What is Lifetime Health Cover in Australia?

What is Lifetime Health Cover in Australia?

What is Lifetime Health Cover in Australia?

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Ah, the Lifetime Health Cover (LHC) in Australia – a term that sounds like it belongs in a game of Monopoly rather than our everyday lives. But make no mistake, it’s as real as the Vegemite on your toast, and it plays a crucial role in how Australians approach their health insurance. 

So, what is Lifetime Health Cover, and why should you care? Let’s find out.

What Is Lifetime Health Cover In Australia?

What is Lifetime Health Cover (LHC)?

Lifetime Health Cover (LHC) in Australia can indeed be likened to an unusual birthday party scenario. Imagine you’re celebrating your 31st birthday, but instead of getting gifts, you find that for every year you’re over 30 and without private hospital cover, a 2% surcharge is added to your health insurance premium. This metaphor effectively illustrates the mechanics of LHC, a policy designed by the Australian government to encourage individuals to take out private hospital coverage earlier in life.

The LHC policy stipulates that if you haven’t obtained private hospital cover by the time you’re 31, you will incur a 2% loading on your premium for every year you are aged over 30. This loading is cumulative, meaning the longer you delay taking out private health coverage, the more expensive it becomes. 

For instance, if you wait until you are 40 to get private hospital cover, you could pay an additional 20% on your premium each year for a decade. If you delay until 50, the extra cost could be 40% per year for 10 years​.

However, there are certain exemptions to this rule. You are not subject to the LHC loading if you are under 31 years old or if you acquire an appropriate level of private patient hospital cover before your LHC’ base day’ (typically the 1st of July following your 31st birthday). Other exemptions include new migrants to Australia who are over 31 and take out hospital cover within 12 months of registering for full Medicare benefits and individuals born on or before 1 July 1934​.

It’s important to note that the LHC loading applies only to private patient hospital cover and not to general treatment cover (also known as ancillary or extras cover)​

When You Can Wave the LHC Loading Goodbye:

The Lifetime Health Cover (LHC) loading is an additional charge imposed on Australian private health insurance, but there are specific circumstances under which you can avoid or stop paying it:

Age Factor: 

If you are under 31 years old, you are exempt from the LHC loading. This loading is designed to encourage people to take out hospital insurance early in life, so being under 31 puts you outside the target group for this loading.

Taking Cover Before the LHC Base Day: 

Your LHC’ base day’ is typically the 1st of July following your 31st birthday. If you remove private patient hospital cover before this date, you can avoid the LHC loading altogether. The government is incentivizing younger individuals to obtain private hospital coverage earlier in life.

New Migrants to Australia: 

If you are a new migrant to Australia aged 31 or over, you will not have to pay the LHC loading provided you take out hospital cover within 12 months of being registered for full Medicare benefits. This exception recognizes that new migrants may not have had the opportunity to take out Australian private hospital cover before reaching the age threshold.

Individuals Born Before 1 July 1934: 

People born on or before 1 July 1934 are exempt from the LHC loading. This exemption acknowledges the different circumstances and healthcare needs of older Australians.

It’s important to note that the LHC loading applies only to private patient hospital cover and not to general treatment cover (ancillary or extras cover). Moreover, the government does not pay the private health insurance rebate on the LHC loading component of a policy.

Three Business People Sitting At A Desk In Australia, Talking To Each Other About Lifetime Health Cover.

LHC and Life’s Twists and Turns:

Life is full of twists and turns, and sometimes, these changes directly impact our health insurance needs. Regarding Lifetime Health Cover (LHC) in Australia, it’s essential to know how life events such as switching health funds, suspending your policy, or going overseas can affect your LHC status.

Switching Between Health Funds: 

Switching from one health fund to another is common and handled flexibly under the LHC rules. The key is not to have a gap of more than 1,094 days (about three years minus one day) in your hospital cover. Your LHC loading (if any) moves when you switch health funds. 

To ensure a smooth transition and avoid using up part of your permitted gap days, starting the new policy the day after your old policy ends is advisable. Health funds often facilitate this process, ensuring no gap in your coverage​.

Suspending Your Health Cover: 

Life circumstances may require you to temporarily suspend your health insurance. This could be due to financial hardship, overseas travel, or other personal reasons. The good news is that suspending your policy generally does not affect your LHC status. 

During the suspension, you might not be able to make claims or pay premiums, but for LHC purposes, you still hold hospital cover. Each health fund has its policies regarding suspension, so it’s crucial to communicate with your fund to understand the terms and conditions of policy suspension​.

Going Overseas: 

If you’re leaving Australia for a short or extended period, it can impact your health insurance needs. Many health funds allow you to suspend your health coverage for overseas travel lasting between 2 months and 24 months. Your LHC loading level is preserved during this suspension, meaning it won’t increase due to your time abroad.

For those anticipating an extended absence (over a year) and who choose to cancel their health insurance, only the periods exceeding 90 days you spend in Australia count towards the 1,094 permitted gap days. Shorter stays don’t impact your LHC loading level. However, upon returning to Australia, you must reinstate your hospital cover within a certain period (usually 12 months) to avoid the LHC loading​.

What This Means for You: 

These provisions offer flexibility and peace of mind, ensuring that life’s unpredictable moments don’t penalize you in terms of your health insurance. The key takeaway is the importance of proactive communication with your health fund. Whether switching funds, needing to suspend your cover, or planning to travel overseas, staying informed and planning can help you maintain your LHC status and avoid unnecessary loadings.

The Certified Age of Entry (CAE) Conundrum:

The Certified Age of Entry (CAE) is a pivotal factor in Australia’s Lifetime Health Cover (LHC) scheme. It determines the starting point for calculating additional premium loadings under the LHC. 

The CAE is the age at which you first take out hospital coverage, and it plays a crucial role in determining how much extra you might have to pay for your health insurance.

To understand this better, let’s delve into the scenario of Kate:


  • Kate was born on March 6.
  • She decided to take out hospital coverage for the first time on June 10, shortly after her 39th birthday.

Calculating Kate’s CAE:

  • Kate’s CAE is calculated based on her age on the 1st of July before she took out her hospital cover.
  • Kate was 38 on the 1st of July before she got her cover, so her CAE is 38.

Impact of CAE on LHC Loading:

  • The LHC loading is applied at 2% each year the individual is over 30 at their CAE.
  • For Kate, having a CAE of 38 means she is 8 years over 30.
  • Therefore, her LHC loading will be 16% (8 years x 2% per year).

The concept of CAE under the LHC scheme is crucial because it affects the cost of health insurance for individuals who delay taking out hospital coverage beyond the age of 31. 

The LHC loading is applied to encourage younger people to take out and maintain hospital insurance early, which in turn helps to balance the risk pool of the health insurance system.

This example underscores the importance of understanding the LHC rules and how they might impact the cost of your health insurance if you’re considering taking out hospital coverage later in life.

The Bottom Line:

In conclusion, Lifetime Health Cover is a bit like a “health insurance time tax” – the longer you wait, the more you pay. It’s a nudge from the government to encourage us to think about our health needs sooner rather than later. By understanding the LHC, you can make informed decisions that suit your life and your wallet. Remember, health is wealth, but in the case of LHC, it’s also about timing!

Frequently Asked Questions:

If I switch health funds, will I lose my LHC status?

No, your LHC loading moves with you when you switch funds.

What happens if I suspend my health cover?

Suspending your policy doesn’t affect your LHC status. You won’t be able to claim during this period, but you’re still considered covered​.

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*The information this blog provides is for general informational purposes only and is not intended as financial or professional advice. The information may not reflect current developments and may be changed or updated without notice. Any opinions expressed on this blog are the author’s own and do not necessarily reflect the views of the author’s employer or any other organization. You should not act or rely on any information contained in this blog without first seeking the advice of a professional. No representation or warranty, express or implied, is made as to the accuracy or completeness of the information contained in this blog. The author and affiliated parties assume no liability for any errors or omissions.