About · Data sources
The benefit limits and waiting periods on this site trace directly to Australia's mandatory health insurance disclosure database.
Quick answer: Every benefit limit, waiting period, and reset date comes from Private Health Information Statements — legal disclosures all registered Australian health insurers must file with the government and keep accurate. Treatment cost estimates are based on the Australian Dental Association's biennial fee survey, which covers more than 120 treatments. Neither source is CoverClear's own research — you can verify both independently.
One thing to flag before anything else: the number you see here is your annual limit, not your remaining balance. If your fund covers $1,300 for major dental and you've already claimed $400 this year, this site shows $1,300 — not $900.
Health insurance data should be transparent. The government agrees — which is why the disclosure requirement exists. Here's what that means in practice.
01 · Why it's the law
Why these numbers are legally required to be accurate.
Every registered Australian health insurer must create a Private Health Information Statement (PHIS) for each product they sell. It's not optional. It's not a marketing document. It's a legal disclosure governed by the Private Health Insurance Act 2007. It specifies what's covered, annual benefit limits, waiting periods, and reset dates.
These statements live at privatehealth.gov.au — an Australian Government initiative managed by the Private Health Insurance Ombudsman. The complete dataset is also published as structured XML at data.gov.au.
When you see “HCF major dental: $1,300/year, resets 1 January,” that figure came from HCF's registered PHIS. Not from independent research. Not from a scrape. From the same document HCF is legally required to keep accurate.
02 · Source by source
Where each type of data comes from.
Where do benefit limits and waiting periods come from?
Benefit limits and waiting periods come from Private Health Information Statements (PHIS), published at privatehealth.gov.au and managed by the Private Health Insurance Ombudsman. All Australian health insurers are legally required to submit and maintain this data.
Funds update their PHIS when products change. The largest wave of updates happens each April, when annual premium adjustments take effect. When a fund updates its PHIS filing, the change flows through to the relevant fund page here — so the limits you see reflect the fund's current registered product. Quarterly audits cover anything the automated monitoring misses.
Browse fund limits by insurer →
Where do reset dates come from?
Reset dates are a required field in every fund's registered PHIS submission — funds can't omit them. Most open membership funds reset on 1 January. NIB is the most notable exception, resetting on 1 July. Every reset date shown here is confirmed from the registered PHIS and cross-referenced against the fund's own published schedule.
When does your fund reset? →
How accurate are treatment cost estimates?
Treatment cost estimates are based on the Australian Dental Association's biennial fee survey, which covers average fees for more than 120 dental treatments across Australia. The ADA surveys practitioners nationwide to establish average fees by treatment and location. A dental crown (item 613) runs $1,100–$2,000 nationally on this data. Fees in Sydney CBD and Melbourne typically sit above the national average; regional and South Australian practices typically sit below it.
These are general practitioner averages. Specialist endodontists and orthodontists typically charge 20–30% above the GP average. For your actual out-of-pocket cost, ask your provider for a written quote before proceeding.
See procedure cost estimates →
Where do market share and industry figures come from?
Market share figures and industry statistics come from APRA (Australian Prudential Regulation Authority), which publishes quarterly and annual private health insurance data. The 27% market share figure attributed to Medibank comes from APRA data — not from any independent calculation. APRA publishes quarterly statistics approximately two months after each quarter ends. Published at apra.gov.au.
Where does fund performance comparison data come from?
Fund performance data — complaint rates, out-of-pocket comparisons, service delivery — comes from the Commonwealth Ombudsman's annual State of the Health Funds Report. Published each March or April, covering the prior financial year. The 2024–25 report was published March 2026. Published at ombudsman.gov.au.
03 · The boundary
What's not in this data.
- Your personal remaining balance. This site shows annual fund limits. Guardian shows your actual remaining balance after this year's claims →
- Hospital cover. This site covers extras (ancillary/general treatment) benefits only. Hospital cover, Medicare gap, and out-of-hospital medical benefits aren't included.
- OSHC and OVHC. Overseas student and visitor health cover operate under different frameworks and aren't in the dataset.
- Gap cover arrangements. Fund gap cover schemes vary by individual provider agreement and don't appear in PHIS data.
- Restricted membership funds with limited data. Some occupational funds publish partial PHIS data. What's available is shown; where data is incomplete, it's noted on the relevant fund page.
04 · Update cadence
How often the data updates.
| Data | Source | Update cadence |
|---|---|---|
| Benefit limits and waiting periods | PHIS database | When funds update their PHIS; full audit minimum quarterly; April review post-premium adjustment |
| Reset dates | PHIS database | When funds update their PHIS |
| Treatment cost estimates | ADA fee survey | Biennially; updated when ADA publishes new survey data |
| Industry statistics | APRA | Quarterly (~2 months after quarter end); annual |
| Fund performance data | Commonwealth Ombudsman | Annually, typically March–April |
05 · Questions
Frequently asked questions.
- Is this official government data, and can I verify it myself?
- The fund benefit limits come from privatehealth.gov.au, an Australian Government website managed by the Private Health Insurance Ombudsman. Funds are legally required to keep PHIS data current. Every figure here can be verified at the same source — the complete PHIS database is public and searchable at privatehealth.gov.au, and available as raw XML at data.gov.au.
- Why does this site show a different number to what my fund told me?
- Three possible explanations. Most commonly, you're comparing the annual limit (the total your fund covers per year, shown here) against your remaining balance (what's left after this year's claims, shown in your fund's app). Your fund may also have updated their benefit schedule since the last PHIS audit — check their website directly. Third: you may hold a group or corporate policy with different limits to the standard product.
- Does this cover all Australian health funds?
- All registered open membership funds are included — Bupa, Medibank, HCF, NIB, HBF, AHM, Australian Unity, Defence Health, Teachers Health, CBHS, and others, where PHIS data is publicly available. Restricted membership funds are included where their PHIS data is public.
- How accurate are the treatment cost estimates?
- They're indicative averages — not guarantees. ADA fee data reflects average fees for general dental practitioners across Australia. Actual fees vary by dentist, location, and procedure complexity. Fees run higher in Sydney CBD and Melbourne, lower in regional areas and South Australia. Specialist endodontists and orthodontists typically charge 20–30% above the GP average. Always get a written quote from your provider before booking.
- Is this site affiliated with any health fund?
- No. This site earns nothing from health funds. The only way we make money is if Guardian is worth $29 a year to you — and if it's not, we'll refund every cent, no forms, no excuses. This site doesn't accept referral fees or commissions from health funds in connection with any data published here.
If you think there's a genuine error, report it →
06 · Corrections
Report a data error.
If any benefit limit, waiting period, reset date, or treatment cost estimate looks wrong, contact us → or email [email protected]. Confirmed errors are corrected within 48 hours of verification against the PHIS database or the fund's published schedule.
About CoverClear
CoverClear is operated by CoverClear (ABN 58 084 157 519). We're independent of all registered health insurers. This site earns nothing from health funds. The only way we make money is if Guardian is worth $29 a year to you — and if it's not, we'll refund every cent, no forms, no excuses.
Related
- Check your cover — free tool →
- Fund extras guides →
- When do extras reset? →
- Waiting periods by fund →
- Guardian — track your extras →
Page last reviewed: 29 May 2026
Fund benefit data current as of: 4 May 2026