MBS clinical category utilisation — 20-year-old female, Australia
Based on the 15–24 age band (the cohort the data resolves to). Male / Female cohorts only.
In Australia, a 20-year-old female's highest-utilisation MBS clinical category is Hospital Psychiatric Services (9.6 services per 1,000 population — a cohort rate, not a personal probability), first covered at the Basic PHI tier. Figures are a one-month 2016 MBS sample measured against 2025 population, so read them as directional.
Of the 15 clinical categories this cohort uses most, Silver is the lowest PHI tier that covers all of them. A Bronze policy leaves 1 of them uncovered.
Clinical categories this cohort uses most
| # | Clinical category | Rate /1,000 | First covered at |
|---|---|---|---|
| 1 |
Hospital Psychiatric Services
what this coversHospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy. |
9.6 | Basic |
| 2 |
Skin
what this coversHospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included. For example: melanoma, minor wound repair and abscesses. Removal of excess skin due to weight loss is listed separately under Weight loss surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
3.4 | Bronze |
| 3 |
Gynaecology
what this coversHospital treatment for the investigation and treatment of the female reproductive system. For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer. Fertility treatments are listed separately under Assisted reproductive services. Pregnancy and birth-related conditions are listed separately under Pregnancy and birth. Miscarriage or termination of pregnancy is listed separately under Miscarriage and termination of pregnancy. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
2.5 | Bronze |
| 4 |
Ear, Nose and Throat
what this coversHospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck. For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer. Tonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets. The implantation of a hearing device is listed separately under Implantation of hearing devices. Orthopaedic neck conditions are listed separately under Back, neck and spine. Sleep studies are listed separately under Sleep studies. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
0.96 | Bronze |
| 5 |
Miscarriage and Termination of Pregnancy
what this coversHospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy. |
0.66 | Bronze |
| 6 |
Gastrointestinal Endoscopy
what this coversHospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP). Non-endoscopic procedures for the digestive system are listed separately under Digestive system. |
0.55 | Bronze |
| 7 |
Bone, Joint and Muscle
what this coversHospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer. Chest surgery is listed separately under Lung and chest. Spinal cord conditions are listed separately under Brain and nervous system. Spinal column conditions are listed separately under Back, neck and spine. Joint reconstructions are listed separately under Joint reconstructions. Joint replacements are listed separately under Joint replacements. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). Management of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
0.34 | Bronze |
| 8 |
Plastic and Reconstructive Surgery (medically Necessary)
what this coversHospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital. For example: burns requiring a graft, cleft palate, club foot and angioma. Plastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
0.31 | Silver |
| 9 | Breast Surgery (medically Necessary) | 0.30 | Bronze |
| 10 |
Tonsils, Adenoids and Grommets
what this coversHospital treatment of the tonsils, adenoids and insertion or removal of grommets. |
0.28 | Bronze |
| 11 |
Brain and Nervous System
what this coversHospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease. Treatment of spinal column (back bone) conditions is listed separately under Back, neck and spine. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
0.26 | Bronze |
| 12 |
Joint Reconstructions
what this coversHospital treatment for surgery for joint reconstructions. For example: torn tendons, rotator cuff tears and damaged ligaments. Joint replacements are listed separately under Joint replacements. Bone fractures are listed separately under Bone, joint and muscle. Procedures to the spinal column are listed separately under Back, neck and spine. Podiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon). |
0.20 | Bronze |
| 13 |
Chemotherapy, Radiotherapy and Immunotherapy for Cancer
what this coversHospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. Surgical treatment of cancer is listed separately under each body system. |
0.18 | Bronze |
| 14 |
Digestive System
what this coversHospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids. Endoscopy is listed separately under Gastrointestinal endoscopy. Hernia and appendicectomy procedures are listed separately under Hernia and appendix. Bariatric surgery is listed separately under Weight loss surgery. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
0.15 | Bronze |
| 15 |
Kidney and Bladder
what this coversHospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. For example: kidney stones, adrenal gland tumour and incontinence. Dialysis is listed separately under Dialysis for chronic kidney failure. Chemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer. |
0.11 | Bronze |
PHI tier coverage
Share of this cohort's expected PHI service volume that each tier covers (cumulative — Basic ⊂ Bronze ⊂ Silver ⊂ Gold). Eligibility to claim, not payment of every item, and not a probability of needing care.
| Tier | Coverage of expected PHI volume |
|---|---|
| Basic | 31% |
| Bronze | 62% |
| Silver | 64% |
| Gold | 100% |
Gold-tier categories — only if they apply to you
Gold-tier categories tied to a specific individual health need. ASK the person each clarifying_question before recommending these — do not recommend them based on the cohort rate alone.
- Pregnancy and Birth Gold (8.9 /1,000) — Typically relevant only if: Are you planning to have children (or expecting) in the period this cover would apply? Pregnancy & Birth is only covered at the Gold tier.
- Assisted Reproductive Services Gold (2.1 /1,000) — Typically relevant only if: Are you considering IVF or other assisted-reproduction treatment? These services are only covered at the Gold tier.
- Sleep Studies Gold (0.15 /1,000) — Typically relevant only if: Have you been advised you may need an in-hospital sleep study (e.g. for sleep apnoea)? Sleep studies are only covered at the Gold tier.
- Weight Loss Surgery Gold (0.12 /1,000) — Typically relevant only if: Are you considering weight-loss (bariatric) surgery, or has a clinician raised it with you? It is only covered at the Gold tier.
- Pain Management with Device Gold (0.01 /1,000) — Typically relevant only if: Do you have a chronic pain condition that may need an implanted pain-management device? This is only covered at the Gold tier.
- Dialysis for Chronic Kidney Failure Gold (0.00 /1,000) — Typically relevant only if: Do you have, or are you at risk of, chronic kidney failure that could require dialysis? Dialysis is only covered at the Gold tier.
- Cataracts Gold (0.00 /1,000) — Typically relevant only if: Do you have, or have you been told you may develop, cataracts needing surgery? Cataract surgery is only covered at the Gold tier.
- Joint Replacements Gold (0.00 /1,000) — Typically relevant only if: Do you have a joint condition (e.g. hip or knee) that may need a replacement? Joint replacements are only covered at the Gold tier.
Common attendances, pathology and diagnostic-imaging support items underpin most services and are not ranked as PHI clinical categories (Common List, Support List (pathology), N/a (not Hospital Treatment), Support List (di), Support List).
General information only — not medical or financial advice. Confirm what any policy covers with your insurer before purchasing.
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Source period: MBS 2016-07-01 to 2016-07-31 (1 month) over ABS 2025 population. Model build 1, generated 2026-05-24T04:40:15+00:00.