PHI 29/16

Page last updated: 19 April 2016

PDF version: PHI 29/16 - Lifetime Health Cover – Permitted Days without Hospital Cover (PDF 394 KB)

PHI 29/16 - Lifetime Health Cover – Permitted Days without Hospital Cover

The purpose of this circular is to reinforce the rules regarding Lifetime Health Cover (LHC) ‘Permitted Days without Hospital Cover’.

Under the legislation relevant to LHC (the Private Health Insurance Act 2007), everyone is entitled to use a provision called permitted days without hospital cover provided they have established their LHC age. During any permitted days without hospital cover, a person is protected against increases to their LHC loading, in specific circumstances, despite not actually holding a hospital cover policy.

There are three different types of permitted days without hospital cover, and it should be noted that they work independently of one another. Therefore, while a person is using one type, they cannot be using either of the other two.

Type 1:
Any days on which a person's hospital cover is suspended by their health insurer. Any periods of suspension are at the discretion of the health insurer.

Type 2:
Any days during which a person is overseas that form part of a continuous period overseas of more than one year. Please note that the person is allowed to return to Australia for periods of up to 90 consecutive days and still be considered to be overseas. Once they are in Australia for any period longer than 90 days, they are considered to have returned from the date they entered the country.

Type 3:
The first 1,094 days (1 day less than 3 years) that the person is without hospital cover. This 1,094 day period can be used intermittently. For example: a year with hospital cover, followed by a year without hospital cover, followed by another year with hospital cover etc.

A person’s insurer should be able to inform them how much of their 1,094 permitted days without hospital cover they have used. Alternatively, the annual statement a person’s health insurer sends them detailing their LHC status should provide this information.

Proof of absence from Australia
If someone commences private health insurance in Australia after returning from an overseas trip, their insurer may ask them to provide evidence of their period overseas. The insurer may request their International Movement Record form (Form 1359), which is available from the Department of Immigration and Border Protection.

The record can be downloaded from the Department of Immigration and Border Protection forms