Are gym memberships covered by health insurance?

Taking out private health insurance with cover for gym memberships could help you save hundreds of dollars in fees, provided you meet certain eligibility criteria as specified by your fund.

Whether you’re just looking to stay healthy, or you need health insurance to aid a sport injury, an extras policy can cover a range of health services, including:

• Gym memberships
• Fitness classes (e.g. yoga, swimming, Pilates)
• Skin cancer screenings
• Health assessments
• Weight management programs
• Swimming lessons
• Access to nutritionists, exercise physiologists and more
• Diet and nutrition consultations.

Not all policies will offer these benefits; the services available to you will depend on your health fund and level of cover. Check the relevant policy brochure to see what’s covered. Furthermore, you may only be able to access these rebates if a GP, physiotherapist or other medical professional signs a health management form (usually provided by your fund), and your gym or fitness centre is included in your insurance provider’s health management program.

It’s simple: If you’re healthier, you’ll claim less often on your policy. Australia’s current average healthy life expectancy ranks the 12^th highest out of 185 other countries at 70.13 years. ³

However, 27.96% of the Australian adult population don’t meet the recommended exercise requirements, which can lead to other health issues. ³

When you stay healthy, you’re less likely to need expensive treatments, which means fewer claims for your insurer. In the meantime, you get the health benefits of keeping yourself fit and healthy. Everybody wins!

Only certain extras policies in Australia can cover gym memberships. Extras policies cover services outside a hospital that are usually not covered by Medicare (unlike private hospital cover, which only pays a benefit when you are admitted to hospital as a private inpatient).

Whether gym memberships and other fitness programs are covered will depend on your health insurance provider and your level of cover. Some providers will only pay for your gym membership or personal trainer if they’re necessary to treat a specific medical condition (e.g. diabetes or obesity). Since these policies can cost more, it’s important to shop around for a good deal.

You’ll be able to claim a set amount of your gym membership fee each year, but the amount you can claim will vary depending on your policy and health fund. Whether this type of arrangement will benefit you financially comes down to which policy you choose, and the limits that are placed on it. Your policy may have an array of limits, such as:

• Combined limits, which are the dollar amount you can claim for one group of different services and treatments (e.g. lifestyle benefits).
• Sub-limits, the dollar amount you can claim for different services under the combined limit category (e.g. exercise class memberships).

For example, a health fund may offer a $300 combined annual limit on all lifestyle benefits, with a $100 sub-limit on gym memberships specifically. Check with your health fund and policy brochure to see exactly what you can claim on.

Once you’ve served your waiting period for these services, you can get in touch with your insurance provider and find out whether there are any restrictions to claiming, some of which we detail below. The full amount you can claim each year will be outlined in your policy brochure.

To organise reimbursement, you’ll need receipts from your gym to send to your health fund.

You may only be able to access these rebates if a GP, physio or healthcare physician signs a health management form, usually provided by your health fund. As such, if a healthcare professional doesn’t think a membership is necessary for you, they may not write you the referral. Talk to your GP about your options to get a better view of this.

Not all gym memberships are eligible for a health insurance rebate; your gym might need to be recognised by your insurance provider. For example, your policy may only let you claim a rebate if you’re with Fitness First, or another health and fitness franchise.

The good news is, according to our research, Australia has the fourth-highest rate of gyms per capita, with 29 gyms per 100,000 population. ²

Health funds may only work with certified and qualified personal trainers, which means your existing PT may not get you a discount. Check with your fund to see if your personal trainer is part of their health management program.