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Apia Health Insurance review

Our verdict: Apia Health Insurance is tailored to seniors, so it doesn't cover treatments like pregnancy. Otherwise, its coverage options are all quite comprehensive.

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Pros

  • Apia is tailor made for seniors. It keeps premiums down by not offering cover for treatments including assisted reproductive services, pregnancy and cosmetic surgery.
  • Essential and Classics Extras keep premiums low by covering only a basic spread of services. Other extras you might need can be added on for an increase in your premium.

Cons

  • It doesn't offer a lot of choice, it only has 3 hospital insurance policies.
  • It doesn't offer basic hospital cover.

Apia Health Insurance: Our verdict

Apia Health Insurance is underwritten by nib and tailored to seniors. It offers 3 hospital options and 3 extras cover policies.

Apia is good if:

  • You're an older Australian and don't need coverage for reproductive services, pregnancy or cosmetic surgery.
  • You want a mid-range policy.

Apia is not great if:

  • You want a Gold policy.
  • You still need cover for pregnancy or medically necessary cosmetic surgery.
  • You prefer not-for-profit health funds.

Review by our insurance and innovations editor Gary Ross Hunter.

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What types of health insurance does Apia offer?

Hospital icon

Hospital Coverage

  • Silver Hospital. This comes with 29 claimable services and cover for the likes of heart and vascular system, back, neck and spine, implantation of hearing devices, lung and chest, blood, dental surgery and more.
  • Silver Hospital Plus. This includes everything covered in Silver Hospital as well as cataracts and joint replacements.
  • Silver Premium Hospital Plus. Another upgraded version of the Silver plan, this also covers dialysis for chronic kidney failure, weight loss surgery, pain management with device, insulin pumps and sleep studies. In total, Silver Premium Hospital Plus comes with 36 claimable services.

Extras icon

Extras coverage

These can be purchased separately, or combined with either of the 2 hospital covers above.

  • Essential Extras. Provides a 60% benefit for a small range of services, including general and major dental treatment, optical appliances and physiotherapy. No annual limit on preventative dental work. Additional extras, including pharmaceuticals, hearing aids and more, can be added on for a higher premium.
  • Classic Extras. This also comes with 60% back on 6 claimable services but has higher annual limits, for example $1,300 for major dental compared to $600 with Essential Extras.
  • Premium Extras. The most comprehensive extras policy available with Apia, you'll get 75% back on 22 claimable services, up to your annual limit.

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Ambulance coverage

Both Apia Health Insurance hospital and extras policies include Ambulance Cover. This includes:

  • Emergency Ambulance transport to a hospital provided by a state or territory ambulance service.
  • Ambulance call out fees (if you're treated at the scene and don't need to go to hospital).
  • Transport between hospitals when transfer is required.

Apia Health Insurance complaints

We looked at the 2022 Ombudsman health insurance complaints to see how good Apia's customer service is (it's underwritten by nib).

  • Apia (nib) had a lower complaints ratio than its market share.
  • Apia (nib) had a larger complaints ratio than some other big insurers like Bupa, Medibank and HBF.

This chart shows the weighted volume of complaints received by each health fund, according to the Commonwealth Ombudsman. The lower the number, the better. Only non-restricted funds with a national market share of at least 0.1% are included here. Apia/nib is ninth overall in this ranking. The weighting ensures that funds are compared fairly; larger funds serve more customers so can potentially get more complaints.

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