Teachers Health Group will increase private health insurance premiums by an average of 3.94% from April 1, below the industry average rise of 4.41% and lower than several major insurers’ approved changes. The increase applies across Teachers Health Group’s five brands:
By comparison, the approved average increases are 5.47% for NIB, about 5.10% for Medibank, 4.96% for HCF, and 4.80% for Bupa. The change comes as the private health insurance sector reports higher use of cover and rising benefit payments. Australian Prudential Regulation Authority (APRA) data for the December 2025 quarter shows industry insurance revenue of $8.6 billion, compared with $8.2 billion in both the December 2024 and June 2025 quarters, and an insurance service result of $468 million.
The average 4.41% premium rise across the sector from April 1 reflects growth in hospital and medical claims and the cost of serving an ageing membership with more complex conditions. Private Healthcare Australia (PHA) chief executive Dr. Rachel David said funds are seeking to balance premium levels with the cost of treatment. “More people are using their health insurance for high-cost hospital care such as joint replacements and cancer treatment, and the cost of delivering care continues to rise. This premium increase reflects those realities. If health funds could keep premiums the same without jeopardising their ability to pay claims, they would. The industry is acutely aware of how tough many Australians are doing it right now,” David said.
David said insurers are focusing on out-of-pocket costs through no-gap and known-gap fee arrangements and models of care that support treatment at home where clinically appropriate. She pointed to services such as drug and alcohol rehabilitation, chemotherapy, and post‑surgical care delivered in the home as examples now available under some policies. She also noted investment in health management and prevention programs aimed at people with chronic disease, with the intention of reducing demand for more expensive, hospital-based care over time.
Teachers Health Group CEO Brad Joyce linked the fund’s 3.94% increase to its benefit payments and not‑for‑profit status. “There are a multitude of ways in which health funds can help look after the communities they care for and ease the cost-of-living pressure on household budgets, above and beyond keeping premiums as low as possible. Specific benefits and programs that are meaningful and designed with member needs in mind will make your dollar work harder. As a not-for-profit, our focus is always on member health and wellbeing, not payouts to shareholders. In 2025, we returned 90c of every premium dollar in claims – well above the industry average of 85c,” Joyce said. He said members are monitoring how much value they receive from their cover. “We know our members want more value from their private health cover, especially at a time when every dollar needs to go further. This year’s below-average premium rise – combined with improvements to our Extras cover – means better benefits and more value where it counts for our members,” he said.
From April 1, Teachers Health Group will extend Extras benefits across all levels of cover to include shiatsu, naturopathy, Western herbal medicine, and Alexander Technique. Top Extras will include a $140 benefit for pelvic floor and incontinence support products and devices. Since Jan. 1, members have also been able to claim Pilates and yoga under the group’s Healthy Lifestyle program. The fund has outlined several ways members can use their cover, including reviewing policy inclusions and limits, using Extras for day‑to‑day health needs, and accessing health support services such as chronic disease management and hospital‑substitute treatment programs where eligible. It is also highlighting women’s health services, mental health benefits and support options, and the role of regular dental and eye check‑ups in preventative care. Members can also access a rewards program that provides cashback when shopping with participating retailers; Teachers Health Group reported more than $50,000 in cashback to members over the past year.
APRA’s December 2025 quarter statistics show rising premium volumes alongside stable capital metrics. Insurance service expenses were $8.1 billion for the quarter, and profit from continuing operations after tax was $417 million, compared with $493 million in the September quarter and $431 million in March 2025. At Dec. 31, 2025, total industry assets stood at $20.3 billion, with liabilities of $7.2 billion and net assets of $13.1 billion. The capital base was $12 billion and the prescribed capital amount coverage ratio was 2.51, broadly in line with recent quarters.
Premium outcomes differ across ownership structures. Members Health Fund Alliance, representing not‑for‑profit and member‑owned funds, reported an average premium change of 3.62%, below the industry average and the current CPI. It said its member funds operate on a net margin of 2.6%, compared with around 7% for the three largest for‑profit insurers, whose average increase is 5.12%. Following confirmation of the 2026 premium round, Medibank shares rose about 6% and NIB gained around 5%, movements that coincided with broader gains in the S&P/ASX 200, particularly among financial and related stocks.
More than 15 million Australians hold private health insurance, including about 12.6 million with hospital cover. Australians reviewing their policies ahead of the April 1 changes are being directed to the government‑run PrivateHealth.gov.au website for independent information. David said policyholders should consider their own and their families’ current and expected health needs and speak with their GP about any likely care when assessing cover options.
