The Australian Prudential Regulation Authority (APRA) has released its annual private health insurance (PHI) statistics for the 2024-25 year, providing insurer-level data on balance sheets, profitability, and premium-claims dynamics against a backdrop of rising global medical costs.
The publication, part of APRA’s regular statistical program for the PHI sector, sets out industry aggregates and detailed results for individual health funds, including financial position, insurance revenue and expenses, and key performance ratios. The release coincides with analysis suggesting that, in 2025, premium increases are expected to track health-related inflation for the first time in five years, and with global projections pointing to further upward pressure on medical trend in 2026.
The latest APRA tables indicate that a small number of national brands hold most of the assets in the PHI system. Medibank Private Limited reported total assets of $3.91 billion and net assets of $1.69 billion in 2024-25. BUPA HI Pty Ltd disclosed total assets of $3.75 billion and net assets of $1.65 billion, while The Hospitals Contribution Fund of Australia Ltd (HCF) reported total assets of $3.31 billion and net assets of $2.43 billion.
Among the not-for-profit and member-based funds, HBF Health Limited reported total assets of $2.03 billion and net assets of $1.46 billion. NIB Health Funds Ltd reported total assets of $1.43 billion and net assets of $745 million. Other mid-sized entities – including Teachers Federation Health Ltd, GMHBA Limited, and Defence Health Limited – reported net assets in the hundreds of millions of dollars, with capital buffers maintained alongside tighter operating margins in some cases.
At the smaller end of the market, regional and restricted funds such as ACA Health Benefits Fund Limited, Mildura District Hospital Fund Ltd, National Health Benefits Australia Pty Ltd, and various occupational schemes (including Police Health Limited and Navy Health Ltd) had positive net asset positions, although on substantially smaller balance sheets and membership bases.
APRA’s financial performance data shows a wide dispersion in profitability across the sector in 2024-25, influenced by scale, product mix, claims experience, operating costs, and investment income. Medibank Private reported insurance revenue of $7.95 billion and profit from continuing operations after tax of $574 million. Bupa HI posted insurance revenue of $8.70 billion and profit after tax of $594 million. HCF reported insurance revenue of $4.14 billion and profit from continuing operations after tax of $191 million.
Margin indicators from APRA’s health insurance business performance tables show Medibank with a gross margin of 14.4% and a net margin of 6.8%, with an expense ratio of 7.6%. Bupa reported a gross margin of 17.6%, a net margin of 6.3%, and an expense ratio of 11.3%. HCF’s gross margin was 12.2%, while its net margin was slightly negative at 0.2%, reflecting the interaction between benefit outlays, operating costs and premium income.
Among not-for-profit and industry funds, HBF Health Limited reported premium revenue of $2.27 billion, a gross margin of 17.8%, a net margin of 4.4%, and an expense ratio of 13.4%. NIB Health Funds Ltd recorded premium revenue of $2.82 billion, a gross margin of 18%, a net margin of 7.3%, and an expense ratio of 10.7%.
Smaller mutuals and restricted funds produced more varied results. For example, Australian Unity Health Limited reported premium revenue of $705 million, a gross margin of 18.4%, and a net margin of 6.2%. National Health Benefits Australia Pty Ltd recorded premium revenue of $46 million, a gross margin of 24.6%, and a net margin of 13.7%. Mildura District Hospital Fund Ltd reported premium revenue of $85 million, a gross margin of 20.5%, and a net margin of 10.3%.
By contrast, some funds with higher relative cost bases operated close to break-even or with slightly negative net margins. Teachers Federation Health Ltd reported a gross margin of 9.7% and a net margin of -2.1%, while Police Health Limited disclosed a gross margin of 6.0% and a net margin of -1.0%. Expense ratios at these funds were higher than those reported by the largest insurers.
Investment income remained an important component of overall results, particularly for funds with larger portfolios relative to premium income. Medibank reported net investment income of $194 million at the health benefits fund level, Bupa $171 million, HCF $208 million, NIB $126 million, and HBF $100 million. For some smaller mutuals, investment returns determined whether they recorded a small profit or a small loss.
The APRA statistics also detail premium revenue composition and claims experience for hospital and general treatment products. Medibank’s premium revenue of $7.65 billion comprised $5.57 billion from hospital treatment and $2.08 billion from general treatment, with insurance claims of $6.55 billion. Bupa reported premium revenue of $7.97 billion, including $5.98 billion from hospital and $1.99 billion from general treatment, and total insurance claims of $6.56 billion.
HCF recorded premium revenue of $4.12 billion, with $3.16 billion from hospital products and $962 million from general treatment, and claims of $3.62 billion. HBF reported premium revenue of $2.27 billion – $1.65 billion from hospital and $621 million from general treatment – with claims of $1.87 billion. NIB’s premium revenue of $2.82 billion included $1.99 billion from hospital and $829 million from general treatment, with claims of $2.31 billion.
For smaller funds, hospital products generally accounted for most premium revenue, with general treatment portfolios contributing smaller shares. Claims ratios varied by fund and business mix, with some regional and occupational funds reporting higher utilisation in certain segments, offset in part by expense controls or investment returns.
The timing of APRA’s 2024-25 release coincides with analysis indicating a shift in the relationship between premium increases and health-related inflation. Industry analysis by Money.com.au suggests that, from 2005 to 2020, premium rises exceeded health inflation by an average of 1.1 percentage points. Since 2021, that pattern has reversed, with premium adjustments lagging health CPI. The gap has narrowed in recent years, moving from 2.6 percentage points in 2023 to 1.1 percentage points in 2025, suggesting that upcoming premium rounds may align more closely with underlying health cost inflation than in the pre-pandemic period.
The domestic data sits within a broader environment of elevated global medical cost trends. According to WTW’s 2026 Global Medical Trends report, global health insurance costs are projected to rise 10.3% in 2026, following increases of 10% in 2025 and 9.5% in 2024. Asia-Pacific is forecast to record the largest regional increase at 14%, while Latin America is expected to move from 10.5% this year to 11.9% next year. The Middle East and Africa are projected at 11.3%, with North America and Europe at 9.2% and 8.2%, respectively. In the US, healthcare costs are forecast at 9.6% in 2026, slightly below 2025 but above 2024 levels.
