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Family Health Insurance

Key Points

  • Importance of family health insurance for covering all family members under one policy.

  • Differences between hospital, extras, and combined cover for families.

  • How to evaluate health insurance policies based on current and future health needs.

  • The significance of hospital cover for treatments like maternity, surgery, and rehabilitation.

  • Extras cover for regular services like dental, optical, and physiotherapy.

  • Key factors affecting health insurance costs, including premiums and excess.

  • The impact of Lifetime Health Cover loading on premiums after age 30.

  • How government rebates and Medicare Levy Surcharge exemptions reduce insurance costs.

  • Steps for comparing health insurance providers and understanding policy limits.

  • Process of switching health insurance without losing benefits or waiting periods.

Taking care of your family’s health is one of your most important responsibilities. Life is unpredictable, and it’s essential to be prepared for any health challenges that may arise. One of the best ways to do that is by having reliable health insurance that you can count on when it matters most. For families, health insurance is even more critical, as it ensures that every member—whether parents or children—is covered under a single, convenient policy.

Why Choose Family Health Insurance?

Family health insurance is designed to make life easier by providing comprehensive coverage for all your loved ones under one plan. With a family health insurance policy, you can simplify healthcare management by customizing coverage based on each family member’s unique needs, all while keeping your payments and claims streamlined in one place. Instead of juggling multiple individual policies, you benefit from unified coverage that saves both time and effort.

Finding the Best Family Health Insurance

Choosing the right health insurance can be overwhelming, especially with so many providers and plans available. At Compare Your Health, we make it easy for you to compare health insurance policies from a wide range of providers. Our platform helps you find the best coverage options that fit your family’s needs at the most affordable price, without any hidden complexities.

Ready to take control of your family’s health coverage? Let’s explore the essentials of family health insurance and how Compare Your Health can guide you toward the right policy for your family.

Why Family Health Insurance?

 

Whether you’re starting a new family, reuniting with loved ones after time apart, or caring for someone in need, the desire to keep your family safe and healthy is universal. While Medicare provides essential coverage through Australia’s public healthcare system, it doesn’t cover everything. Services like dental care, glasses, and ambulance transport may not be included, and public waiting times for non-emergency procedures can be long. According to data from the Australian Institute of Health and Welfare, waiting times for procedures at women’s and children’s hospitals reached their highest levels in five years during 2022-2023.

In contrast, private health insurance offers a solution that covers your entire family under one plan. Each family member has unique needs at different stages of life—whether it’s maternity care, pediatric treatments, or regular checkups and pathology tests. With private health insurance, you can tailor coverage to meet the individual needs of each family member, ensuring that everyone gets the care they need when they need it.

Benefits of Private Family Health Insurance

Private family health insurance not only ensures your family’s health and safety, but it also provides peace of mind. It covers a wide range of medical services, including:

  • Hospital Stays: Coverage for any hospital admissions, whether planned or emergency.
  • Surgeries: Financial protection for surgeries and medical procedures.
  • Medical Services: Coverage for services like scans, x-rays, and specialist consultations.

Beyond these essential treatments, private health insurance protects you from financial stress. Hospital bills, surgery costs, and medical procedures can add up quickly, and paying out of pocket can be overwhelming, especially for families living paycheck to paycheck. With the right family health insurance, you can avoid these hefty expenses and enjoy greater financial security. It’s a sensible and responsible choice to ensure both the health and well-being of your entire family.

Types of Family Health Insurance

When it comes to family health insurance, there are various options designed to cater to the diverse needs of your family. Depending on the health requirements of each family member, you can tailor the coverage to suit individual needs. Family health insurance generally falls into three main categories: hospital cover, extras cover, and combined cover. Here’s a detailed breakdown of each:

Hospital Cover

Family hospital cover provides protection when a family member requires inpatient treatment at a hospital. This coverage includes anything from day surgeries, like colonoscopies, to major procedures, such as heart surgeries that require extended hospital stays. Hospital cover is available in different levels:

  • Gold Level: Ideal for growing families, this level includes comprehensive coverage for maternity care, pregnancy, and childbirth, offering private hospital care during these significant events.
  • Silver & Bronze Levels: For families with fewer health concerns or those who’ve completed their family, these options offer more basic coverage at a more affordable price. They cover essential treatments and services while keeping costs lower.

Extras Cover

Extras cover focuses on a range of out-of-hospital services that your family is likely to need regularly, such as dental care, optical services, physiotherapy, and hearing aids. Unlike hospital cover, which you may rarely need, extras cover is designed to help you manage costs for the routine healthcare services your family uses, such as:

  • Dental: Regular check-ups, cleanings, and dental treatments.
  • Optical: Eye exams, glasses, and contact lenses.
  • Physiotherapy: Treatment for injuries, mobility issues, or rehabilitation.

With extras cover, you can claim a portion of the costs for these services, making it an affordable way to manage ongoing health needs for everyone in the family.

Combined Cover

Combined cover offers the best of both worlds by bundling both hospital and extras coverage into a single policy. While there is no significant advantage or disadvantage to having a combined policy versus separate hospital and extras plans, combined cover can be more convenient for families who prefer managing everything under one policy. It simplifies the process by providing comprehensive coverage for both in-hospital and out-of-hospital needs without the complexity of dealing with multiple providers.

Key Considerations When Choosing a Policy

With all these different types of health insurance provided by different companies, it is important to first talk about how to choose the best one for yourself and your family according to your needs. This can be done after you compare family health insurance policies from different companies based on key considerations. There are five key considerations that you should keep in mind:

Current Health Status

Before selecting a family health insurance policy, it’s essential to evaluate the current health needs of each family member. Consider how often you, your partner, or your children have required medical attention recently. Ask yourself: How many GP visits, checkups, or emergency appointments have we had in the last few months? Are there any ongoing health issues or chronic conditions within the family? What medications are you or your family members taking regularly?

By answering these questions, you can better determine the level of coverage your family requires. If your family generally has good health and minimal medical visits, a basic health insurance plan might suffice. However, if there are chronic conditions or frequent medical needs, you may need more comprehensive coverage that includes extras like dental, optical, and physiotherapy to ensure all bases are covered.

Future Health Needs

Beyond the present, it’s important to consider what your family’s health needs might look like in the future. Think about the ages of your children and their potential healthcare requirements. For example, will they need braces in a few years? Are regular trips to the speech therapist or physiotherapist part of their routine? Do they play sports and require annual checkups or protective equipment like mouthguards?

Similarly, consider your and your partner’s health needs in the coming years. Planning ahead allows you to choose a health insurance policy that not only addresses your current situation but also prepares for future medical expenses.

Cost

Cost is one of the most important points to keep in mind while choosing a health insurance policy. The reason behind this is that different companies offer different pricing for hospitals, extras, and combined covers. To find the best one, you will need to compare health insurance cost, policies, and their offered premiums, excess, and out-of-pocket costs. Remember, though, the cheapest doesn’t always mean the best. Sometimes, it’s better to pay a little bit more because you’ll end up getting more back in the long run.

Extras Policy Limits

When selecting family health insurance, it’s crucial to pay attention to the coverage limits on your extras policy, as well as the rebates offered. Many people focus on the “yearly limit,” which is the maximum amount you can claim for a particular service in a year. For example, a policy might offer a $300 yearly limit for physiotherapy, meaning each individual can claim up to $300 in physiotherapy services within the health fund year.

However, it’s equally important to understand policy limits, which are sometimes referred to as family limits. These limits apply to the total amount a family can claim as a whole. For instance, a policy might allow each family member to claim up to $600 per year for major dental work but cap the total family claims at $1,200. Once your family reaches the combined policy limit, no more claims for that service will be reimbursed, even if individual members haven’t used their full annual limits.

This distinction between annual limits and policy limits is particularly relevant for families. While single or couples’ cover rarely faces this issue, families with several members may hit the policy limit more quickly if multiple people are accessing the same services. It’s important to review both limits to ensure that your family’s healthcare needs are fully covered without unexpected restrictions.

The Excess Structure

When purchasing a hospital policy, it’s important to understand how the excess works. The general rule is that the lower the excess, the higher the premium, which is why many families opt for a $500 or $750 excess to keep premiums manageable. An excess is a pre-agreed amount that you’ll need to pay upfront when admitted to the hospital. It only applies to hospital admissions and not to extras claims like dental or physio.

However, not all policies treat the excess the same way when it comes to dependents. Some policies require your children to pay the excess if they are admitted to the hospital, while others waive it entirely for children under a certain age. For instance:

  • Some policies may not charge an excess for children under 21 or 23.
  • Others may require your children to pay an excess only after they reach a certain age, or in specific circumstances.

To avoid unexpected costs, it’s essential to understand how your policy handles excess payments for your family. Knowing whether your children will be charged an excess can help you budget better and avoid surprises when a family member is admitted to the hospital. Be sure to review the terms of your policy to ensure you’re fully aware of when and who will need to pay the excess.

Extras Cover for Families

Extras cover is a vital component of private health insurance, especially for Australian families. It provides coverage for a broad range of out-of-hospital services that contribute to maintaining and improving your family’s overall health and well-being. These services include essential care like physiotherapy, dental treatments, optical services, and specific treatments for children, such as braces, speech therapy, and medical aids. With healthcare costs continuously rising, extras cover ensures that these routine and necessary services don’t result in overwhelming out-of-pocket expenses.

The Benefits of Extras Cover
One of the most significant advantages of extras cover is the potential for substantial savings. By claiming for services your family already uses regularly, you can effectively get more value out of your health insurance policy. Take nib’s Core Extras policy in Victoria as an example: for a family, this policy costs approximately $896.56 per year (after applying base-tier rebates and direct debit discounts). This policy covers services like:

  • Preventive Dental: Routine check-ups and cleanings.
  • General and Major Dental: Fillings, crowns, and more.
  • Physiotherapy: Treatments for injury or rehabilitation.
  • Optical Services: Eye exams, glasses, and contact lenses.
  • Ambulance Services: Coverage for emergency transport.

Real-Life Savings Example
Let’s say your family consists of two adults and two children, all of whom visit the dentist twice a year for check-ups and cleanings. If you choose nib’s no-gap dental providers, like Pacific Smiles Dental in Melbourne, each check-up and clean typically costs $192. With four people visiting twice a year, you’d be claiming $1,536 in dental services alone.

But it doesn’t stop there. If two family members need new glasses and opt for frames priced at $199 from Specsavers (another no-gap provider), that’s an additional $398 in benefits claimed, with no extra out-of-pocket cost.

In total, your family would be claiming $1,934 in benefits, which is more than double the amount paid for the extras policy in the first place. By carefully choosing providers and making full use of your policy’s benefits, your family can significantly reduce healthcare expenses while still receiving the essential care you need.

More Than Just Savings
Extras cover isn’t just about saving money—it’s about ensuring your family has access to essential healthcare services that support long-term health and well-being. Regular dental check-ups, optical services, and physiotherapy can help prevent more serious health issues down the road, making extras cover a smart, proactive choice for Australian families.

Understanding Costs

Family health insurance costs can vary from one insurance provider to another and also depend on what sort of insurance coverage you have for the entire family. There are many different types of costs associated with insurance generally, and understanding what each of them means and entails is important for making an informed decision while buying a policy and, consequently, using it where needed. Here, we explain each type of associated cost:

Premiums

Premiums are the regular payments you make to keep your family health insurance policy active. Depending on your budget and provider, you can choose to pay your premiums fortnightly, monthly, quarterly, or yearly. The amount of your premium will depend on several factors, including the type of coverage you select, the services covered, and any additional features or benefits you opt for.

It’s essential to talk to your provider in detail about your premium structure and payment options. For instance, some providers offer discounts if you pay through direct debit from your bank account instead of a credit card. Additionally, paying annually instead of monthly may also result in a discount. It’s important to note that if you stop paying your premiums, your coverage will cease, leaving your family without insurance protection.

Excess and Co-payments

An excess is an out-of-pocket cost that you agree to pay when you’re admitted to the hospital. The general rule is that the higher your excess, the lower your premium will be. Families often opt for a higher excess to keep premiums more affordable. However, you will only be required to pay this excess when you or a family member is admitted to the hospital for treatment—not for claiming extras services like dental or physiotherapy.

Co-payments, though less common in 2024, are another type of out-of-pocket cost you may need to pay each time you’re admitted to the hospital or use certain services. It’s important to double-check your policy to see if co-payments apply.

When reviewing your policy, pay special attention to how the excess applies to your children. Some policies will waive the excess for children under a certain age, while others will require a payment. Additionally, some policies may waive the excess altogether if the hospital admission is due to an accident. Understanding these details upfront ensures that you’re not surprised by unexpected costs when a family member needs hospital care.

By understanding the costs associated with family health insurance, you can make smarter decisions that ensure your family is protected while balancing affordability. Always review the fine print in your policy to ensure you know exactly what you’re paying for, and take advantage of discounts and options that work best for your financial situation.

Lifetime Health Cover Loading

Lifetime health cover loading is the additional cost for those who take out hospital cover after the age of 31 years. This means that if you have not taken out any private hospital cover after turning 30, and later on you decide to buy one, you will have to pay a 2% LHC loading cost on top of your premium for every year you are aged over 30.

A simple example for you to understand this loading fee is that imagine if you take out private hospital coverage at the age of 35 years old you will then have to pay an extra 20% on the cost of this coverage per year for 10 years. Likewise, if you buy a policy when you are 50 years old, you will pay 40% more per year for 10 years. This is why it is recommended that before you turn 30, you should have private health insurance in place, which will save you a good amount of the loading fee in coming years.

Government Rebates

The Australian Government’s rebate can reduce premiums based on the policyholder’s age and income. In the case of family health insurance, the government rebates can apply and be even more beneficial if the household is dual-income. This page describes various situations of a policyholder and how they may receive their private health insurance rebates. Please check out the page, and if you have any questions, please feel free to email us your inquiries at enquiries@healthdeal.com.au.

All the above-mentioned costs related to health insurance for a family can be reduced and managed well according to your chosen policy and its coverage. It is, however, very important to balance your costs with benefits from your insurance provider and government rebates for family health insurance. This will help you manage your bills more efficiently and ensure value for money while keeping your loved ones protected.

Tailored Family Policies

Many health insurance providers offer specially tailored family health policies designed to meet the unique needs of families. For example, young families may prioritise coverage for maternity care and services like speech therapy or dental for children, whereas older families might focus on managing chronic conditions or higher-level hospital care. These family-specific policies often include additional benefits, such as no-gap arrangements with preferred providers, meaning you won’t be out of pocket for certain treatments like dental check-ups and glasses.

Health funds like Bupa, Australian Unity, hif, NIB, ahm, and Westfund provide a range of family cover options. Each fund offers unique features; for instance, some may cover children’s mouthguards under dental, while others may have higher limits for speech therapy or physio. These details matter when choosing a policy, as they allow you to customise your coverage based on your family’s individual health needs.

If you want to compare policies quickly and efficiently, tools like Compare Your Health  comparison service are invaluable. By using this tool, you can compare policies from multiple providers and find the best coverage for your family’s needs without the hassle of contacting each insurer individually.

Government Rebates and Incentives

Government rebates and incentives are key to making family health insurance more affordable. In Australia, there are two main programs that can help families manage the cost of health insurance: the Private Health Insurance Rebate and the Medicare Levy Surcharge (MLS) exemption.

  • Private Health Insurance Rebate is a government program that provides a rebate to most Australians who hold private health insurance, helping reduce the cost of premiums. The rebate is income-tested, meaning the percentage you’re eligible for depends on your family’s combined income and the age of the policyholders. For example, families with lower incomes receive a higher rebate percentage.
  • Medicare Levy Surcharge (MLS) is a tax imposed on Australians who earn over a certain income threshold and do not hold private hospital insurance. If you and your spouse’s combined income exceeds the threshold, you may need to pay the surcharge unless you have private hospital cover. However, holding family hospital cover can exempt you from this additional tax, providing a significant financial incentive for those earning above the MLS threshold.

For more detailed information on your eligibility for these rebates and exemptions, you can visit official government websites or consult with your health insurance provider.

Comparing Providers

We’ve provided a wealth of information about family health insurance types, coverage options, providers, tiers, rebates, and associated costs. But the ultimate question remains: which health insurance provider is the best fit for your family’s health and medical needs?

When evaluating insurance providers, several factors must be taken into account, including:

  • Coverage Options: Does the provider offer the specific coverage your family needs, such as maternity care, pediatric services, or extras like dental and optical?
  • Cost: What are the premiums, excesses, and out-of-pocket expenses? Does the policy fit within your budget while offering the coverage you require?
  • Provider Networks: Are the healthcare professionals and hospitals you prefer included in the provider’s network?
  • Customer Service: How responsive and helpful is the insurer’s customer support?
  • Ease of Claims Process: How straightforward is the process of submitting and receiving claims?

To make a well-informed decision, we strongly recommend that you compare family health insurance providers and their offerings. While most insurers offer similar policies, the details can vary, so it’s essential to understand the differences. Reading product disclosure statements and reviewing detailed information on insurance company websites is crucial.

Additionally, family health insurance reviews and ratings can be very insightful. Websites like ProductReview offer customer feedback and ratings, which can provide a clearer picture of the insurer’s performance and customer satisfaction levels.

By taking the time to compare, you can ensure that you choose the best health insurance provider tailored to your family’s specific needs.

Top Health Insurance Providers for Families

A common misconception in the health insurance industry is that there’s one “best” health insurance provider for families. In reality, no single health fund is the best fit for everyone, as health insurance is a highly personal choice. While some health funds may receive accolades or awards from sources like Canstar or Choice, it’s important not to rely solely on these recognitions. These awards might highlight specific strengths of a health fund, but they don’t necessarily mean that provider is the best option for your unique health needs.

For example, a highly rated health fund might offer excellent customer service or affordable premiums, but it may not have agreements with every hospital or specialist you prefer. If you choose a provider based only on awards and later discover that your preferred hospital or surgeon isn’t covered, you could face significant out-of-pocket expenses.

When selecting the best health insurance for your family, it’s essential to look beyond accolades and ask the important questions:

  • Does the health fund have agreements with your preferred hospitals and specialists?
  • Does it cover the services your family is likely to need, such as maternity care, pediatric services, or extra support like at-home healthcare?
  • Does the provider offer a network that aligns with your family’s healthcare needs, both in terms of treatment options and geographic location?

By tailoring your decision to meet your family’s specific needs, you can ensure that you choose a health fund that provides the right coverage without unexpected limitations. Always consider your personal requirements and do thorough research to find the best health insurance provider for your family.

Customer Reviews and Ratings

In today’s world, customer reviews are an invaluable tool when researching health insurance providers. They offer real-life feedback and insights from people who have firsthand experience with the company’s services. While it’s helpful to read about others’ experiences, it’s important not to rely solely on reviews when choosing a health fund. Every family’s needs and circumstances are unique, and what works well for one person may not be the best fit for you.

Use customer reviews as one piece of the puzzle, but balance them with a thorough comparison of coverage, cost, and the specific features of each policy. Always ensure the policy meets your personal and family needs before making a decision.

How To Switch and Save on Family Health Insurance

Switching family health insurance, especially with Compare Your Health , is super simple. Compare Your Health  will handle the entire switching process for you, so you won’t have to lift a finger. When you sign up for a family health insurance policy through Compare Your Health , they’ll ask you for information like your Medicare card number, your previous health fund member number, and payment details. Once you click submit on your application, the following will occur:

  1. Compare Your Health  will securely transmit all your information over to your new health fund.
  2. You will receive a welcome email from Compare Your Health  with your new health fund.
  3. Your new health fund will send a transfer certificate request to your old health fund. This is the document that outlines all the waiting periods you have already served.
  4. Your old health fund will cancel your ongoing direct debit and will refund you any money you have pre-paid them for the fortnight/month/quarter/year on a pro-rata basis (this takes about 10 working days to receive the refund).
  5. Your new health fund will send you a card in the post, and you’ll receive an onboarding welcome call from someone in their customer service team.
  6. All your payments will have been set during the signup process, so you can just sit back, relax, and enjoy your new health fund.

Remember, when switching health funds, you will not have to re-serve any waiting periods you’ve already served, and any money you’ve pre-paid will be refunded to you. Please also bear in mind that any claims you’ve made on your extras will follow you across, so if you’ve claimed $100 on your general dental limit with your current fund and switched to a new one, that $100 will be deducted from your yearly limit when you switch across.

FAQs

 

Here are answers to some of the most common questions about family health insurance:

What is covered under hospital and extras cover?
Hospital and extras cover can include a variety of in-hospital and out-of-hospital services. The specific services covered will depend on your insurance provider and the coverage tier you select, but generally, services covered include:

  • Hospital Cover: You may have the option to choose between public or private hospitals, select your specialist, and have access to private room options (subject to availability).
  • Extras Cover: Common services included in extras cover are hearing aids, dental treatments, optical services, and physiotherapy. Depending on your policy, some services may be covered separately, while others may be included in a combined hospital and extras policy.

To learn more about what is covered under hospital and extras cover, use our Compare Your Health Insurance Tool to make an informed decision.

How do I claim the Australian Government Rebate on Private Health Insurance?
There are two ways to claim the rebate:

  • Upfront Claim: You can claim the rebate directly from your health insurance provider as a reduction on your premium.
  • Tax Return Claim: Alternatively, you can claim the rebate when filing your tax return through the Australian Taxation Office (ATO).

The choice is yours based on what’s more convenient for you. For more information on health insurance rebates for families, please visit our dedicated page.

What are waiting periods?
Waiting periods refer to the initial waiting time after purchasing an Australian private health insurance policy, during which you will not be able to access the benefits covered by the policy. If you need medical services during this period, you will need to cover the full cost.

Here are the standard waiting periods for common health insurance benefits:

  • New Conditions: 2 months
  • Pre-existing Conditions: 12 months
  • Rehabilitation, Psychiatric Care, and Palliative Care: 2 months
  • Pregnancy and Birth-related Services: 12 months
  • IVF and Assisted Reproductive Services: 12 months
  • Weight Loss Surgery: 12 months

If you’re switching to a new policy and have already served the waiting period with your previous insurer, you won’t need to serve it again. For more information on waiting periods for senior health insurance, visit our page.

How can I reduce my premiums?
There are several ways to reduce your family health insurance premiums:

  • Compare Policies: Compare different policies and their rates to find the most cost-effective option.
  • Switch to Lower Premium Plans: If your needs change, you can switch to a policy with lower premiums.
  • Tailor Your Coverage: Only pay for the services you and your family will use. Remove coverage for services you no longer need.
  • Prepay Your Premium: Many providers offer discounts if you pay your premiums for at least 12 months in advance.

If you have additional questions about family health insurance, feel free to reach out to us at enquiries@compareyourhealth.com.au.

Compare now

Comparing family health insurance is the most effective way to find the best coverage for you and your loved ones. With our Compare Your Health Insurance Tool, you can easily compare different health insurance plans, costs, and providers, ensuring you select the best option for your family’s needs.

Need Expert Advice?

if you need expert guidance,feel free to reach out to us:

Contact: Compare Your Health
Email: info@compareyourhealth.com.au
Phone: 1300 631 373

Get in touch with our experts for tailored advice and support in making informed health insurance decisions for you and your loved ones.

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Frequently Asked Questions

Depending on the policy, private health insurance can help cover the cost of your medical treatments in or out-of-hospital that Medicare sometimes won’t cover. Out of hospital treatment can include services such as Dental, optical, physiotherapy or even remedial massage

Private health insurance can help cover medical treatment received when hospitalised. Therefore, it is important to select the right level of cover for the clinical categories that are necessary to you.

Your private health insurance should change as often as needed to ensure you are covered at all the different stages of your life.

Also, private health insurance gives you the ability to choose your own doctor and avoid any public waiting lists for categories covered by your policy.

There are many top competing health funds, however you want to find one that is best suited to your individual health requirements and not just a health fund that is the best in the market.

This can sometimes be a difficult task for individuals, therefore companies like Health.Compare can offer comparisons of different health insurance policies to help you choose a policy that is catered to your health circumstances and budget.

Excess is the amount you pay upfront to cover some of the hospitalisation expenses if you ever get hospitalised. The higher the excess, the lower your private health insurance premiums will be. This usually applies to people with relatively lower health concerns who do not see themselves being in hospital anytime soon and in the event that they are hospitalised, they can agree to pay a higher excess, ultimately reducing their regular premiums.

Please be aware that excess amounts do vary depending on the health insurance provider, so it may be beneficial for you to consider your individual health and financial circumstances at the time of buying the insurance policy before agreeing to the Excess amount.

In Australia, health insurance is not tax deductible however you can receive rebates for your private health insurance. When taking out Private Health Insurance you choose whether or not to claim a rebate from the government. The government rebate is dependent on a number of factors including age and taxable income.

This can be applied to Hospital, Extras or combined products.

According to a recent report by APRA, 55.2% of Australians have extra cover, and 45.2% have hospital cover. These are the verified figures as of June 2022.

While the average cost of private health insurance adds up to $160 per month per person, your premiums may go up or down depending on the type of cover you choose or the excess amount you agree upon.

The starting point for many, is to look at your individual needs, preferences and financial circumstances.

We will help guide you through this conversation by first understanding and then matching your needs to a tailored level of cover. Ultimately, what’s best for you and your situation will be completely different to many others who are eligible for Private Health Insurance.

Yes you can have a private hospital insurance policy with one health fund and extras cover with another. This can be helpful as some funds might have a hospital policy you like, but not the extras cover you require for the specific out-of-hospital treatments.

Private health insurance provides many benefits to its members giving them access to a wide choice of health providers, faster access to medical services and the ability to avoid long wait times experienced in the public hospital system. In this FAQ we will answer some of the common questions about private health insurance.

What are the benefits of having private health insurance?

  • Access to private hospitals and faster treatment times
  • A wider range of treatment options
  • Ability to choose your own doctor and hospital
  • Reduced out-of-pocket expenses
  • Access to many health services and treatments not covered by the public system

Can I choose my own doctor and hospital if I have private health insurance?

Yes, with private health insurance you have the ability to choose your own doctor and hospital, giving you greater control over your health care to achieve a better overall health outcome.

How can I choose the right private health policy for me?

When choosing private health insurance, there are a few factors to consider:

type of cover required (hospital or extras)

  • your budget
  • your age and pre-existing medical conditions
  • the level of cover required
  • the range of health services you need to be covered for

Why should I get extras cover?

extras cover will give you further coverage on a range of treatments such as dental, optical, chiropractic, massage and physiotherapy.
some extras health policies also include further natural therapies such as acupuncture and Chinese medicine

How much does private health insurance cost?

The cost of a health policy in Australia varies depending on what type of cover you choose, your age, if you have any dependents and any pre-existing conditions. On average, the cost of private health insurance is around $2,000 per year for an individual and $4,000 per year for a family.#

In Australia, private health insurance is available to provide financial protection and contribution to medical expenses, but not all medical expenses are covered by your private health policy. In this FAQ we will explain the questions you have around what is typically covered and what’s not covered with private health insurance.

What is not covered by standard private health insurance?

The most common exclusions from private health insurance policies in Australia include:

  • Elective cosmetic operations, such as cosmetic surgery and cosmetic dentistry
  • Weight loss surgery, unless it is deemed medically necessary
  • Infertility treatments, such as IVF
  • Alternative therapies, such as homeopathy, aromatherapy, kinesiology, reflexology and iridology
  • Mental health services, such as counseling and psychotherapy, unless they are part of a hospital treatment plan
  • Non-medical services, such as transportation and accommodation for medical treatment
  • International travel for medical treatment
  • Experimental treatments or procedures that are not yet widely accepted or covered by Medicare

Does private health insurance cover dental services?

No, private health insurance does not generally cover routine dental services, such as check-ups, cleanings, and fillings. However, some private health insurance policies may offer coverage for more extensive dental procedures, such as orthodontics and oral surgery, that are performed in a hospital setting.

Does private health insurance cover optometry services?

Similar to dental, optometry services are not covered by private health insurance such as eye examinations although prescription glasses and contact lenses are covered by private health extras policies.

Am I covered for ambulance services?

Not all private health policies cover individuals for ambulance services. However, some states in Australia automatically cover policy holders through their state or territory.

Will my private health policy cover prescription drugs?

No, private health insurance policies in Australia do not cover prescription drugs. Prescription drugs are covered by the Pharmaceutical Benefits Scheme (PBS), which is a government-funded program.

In conclusion, it’s important to understand what is not covered under your policy to avoid any surprises when you need to make a claim. While most health insurance policies provide coverage for a wide range of medical expenses, there are still some things that are not covered, and it is important to understand these exclusions.

So, you have private health insurance and want to know how much you might have to pay for medical treatments out of your own pocket? We’ve got you covered with our easy guide FAQ.

What does ‘no gap’ mean when it comes to private health insurance?

Basically, it means that you won’t have to pay anything out of your own pocket for certain medical services, these are covered by your private health insurance. It’s the difference between what your doctor or hospital charges and what Medicare and your private health fund will pay and it’s known as the ‘gap’. With a ‘no gap’ arrangement, your insurance will cover the full cost of the service.

So, I won’t have to pay anything extra?

That’s right! With the ‘no gap’ arrangement, you won’t be left with any unexpected bills to pay. Your private health insurance will cover the full cost of the medical service, so you can focus on your health and recovery.

How does it work?

To be eligible for a ‘no gap’ service, you’ll need to use a provider who is part of your private health insurance provider’s ‘preferred provider’ network. This means that the provider agrees to charge you a set fee for a particular medical service, and your private health insurance will cover this fee in full. This way, you can be sure that you won’t have to pay anything out of your own pocket.

Can I get ‘no gap’ for any medical procedure?

Unfortunately, ‘no gap’ is only available for some medical services, and only if you use a provider who is part of your private health insurance provider’s ‘preferred provider’ network.

Is ‘no gap’ the same as ‘bulk billing’?

No, they’re not the same thing. ‘Bulk billing’ is when medical providers bill Medicare directly for their services, so you don’t have to pay anything out of your own pocket. ‘No gap’ is a service that’s offered by private health insurance providers, and it covers the full cost of certain medical services.

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