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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