Generally, when it comes to thinking about health insurance, I can feel my eyes glaze over and my mind start to wonder to what’s on the menu for tonight’s dinner. I got hospital cover because I was told that I had to and yeah, every couple of years I upgrade my glasses but apart from that am I really getting my monies worth on what I spend for my cover?

It wasn’t until I spoke to a work colleague that I realised there may be lots of services that I am paying for that could already be covered by my Extra’s policy. Some funds will actually cover (or partially cover) memberships to health and lifestyle programs including:

  • Gym memberships
  • Health assessments
  • Weight management programs
  • Access to nutritionists and exercise physiologists

At first, I thought is was a bit strange. Why would these be included in Health Insurance policies but the more you think about it the more it makes sense. The healthier you are now the less likely you will be to have significant health issues later in life. And I guess, for Private Health Insurers, this means there will be fewer premium payouts they need to make later.

For me, the gym membership inclusion is of particular interest. So, I decided to reach out and find someone with a better head for such matters who could boil it all down and give me just the information I needed. Enter Michelle Maynard from Carbon Group.

“It’s important to do your research and shop around. Make sure that you compare what’s covered as well as the actual cost of the premiums. The policy you choose needs to be one that fits in with your lifestyle and includes things you actually need,” Michelle explains.

Okay. So, what do we actually need to look for or ask for when speaking to Private Health Insurers? Are there alternatives and where to actually start?

Starting out
If you already have private cover grab your member number and head down to the local branch of your insurer. I have found the service staff to be very helpful and always willing to help me find the best solution for my situation; whether that involves reducing my cover or not. Make sure you have an idea of what you need from your extras cover. Things that suit the lifestyle you lead. Grab your ticket from the ticket machine, what for your number to be called on the little screen and then fire away with your questions.
To start with ask the insurer what they offer in the way of ‘health management’, ‘lifestyle’ or ‘wellness’ benefits to find the services that may be of interest to you. Next compare this to your current policy. You may be surprised at some of the services you are entitled to under your current cover. Also find out what is required to claim this money back. In some cases, you may need a referral from your GP, a plan from a personal trainer or a receipt from your gym. Some insurers may not cover the cost of personal training while others may only cover sessions conducted by a trainer holding recognised certification. It’s also a good idea at this point to check what your annual limit is.

What’s covered?
Health maintenance programs contain a range of services that are designed to prevent illness and promote healthier living. These will generally differ from provider to provider.
Unfortunately for us, due to government changes to rebates (no…I don’t know what they are either) as of April 1st 2019, some natural therapies like yoga, pilates and massages (why did I not know about this before), may no longer be covered in extras policies. These services were generally only included in the higher levels of extras cover.
It’s still a good idea to check what’s covered in each policy and more importantly, what you need to do to claim these benefits.

How to Claim
Some funds may require you to have a health professional fill in a health management form stating that you require the specific membership/class to help improve a specific health condition. These forms are generally valid for two years before they will need to be renewed.
It’s also a good idea to hang on to your membership receipts as you may need to provide these as well.

How much can I claim?
Gym membership and fitness benefits differ by provider and may be percentage-based or have monthly or annual limits. They can also change over time. Make sure to check any conditions when you sign up and then keep an eye on any changes to your policy. Yes, this does involve actually reading all the mail you receive from your provider and not just using the unopened envelope as scrap paper.

Is all of this worth it?
So, one of the questions I had for Michelle was is it worth having private health cover? The words she responded with are those that I see when I lodge my tax each year but never actually took the time to fully understand. MEDICARE LEVI SURCHARGE! I won’t pretend to have understood everything, but I think I managed to capture the important stuff.


  • The Medicare Levy is paid by most Australians in their end of year tax return. It is 2% of your taxable income and funds our Medicare System.
  • However, if your income exceeds the thresholds, you will also pay the Medicare Levy Surcharge, which is an additional amount payable, if you do not have appropriate hospital Cover.
  • The Medicare Levy Threshold changes depending on whether you are single or a family.

MLS threshold

Note: The family income threshold is increased by $1,500 for each Medicare levy surcharge dependent child after the first child.

  • You may also be eligible for a Private Health Insurance rebate. This is the amount the Government contributes towards the cost of your Private Health Insurance.
  • This rebate can be claimed for premiums paid for hospital or extras cover.
  • You can claim this rebate directly as a reduction in the premiums you pay to your insurer. Alternatively, you can pay the full amount and claim the refundable tax offset when you lodge your return.
  • The PHI rebate is also income tested and the amount of rebate you can receive is dependent on your family income.

So here is what I am taking away from this. The decision on whether or not to get/keep private health cover is very much an individual one and should be based on your circumstances. The inclusion of cover for your gym membership should no bet the only consideration when choosing your private health cover provider. Make sure to do your research and find someone to talk to if, like me, that’s what you need to make sense of everything. Good Luck!