Find out if Apia health insurance is right for you.
Apia is one of the few funds in Australia that specialises in providing health insurance cover for over 50s and seniors. Underwritten by Suncorp for a high level of security. They take pride in offering sensible real world health insurance policies that cover what’s important without making you pay for unwanted extras.
How can this page help me learn more about Apia Health Insurance?
Like almost all health insurance funds, Apia offers two different types of cover, hospital and extras.
- All hospital cover policies are required to pay benefits for any in-hospital medical treatments that are also covered by Medicare. This covers almost all vital medical procedures. For added value, funds will also cover other non-essential procedures and get you private hospital access.
- Extras policies cover treatments and procedures that are not covered by Medicare, such a physiotherapy, complex dental work, health aids and much more. The exact benefits offered by extras policies depend largely on the fund, and Apia’s extras focus on pragmatic benefits that a lot of over 50s can take advantage of.
Apia hospital cover options
Medicare, Australia’s public health insurance, will pay for vital medical treatments in public hospitals, usually in shared rooms. You cannot choose your doctor, have little control over your own treatment plan and can only access certain treatments through a waiting list, subject to availability. By contrast, Apia hospital cover lets you:
- Receive benefits for a wider variety of treatments, including non-essentials
- Choose your doctor and the specialists who treat you
- Get covered for stays at private hospitals as well as public hospitals
- Choose to stay in a private room
- Have more say over your treatment plan and timeframe
- Get quicker treatments and skip public hospital waiting lists
Apia offers two levels of hospital cover, Essential and Premium. The former is cost-effective basic cover, while the latter is a more comprehensive option.
- Premium covers eye treatment and eye surgery, obesity surgery and renal dialysis while Essential does not.
- Premium pays more benefits for psychiatric treatment while Essential only pays the minimum required.
Other than those differences, all Apia hospital cover policies offer the following:
|What is covered||What it is||Waiting period|
|Accidental injury||Immediate medical treatment following an accident||1 day|
|All Medicare-approved treatments||All essential medical procedures that are also covered by Medicare||Varies|
|Ambulance||Ambulance call outs, emergency transport and between-hospital patient transport||1 day|
|Back surgery||Surgery to treat back abnormalities or injuries such as spinal fusion or a herniated disc|
|Brain surgery||Surgery of the brain for reasons such as tumour removal, hemorrhage, blood clots, aneurysms and more|
|Cancer treatment||Approved cancer treatments including surgery, radiotherapy and chemotherapy|
|Colonoscopies||Intestinal diagnosis and examination for bowel cancer, polyps, unexplained pains and more|
|Dental surgery||Teeth extractions and dental procedures that require general anaesthetic|
|Gastroscopies||Medical examination of the digestive system to investigate and diagnose issues such as ulcers, cancer, difficulty swallowing and more|
|Gynaecological services||Female reproductive system health when not related to infertility, such as the treatment and diagnosis of endometriosis|
|Heart procedures||Pacemaker and defibrillator insertion, stent insertion, heart transplants, coronary angioplasties, heart valve surgeries and much more|
|Hernia repair||Treatment of hernias|
|Joint investigations||Diagnostic joint surgery|
|Joint reconstructions||Reconstruction of damaged joints and ligaments|
|Joint replacement||Replacement of damaged joints with a prosthesis|
|Palliative care||Ongoing pain-relief care, active living support for health issues||2 months|
|Rehabilitation||Physical therapy and exercise treatments for reasons such as stroke recovery or strengthening joints||2 months|
|Stroke treatments||Treatment for a stroke, usually urgent and to fix a blockage or haemorrhage|
- Apia hospital cover will pay the full cost of hospital accommodation, operating theatre fees, intensive care, coronary and neonatal care, meals, medical supplies and all approved pharmaceuticals. Some of the more expensive types of medication, such as those used in oncology, may not be covered.
- You can choose between a $250 excess or a $500 excess. This is a fee that you will need to pay once a year in any year where you make a claim for hospital benefits. Choose $500 for lower premiums, or $250 for a lower excess but higher premiums.
Apia extras cover options
Health insurance extras covers non-vital treatments and services such as glasses, podiatry, health aids and nonessential dental work. Apia has three levels of extras cover to choose from - Essential, Essential Plus and Premium. The limit is the most you can claim for a treatment in a year, and it steadily gets higher with more comprehensive policies. Essential and Essential Plus will pay 60% of the costs of the treatment back to you, while Premium will pay for 75% of the costs.
|Is it covered?||Essential (60%)||Essential Plus (60%)||Premium (75%)|
|Ambulance||Yes, no limit||Yes, no limit||Yes, no limit|
|General dental||$600 limit||$700 limit||$1,000 limit|
|Preventative dental||Yes, no limit||Yes, no limit||Yes, no limit|
|Hearing aids and speech processors||No||No||$1,200|
|Home nursing services||No||No||$200|
Apia lets you customise your extras policy. Get everything under a Premium policy, or choose Essential or Essential Plus and then add anything that’s important to you, such as hearing aid cover, orthoptics or extra pharmaceutical benefits.
General exclusions, waiting periods and excesses
As with all health insurance policies, Apia has exclusions, waiting periods and excesses.
These are circumstances in which you cannot claim benefits. Apia will not pay for:
- Non-Medicare treatments. Typically this will only rule out newer robotic surgeries and experimental drugs and it won’t adversely impact your level of treatment.
- Cosmetic procedures, including dental implants, if not medically necessary. For example, it will pay for a rhinoplasty if doctors recommend it as a treatment for apnoea, but will not pay for it for purely cosmetic reasons.
- Beauty services, phone calls, TV hire, luxury rooms and other hospital costs that aren’t directly related to your treatment and care.
- Admission or booking fees charged by specialists or hospitals.
- Medications that are already covered by the pharmaceutical benefits scheme (PBS).
- Blood drawing and storage, although it will pay for necessary blood tests.
- Procedures performed in a doctor’s surgery rather than in a hospital.
- Private hospital emergency or outpatient fees, and outpatient services performed by a doctor or specialist.
- Special nursing requirements or at-home nursing care for patients discharged early.
Apia does exclusions differentlyMany health insurance providers will exclude pre-existing conditions, meaning that they will never pay benefits for them. This is a problem for many seniors looking for health insurance because there will almost always be some pre-existing condition that needs to be covered. Apia does not exclude pre-existing conditions and you can still claim benefits for them.
A waiting period is the amount of time you must wait after taking out or upgrading a policy before you can claim any benefits. Each kind of treatment usually has its own waiting period, and typically it’s around 2 months for less severe issues, and 12 months for potentially more expensive or severe issues. In some cases, such as for psychiatric treatment and palliative care, health insurance providers are legally not allowed to set a waiting period any longer than 2 months.
Apia does waiting periods differently Because Apia’s policies are specially designed for seniors with whom health events are more likely to occur suddenly and with little warning, Apia only has no more than a 2-month waiting period for everything, even serious treatments that other funds won’t cover for 12 months. The exception is pre-existing conditions, which carry a 12-month waiting period with Apia.
This is a fee to be paid whenever you make a claim. Some policies may have a separate excess for each treatment, or a separate hospital and extras excess to be paid each time you make a claim. If you’re not careful, a high excess can undermine the value for money of your health insurance policy.
Apia does excesses differently Once again, Apia specialises in healthcare for seniors and can appreciate that you spend a lot more time with your doctor as you get older. Apia’s hospital policies carry just one yearly excess of either $250 or $500 (you decide). No matter how many times you go to hospital that year, you will not have to pay more than one excess.
As mentioned above, Apia handles exclusions, waiting periods and excesses differently to most funds, and in a way that seniors in particular can benefit from. In addition to this you can also tailor your policy to cost-effectively add specific types of cover without paying for benefits you’ll never use.
- Apia keeps costs down by not offering any fertility and birthing services. No assisted reproductive services, no infertility investigations and no pregnancy or birth support. If you don’t need it, don’t pay for it.
- Apia can more flexibly accommodate pre-existing conditions and other health challenges faced by the elderly.
- Health insurance providers pay for your treatment by negotiating with hospitals directly. Apia has agreements with over 70% of Australian private hospitals, which lets them reduce hospital costs and keep your premiums down while simultaneously making sure you can find quality health care almost anywhere in Australia.
- Compared to other funds, Apia has a lot of elderly policyholders. By working with hospitals directly they can use this to deliver good economy of scale and further reduce your premiums.
- Best of all, Apia lets you customise your extras policy. Keep costs down by choosing an Essential or Essential Plus extras policy, and then add the advanced extras that are most important to you without paying for additions you don’t need.
Choose your advanced extras from just a few dollars per week
|Advanced extras||What it is||Annual limit||Waiting period|
|Chiropractic and osteopathy||Physical treatments focused on the back, joints and musculoskeletal system||$300||2 months|
|Podiatry and foot orthotics||Specialist diagnosis and treatment of foot conditions and foot orthotics like insoles||$250||2 months|
|Non-PBS pharmaceuticals||Pharmaceuticals that are not covered by the government benefit scheme, including new and experimental treatments||$250||2 months|
|Health aids||Surgical stockings, erectile dysfunction pumps, walking frames, blood coagulation devices, blood pressure monitors and other health aids||$300 (separate appliance limits also apply)||12 months|
|Healthier lifestyle benefits||Active living programs like yoga, pilates and personal trainers, approved weight management programs, smoking cessation programs and other healthy living programs||$250||6 months|
|Preventative tests||ThinPrep pap smears, bone density tests, bowel screenings, breast cancer screenings, blood tests and other preventative tests||$200 (separate service limits also apply)||6 months|
|Hearing aids||Hearing aid devices||$800 (separate appliance limits also apply)||36 months|
|Eye therapy and orthoptics||Vision improvement and eye training programs, both alongside and as an alternative to glasses and contact lenses||$200||2 months|
It’s more important that you have a suitable health insurance policy for your needs than that you are with the “right” brand. Apia does not offer loyalty benefits, and you are encouraged to shop around for the most suitable policy rather than be loyal to a brand name. In fact, a lot of older Australians switch to Apia for precisely this reason. To make the transition easier without needing to risk new waiting periods all over again, Apia will recognise the waiting periods you’ve served with other funds. This means that if you’ve been with your old health insurance company for six months and you switch to Apia, those six months will be counted towards your Apia waiting periods and you can start claiming benefits immediately rather than having to start all over again.
Apia keeps it simple and gives you several options for claiming:
- You can make a claim online. Simply login to your account on the Apia website and follow the instructions provided.
- You can send in a claims form via fax, mail or email. Just fill in details of the treatment you are claiming and provide information on how you want them to pay you. Remember to include an itemised receipt.
- Not sure how to make a claim? Just call 13 50 50. Apia can help you out 24 hours a day, 7 days a week.
- Choose Essential or Premium hospital cover
- Select one of the three Extras plans
- Add any desired Advanced Extras