Days of absence: the 1,094 days you can go without hospital cover
Add up the days you have been without hospital cover since your base day and enter your current loading: you see how many days remain, or the loading you would rejoin with.
Days of absence you still have
25 days
Rejoin within 25 days and your loading stays at 4 %.
| Lifetime allowance | 1,094 days |
| Used | 1,069 days |
| Loading on rejoining | 4 % |
| Per year on the cheapest single policy | $47 |
Prepared by Radif Partners · How the figures are built · thresholds read on ato.gov.au, premiums from privatehealth.gov.au data · not tax advice
Once you have held private hospital cover on or after your Lifetime Health Cover base day, you can stop it and restart it without penalty, within a lifetime limit of 1,094 days, three years less one day. These are your days of absence. They cover the gap when you change insurer, a lean year, or a break between jobs. Some periods are not taken from them: an approved suspension of your policy, time spent overseas after you cancel cover to live abroad for at least a year, and service in the ADF. Use them up, with a total gap of 1,095 days or more, and you pay a loading when you rejoin: your previous loading, plus 2 %, plus 2 % for every further year without cover, and your ten years towards removal start again. The Ombudsman's example of Marit shows the safe side: 1,069 days without cover and her 4 % loading did not move.
A budget of days, spent across your life
Think of the allowance as a bank account opened on your base day with 1,094 days in it. Every day you hold hospital cover leaves it untouched; every day without cover takes one away. It is described on PrivateHealth.gov.au under the heading "permitted days without hospital cover", and it only exists if you held hospital cover on or after your base day. Someone who has never had cover has no allowance to spend: their loading simply grows with age.
| Days used so far | Loading before | Result if you rejoin now | Per year on the cheapest SA single policy |
|---|---|---|---|
| 300 | 0 % | 794 days left, loading stays 0 % | $0 |
| 1,069 | 4 % | 25 days left, loading stays 4 % | $47 |
| 1,094 | 4 % | 0 days left, loading stays 4 % | $47 |
| 1,095 | 4 % | 6 % (estimate) | $71 |
| 1,494 | 4 % | 8 % (estimate) | $95 |
| 1,894 | 10 % | 16 % (estimate) | $190 |
| 3,094 | 0 % | 12 % (estimate) | $142 |
Marit stays inside the limit
Marit was born on 12 February 1976 and took out hospital cover on 30 August 2008, aged 32, with a 4 % loading. She cancelled on 15 March 2011 and rejoined on 16 February 2014: 1,069 days without cover. That is 25 days short of the limit, so she pays the same 4 % she paid before. Had she waited another month, her gap would have passed 1,094 days, and she would have rejoined on a higher loading with a fresh ten year count.
How many days do you have left?
Days of absence you still have
274 days
| Lifetime allowance | 1,094 days |
| Used | 820 days |
| Loading on rejoining | 6 % |
| Per year on the cheapest single policy | $71 |
What the allowance does not pay for
Several periods without an active policy are not deducted at all. The Ombudsman lists them:
- Approved suspensions. If your insurer agrees to suspend your hospital cover for a short period, such as an overseas holiday, those days are not taken from the 1,094. Each insurer sets its own conditions.
- Living overseas. If you cancel after your base day to go abroad for at least one continuous year, the days outside Australia do not count. Visits home of up to 90 consecutive days leave you overseas; longer stays are deducted. Returning from overseas has the examples.
- ADF service and the Gold Card. Full-time ADF members whose care comes through the ADF, and people listed on a DVA Gold Card, are treated as covered. After discharge or withdrawal of the card, the 1,094 days start.
When the days run out
A total gap of 1,095 days or more changes three things. First, a loading applies on rejoining: the loading you had before, plus 2 %, plus 2 % for each further year without cover. Second, the continuity of your ten loaded years is broken, and you start the count again from the date you rejoin. Third, if your loading had already been removed after ten years, you can become liable for one again. A person who had a 10 % loading and stays out 1,894 days comes back on about 16 %, which on the cheapest SA single policy costs $190 a year, for ten more years.
Two people, the same gap, different results
The allowance only protects people who held cover on or after their base day. Take two friends who both turn 31 in 2020 and both go without hospital cover for the whole of the next four years. The first held a policy on her base day and cancelled it a month later: her gap of about four years uses up her 1,094 days and she rejoins with about 4 %, by our estimate of the Ombudsman's rule. The second never had cover: there is no allowance to spend, and on rejoining his loading is set by his age on the 1 July before he joins, 10 % at 35. The rule rewards having started, even briefly, before the deadline.
Counting your own days
Add every period without hospital cover since your base day, excluding approved suspensions and qualifying time overseas. Your current and former insurers can tell you their dates; the clearance certificate is the reference. If the total is close to 1,094, the safest move is to rejoin before it is reached, even with a Basic policy, then compare at leisure. Basic policies that also avoid the Medicare levy surcharge start at $98.81 a month in South Australia (basic hospital cover). The loading rules in full are on the Lifetime Health Cover loading page, and the ten year count on the removal page.