How these assessments are produced

Data: the Australian Government's PrivateHealth.gov.au releases.

ClearChoiceHealth is a free, non-commercial comparison guide: answer a short questionnaire and every private health insurance product open for sale in your state is filtered against your answers, with each surviving product given a market-relative value assessment. This page explains how those assessments are produced, whether you have used the tool yet or not.

1. The one question we assess

For every private health insurance product open for sale in Australia, we ask a single question:

What would the market normally charge for this product's cover, and is its actual premium above or below that?

A product priced well below what the market normally charges for equivalent cover represents stronger value; well above, weaker value. This is deliberately different from "cheapest first": a bare low price with thin cover earns no credit here. It is also not advice: the assessment says nothing about whether a product suits you, your health, or your budget.

2. A worked example

Take a fictional but typical product (the same steps run for every real one):

"Example Silver Plus Hospital $500 excess", NSW, single person, $234.00/month.

Step 1: Your requirements filter the market

If you told us a hospital category is a must-have (say, pregnancy and birth), every product that does not provide it is removed before any assessment happens. The results page always tells you how many products each requirement removed. A category covered on a restricted basis counts for most requirements; hospital psychiatric cover is the exception: the questionnaire promises full inclusion, so restricted cover does not pass that one.

Step 2: The market's expected price for this cover

From the published data, we group products by what they actually provide: the full 38-category hospital treatment profile, excess and co-payment arrangements, who is covered, and the state. Looking at how the whole market prices each cover profile, we estimate what this product's cover would normally cost: for our example, say $248/month, with an expected range reflecting normal market variation.

Every estimate carries a confidence level (high, moderate, low, or insufficient) that depends on how much comparable market evidence exists: a profile sold by many funds gives a confident estimate; a profile sold by one fund alone cannot be checked against anyone else and is treated accordingly.

Step 3: Actual vs expected

The product charges $234.00; the market-expected price is $248.00. The premium sits about $168/yr below the market-expected price (−5.6%).

Step 4: Is that difference meaningful?

A difference only counts when it is larger than the model's own measured error for predictions at that confidence level, and never smaller than normal market price variation. Small gaps land as "in line with the market-expected price"; clear gaps as "below" or "above"; only differences that clear a much higher bar earn "materially". Our example lands in "Below the market-expected price" (stronger value).

Step 5: Honesty gates can override the arithmetic

• Insufficient evidence → no verdict. The product appears as "not assessed" with its factual cover details, never hidden, never ranked.
• Low confidence → no strong claims. A low-confidence estimate can never produce a "materially" verdict.
• Prices driven by features we cannot see → no negative verdict. Some products are priced on features that exist only in free-text descriptions. Calling one "weaker value" would be an accusation the data cannot support, so we say exactly that instead.
• Hospital and extras stay separate. A combined product shows each component assessed on its own; a strong overall verdict can never hide a weak component.

3. What the premium figures mean

Every product's price starts from the fund's published monthly premium (per policy, for the stated household type and state). If your answers let us place you in a rebate tier, the headline figure is an estimated price with the Australian Government Rebate applied; the approved premium itself is always shown in the product's price breakdown, and if we can't estimate your rebate, prices are shown exactly as published. Your payable price may still differ with your confirmed rebate, Lifetime Health Cover loading and any fund discounts.

The rebate line. If you answered the income and age questions, the results page states which rebate tier your answers place you in, using the statutory income thresholds for the rates year shown, and applies that tier's statutory percentage to estimate your price. The itemised breakdown on every product shows exactly what was applied. Because your tier comes from banded answers it is always an estimate, never a quote. Two things never change with it: value assessments are computed on the approved premium, and results are never re-ordered by your personal adjustments. For household policies the tier also depends on the age of the oldest person covered, which we don't ask; and if you preferred not to answer, we simply say a rebate may apply. The same applies to the Lifetime Health Cover and age-based discount notes: both are honest pointers to rules that depend on details no questionnaire answer can compute (certified age at entry, per-product discount schedules). Confirm the exact figures on PrivateHealth.gov.au.

The Medicare Levy Surcharge note. If your income tier is at or above the first surcharge threshold, the results page notes that the surcharge is removed only by private hospital cover whose excess is within the statutory cap (currently $750 or less for a single, or $1,500 or less for a couple, family or single-parent policy) and never by extras-only cover. A cheaper policy with a higher excess does not remove the surcharge. If you told us you're young and mainly want the cheapest cover that just covers the basics, an optional filter lets you narrow your results to Basic and Basic Plus policies, the cheapest tier, which still carries the things a younger person is more likely to use (such as joint reconstructions and tonsils, adenoids and grommets). The filter hides higher tiers that cover more than you asked about, and for a higher earner Basic and Basic Plus are also the policies that satisfy the surcharge. It only hides products, it never re-orders them, and you can switch it off. This is a pointer to a tax rule, not tax advice, and prices shown here never include or offset the surcharge itself. Confirm your own position on PrivateHealth.gov.au or with the ATO.

Provider networks are not assessed. The published data set does not include which hospitals or doctors have agreements with each insurer, so no result here reflects whether your preferred hospital participates in a product's network. This limitation applies to every product and every user equally. Check agreement hospitals for any product on PrivateHealth.gov.au before acting on a comparison.

4. How matching against your answers works

Alongside its market-value assessment, each product family shows a "Your stated requirements" note. This is not a second score. It is a restatement of your own answers against the product's published cover list:

• Only your ratings drive it. If you rated an extras category as important (the top of the importance scale), we check whether the product's published benefits include it; if you rated it not important, we say when you'd be covered for it anyway. The scale's middle option ("moderately important") is treated as neutral: moderate interest is not a stated requirement, so we never build a claim on it. Categories you were never asked about are never assumed.
• The questionnaire's categories map to the government's. "Allied health" covers the services the question named: chiropractic, remedial massage and podiatry; "major dental" includes root canal (endodontic) cover. Fit notes always name the specific services a product actually includes.
• Matching never changes the value assessment. A product's market-value band is computed from market pricing alone. The two can disagree: a product can be strong value but miss something you rated important, or match everything you rated important while being priced above the market expectation. Both facts are shown; neither overrides the other.
• No ranking. The "closest matches only" control is a filter you switch on. Like the requirements filter in step 1, it narrows what is shown and tells you by how much. Nothing is ever ordered by fit, scored, or picked for you.
• Coverage, not benefit amounts. Fit notes state whether a category is included in the product's published benefits. They make no claim about how generous those benefits are, and your spend answers are never turned into payout estimates.
• Shared annual limits. Most policies do not give each service its own pot of money: they group several services under one shared annual limit. Where a category you rated as important shares its limit with other services, we say so and name them. This is published information: we simply read the grouping the insurer declared, so you can tell apart two products whose cover lists look identical.
• Two numbers, stated separately. Where a product publishes a plain per-person annual figure for that shared limit, we show it, and where the amounts you told us you spend fall clearly above or below it, we say that too. These are two different quantities (what you spend out of pocket is not what a fund pays back), so we never combine them into an estimate of what you would get back or of whether you would be "covered".
• When we stay silent. Some products describe their limits in ways that cannot honestly be compared to a single dollar figure: limits set per policy rather than per person, limits written in free text, sub-limits inside a shared pot, or "choose your own" extras where the active services are not published. In those cases we describe the grouping and stop there. Silence means the published data does not support the statement, never that the product is worse.

"People in your position" notes. Where your journey includes hospital cover, each product may show which hospital categories it does not fully cover among those most commonly used by people in your demographic position (your age, and your household and sex if you told us). These are population service-usage rates from national Medicare data (a 2016 snapshot), never a prediction about you: a rate describes how often people in a group use a service, not whether you will. The notes name gaps only: they never score, rank, or reorder products, and they never change the market-value assessment. Categories you already told us about are left out (you've answered those directly), sensitive categories are never inferred from your demographics, and a few categories have no usage data (such as rehabilitation) so they aren't part of the comparison; "no data" is not "not used".

5. What this is not

• No product recommendations, no rankings, no "best" lists: grouped assessments only.
• No suitability or affordability claims: fit notes restate your own answers against published cover lists; they never predict what you will need, use or be paid.
• No statements about any insurer's profitability or conduct: a price above the market expectation is a fact about one product's price, nothing more.
• No sales relationship: no fund pays us, and the only outbound links go to the government's own product information statements.

6. Data, freshness and provenance

All data comes from the Australian Government's PrivateHealth.gov.au dataset (published monthly; used under CC BY 3.0 AU). Results always state which release they were computed from. Until the model has seen a full annual market repricing, assessments are calibrated on a single market snapshot and carry a note saying so. They firm up as more market history accrues.

We use only the Australian Government's PrivateHealth.gov.au dataset for product data. Historical Medicare (MBS) statistics and ABS population estimates inform our population utilisation context, never product content or pricing. We do not currently use APRA or AIHW data, and no commercial or insurer-supplied data of any kind.

Your answers never leave your browser: the assessment runs on your device against the published data for your state.

7. Ombudsman complaint levels

ClearChoice compares each insurer’s share of complaints received by the Private Health Insurance Ombudsman with its share of Australian private health insurance policies. Lower is better. This is not a customer satisfaction survey.

Basis: Rolling 12 months of quarterly Ombudsman reports, covering October 2024 to September 2025. Market share as at 30 June 2024.

* Complaint results are reported jointly for this brand and other brands operated by the same registered insurer.

ClearChoice’s complaint-level indicator compares an insurer’s share of complaints received by the Commonwealth Ombudsman, acting as the Private Health Insurance Ombudsman, with the insurer’s share of Australian private health insurance policies. The indicator is independently calculated by ClearChoice Health.

It is not a direct customer satisfaction survey and does not measure every interaction with an insurer. Complaint levels may be influenced by fund size, unusual operational events, consumer awareness of the Ombudsman, the complexity of complaints, brand structure, internal complaint handling and changes to reporting or insurer ownership.

A complaint does not necessarily mean that the insurer acted incorrectly. The Ombudsman’s complaint categories include matters that may be finalised without further action, referred to an insurer or formally investigated.

ClearChoice uses the most recent official reporting period with sufficient validated data. Smaller insurers may have insufficient data or greater statistical volatility. The date range, source documents, confidence level and calculation method are published with each result. The Ombudsman’s complaint data is dynamic and may be revised in later publications.

ClearChoice’s categories are not ratings issued or endorsed by the Commonwealth Ombudsman, APRA, the Australian Government or any insurer.

Source: Commonwealth Ombudsman, Private Health Insurance Ombudsman quarterly updates and State of the Health Funds reports. Market share is reported from APRA Market Share, All Policies.

Calculated from these committed period files:

• quarter-2024-12.json
• quarter-2025-03.json
• quarter-2025-06.json
• quarter-2025-09.json

Official source documents:

• State of the Health Funds Report 2024-25
• Private Health Insurance Ombudsman Quarterly Update: June 2025
• Private Health Insurance Ombudsman Quarterly Update: September 2025