people with disability and older people. Here is how to think about which one applies and what to do if you are not sure.
- Keeping records of your NDIS supports: a simple system: Good records make plan reviews, claim queries and changes of provider far easier. Here is a light-touch way to keep them.