Australian health insurers see record high hospital claims

A total of 453,259 high claims—or those higher than A$10,000— were paid out during the year.

Total health benefits paid out by insurers in Australia reached about $6.15b (A$9.4b) in the 12-month period to December 2024, according to a report by Private Healthcare Australia published in November 2025.

A total of 453,259 hospital high claims were paid out by health funds in 2024, the highest volume on record, and a 9% increase compared to the same period a year earlier, according to the “Annual Hospital High Claims 2025” report.

High claims refer to those where the total insurer benefit payment exceeded A$10,000.

High claims accounted for 50.4% of all hospital benefits paid in 2024, up 1.3 percentage points compared to 2023.

This growth reflects the rising complexity and cost of hospital care in Australia, according to Private Healthcare Australia.

The largest single claim paid was A$697,267 for a patient requiring mitral valve replacement (bioprosthesis) following severe valve disease.

Most of the claims are between A$10,000 to A$20,000— at 62.4% or 283,027 of the claims. Meanwhile, 23.8% or 107,660 claims are between the A$20,000 to A$30,000 range.

Those greater than A$200,000 make up only 0.03% or 138 claims.

(US$1 = A$1.53; as of 1 December 2025, Morningstar via Google)