Community rating

Community rating is a fundamental principle of the Private Health Insurance Act that prevents private health insurers from discriminating between people.
 
What basis would count as discrimination?
 
A person’s health, their age (other than age at entry for Lifetime Health Cover (LHC), gender, race, sexual orientation, state of health, religion, or the size of their family.
 
Please note: private health insurance is not risk rated.
 
Community rating means an insurer can’t discriminate on the basis of:

  • Suffering by a person from a chronic disease, illness or other medical condition or from a disease, illness or medical condition of a particular kind
  • Gender, race, sexual orientation or religious belief of a person
  • Age of a person, except to the extent allowed under Lifetime Health Cover (LHC)
  • Where a person lives
  • Any other characteristic of a person (including, but not just matters such as, occupation or leisure pursuits) that is likely to result in an increased need for treatment
  • The frequency with which a person needs treatment
  • The amount or extent of the benefits to which a person becomes entitled, except as allowed by annual claim limits for each treatment.

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