What Is a Private Health Information Statement (PHIS) and How Do You Use It?
A Private Health Information Statement (PHIS) is a standardised summary that every private health insurer in Australia must give you for each policy it sells. It exists so you can compare policies from different insurers on the same terms, rather than trying to decode each insurer's own marketing language. You use it by reading the same sections across two or more policies — premium, excess, waiting periods, and what is and isn't covered — and matching them against your own needs.
The PHIS is one of the tools referenced on PrivateHealth.gov.au, the independent site run by the Commonwealth Ombudsman, alongside its policy comparison, insurer details, and Lifetime Health Cover calculators.
Why the PHIS exists
Before standardised statements, comparing policies meant reading brochures written in different formats with different definitions. A "comprehensive" policy from one insurer could cover less than a "basic" policy from another. The PHIS removes that problem by forcing every insurer to present the same information in the same order, using the same definitions.
This matters because private health insurance in Australia is complex: hospital cover, extras cover, waiting periods, excesses, co-payments, restricted benefits, and government rebates all interact. A standard format lets you put two statements side by side and see real differences instead of wording differences.
What a PHIS contains
A PHIS is structured into fixed sections. The exact layout is set by the regulator, so the headings are consistent across insurers. The core sections cover:
- Policy type and cover category — whether it is hospital, extras (general treatment), or a combined policy, and the insurer's own tier label.
- Premium — the amount you pay, including the frequency (fortnightly, monthly, etc.) and whether the government rebate is already applied.
- Excess or co-payment — the amount you pay toward a hospital admission before the insurer pays, and any daily co-payment arrangements.
- Waiting periods — how long you must hold the policy before you can claim for particular treatments, including the standard 12-month wait for pre-existing conditions and pregnancy.
- What is covered — the treatments and services included, often grouped by clinical category.
- What is not covered or is restricted — treatments excluded entirely, or where the insurer pays only a limited benefit.
- Gap arrangements — whether the insurer has agreements with hospitals and doctors to reduce or eliminate out-of-pocket costs.
Because these sections are identical in structure, you can compare a hospital policy from one fund against a hospital policy from another without translating between formats.
How to use a PHIS to compare policies
The practical method is to compare like with like, section by section.
1. Match the cover category first
Only compare policies that cover the same type of treatment. A hospital policy and an extras policy are not substitutes. If you are comparing hospital cover, check that both policies include the clinical categories you actually need — for example, cardiac, orthopaedic, or maternity.
2. Compare the premium on the same basis
Check whether each quoted premium includes or excludes the government rebate, and whether it is for the same payment frequency and the same number of people (single, couple, family). A fortnightly premium with the rebate applied is not comparable to a monthly premium without it.
3. Compare excess and co-payments
A lower premium often comes with a higher excess. Decide what you could afford to pay if you were admitted to hospital, then compare the excess figures directly. Also check for daily co-payments, which apply per day of admission and can add up quickly.
4. Compare waiting periods
Standard waiting periods apply across the industry, but insurers can impose longer ones for some treatments or for people joining without prior cover. If you need cover soon, this section decides whether a policy is usable for you.
5. Compare what is excluded or restricted
This is where policies differ most. Two policies with similar premiums can have very different exclusions. Read the "not covered" and "restricted" sections carefully — a restricted benefit means the insurer pays only a set amount, leaving you with a gap.
6. Check hospital and doctor agreements
If avoiding out-of-pocket costs matters to you, look at whether the insurer has agreements with the hospitals and doctors you are likely to use. The PHIS indicates whether gap cover arrangements exist, but you may need to check specific hospitals separately.
Where to find a PHIS
- From the insurer — every insurer must provide a PHIS for each policy it offers, typically on its website and on request.
- On PrivateHealth.gov.au — the site's policy comparison tool and insurer details pages are built around standardised policy information, so you can compare policies across funds in one place. It also links to related tools such as agreement hospitals, gap cover for doctors, and Lifetime Health Cover calculators.
Common pitfalls when reading a PHIS
- Assuming "comprehensive" means the same thing everywhere. Tier labels are the insurer's own; the covered and excluded sections are what actually matter.
- Ignoring the rebate basis. A premium that looks cheaper may simply have the rebate deducted, or be quoted at a different frequency.
- Skipping the restricted benefits section. "Covered" does not always mean "fully covered" — restricted benefits leave a gap.
- Overlooking waiting periods. A policy that looks ideal on price and cover may not pay for your treatment for 12 months.
- Comparing extras policies by premium alone. Extras have annual limits and per-visit limits that vary widely; the PHIS shows these, but you have to read them.
If you are choosing between policies, the PHIS is the document that lets you do it honestly. Start with the sections that affect your situation most — usually exclusions, excess, and waiting periods — and use the standard format to line policies up against each other.