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When would you like to start your membership?

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Details of family members covered under your policy

Additional member 1
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Additional member 2
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If you're part of another health fund, we can switch you over

Declaration and rebate application

You can download the form here and upload it in this page.

Alternatively, you can fill the online form below.

Families and individuals who pay private health insurance premiums may be eligible for Australian Government rebates.

Your costs may be reduced if you have a health insurance policy with an Australian registered health insurer that provides the following cover:

- Hospital
- General and extras, or
- Both

The rebate reduces the amount you pay for private health insurance. The rebate amount you get is based on the age of the oldest person covered by the policy and by annual earnings.

You must be covered by the policy and be eligible for Medicare to receive the rebate. For more information, you can go to humanservices.gov.au

Application to receive the Australian Government Rebate on Private Health Insurance as a reduced premium form

Important Information

Complete this form and lodge it with your Health Fund to receive the Australian Government Rebate on Private Health Insurance as a reduced premium.

All the people listed on the policy must be eligible to claim Medicare for you to receive the rebate as a reduced premium.

Policy holders must nominate the level of rebate they believe they are entitled to.

Rebates 2023 *Income thresholds increase by $1500 for every child after the first.

If a policy holder claims a rebate level above their actual entitlement a recovery of monies will occur through the Australian Taxation Office (ATO) as a tax debt.

If a policy holder claims a rebate level below their actual entitlement a refund will occur through the ATO as a tax credit.

If at any stage you wish to stop receiving or wish to nominate a new income tier for the Australian Government Rebate on Private Health Insurance as a reduced premium, you must notify your Health Fund as soon as possible.

Assistance

For more information about the Australian Government Rebate on Private Health Insurance, go to privatehealth.gov.au

Questions about Medicare eligibility can be made at any Human Services' Service Centre or by calling 132 011.

Note: Call charges apply – calls from mobile phones may be charged at a higher rate.

Claimant's details

ACA Health

Your full name as it appears on your Medicare Card

Details of People Covered by Policy

Note: Provide details of all people covered by the policy (do not include yourself).

Additional person 1
Add person

All people listed on the policy must be eligible to claim Medicare for you to receive the rebate as a reduced premium.

If you are unsure whether you are eligible for Medicare, go to for more information.

Applicants not covered by the policy cannot claim the Australian Government Rebate on Private Health Insurance (excluding child only policies) and employers and trustees of organisations cannot claim the Australian Government Rebate on Private Health Insurance on policies paid on behalf of employees.

Declaration

More information

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