Looking for the best health insurance?

What you need to do to find the right health fund for your needs.

Are you looking for the best health insurance* policy? While it may seem a simple task, getting the best private health insurance* in Australia is a matter of perspective.

Why? Because what you think of as the best medical insurance* may not be the right cover for someone else. You might value a policy that provides you with comprehensive extra cover, while someone else may just be looking for cover to help them avoid paying the Medicare Levy Surcharge if you earn over a certain income. Make sure you choose the right health fund for your situation.

Continue reading this guide to find out what to look for in a policy to make sure you're getting the best* value for your chosen health fund.

Looking for the *best health insurace for you? Speak with an adviser to help you 

What’s the best* type of health insurance?

The best* health insurance policy is the cover that is best* for you, your family and your circumstances. In general, the fund should:

  • Have low or no gaps between what is covered by Medicare and what your insurance will pay
  • Come from an insurer with a good industry rating, high retention rates and few complaints
  • Have only minimum waiting periods
  • Cover more procedures with no out-of-pocket expenses
  • Include lots of extras, benefits and discounts
  • Have lower management expenses as a percentage of premiums
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How do I choose the right health insurance policy?

The first question you should ask yourself when choosing private health insurance is "Do I need it?". As an Australian, you already have hospital cover under the Medicare public health system. Whether you need more cover than this will depend on whether you want:

  • Treatment at a hospital of your choice
  • Your own doctor to treat you
  • A private or semi-private room
  • Elective surgery when you need it, rather than joining a waiting list
  • Cover for ancillaries not covered by Medicare

If you decide you do need private health insurance, choosing the right cover involves determining your needs and the level of cover each policy provides:

  • If you are young and single, hospital cover may not be a high priority, so you will need to find a policy with the best* cover for ancillaries such as optical and dental
  • If you have dependants, you will need to find a policy that provides the best* family cover, preferably with individual rather than overall capped benefit limits
  • If hospital cover is important to you, you will need to find a provider who has agreements with hospitals in your area and a policy that covers a high percentage of costs, so you don’t end up paying a large gap
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What type of extras cover do I need?

While hospital cover is there for when you need it, extras cover is an area where you can actually get something back on what you have paid out for things such as dental, optical and chiropractic services.

  • The benefit paid on such extras varies considerably with insurers and you need to look carefully at what the benefit limits are on a policy to decide whether it offers good value for money. Basically, if you are paying out a lot more than you are getting back, you may need to look at adjusting your cover or finding another insurer.
  • If you use one service more than most, such as requiring regular dental treatments, you should find a policy that pays higher benefits in this area, rather than just paying a fixed premium for a range of services you barely use.
  • Also rather than paying a set amount for a service, look for policies that cover a percentage of your bill, the higher the better, as this provides better value, particularly if your healthcare provider charges above-average prices.
  • When shopping for the best* extras cover, also look for insurers who offer discounts for using their preferred service providers, as this can work out much cheaper and also look for policies that include lifestyle cover, which can give you access to a range of health and lifestyle-related discounts.
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Can I switch health funds to find the best* cover?

Switching health insurance providers is easier than most people realise. Given that the cost of health cover is on the rise in Australia, there’s never been a better time to shop around and switch if necessary. If your current policy no longer meets your needs, if you’ve found a better deal or if your personal circumstances have changed, switching insurers makes good sense. And you won’t be penalised for doing so. Providing your current policy is paid and up-to-date at the time of switching, your existing benefits will travel with you to the new provider. These include:

  • Your Lifetime Health Cover status. Your level of age loading will remain unchanged.
  • Your government rebate. Providing your level of cover isn’t changing, you will receive the same government rebate as you received previously.
  • Your waiting period exemption. If you have already served your waiting period, your new insurer cannot make you serve a further waiting period.

The process of switching is fairly straightforward. Once you have found the insurer and policy you want to switch to, you simply notify your current insurer of your intention to switch. They will then send a Transfer Certificate to you or your new insurer, which will confirm your level of cover and current waiting period and age loading status.

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How does my age affect my health cover?

 Your medical insurance needs change as you get older, which means that what was the best medical insurance policy when you were 20 may not be the best policy when you're 40

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How do I get the best value for money?

The best* way to get value for money on your health insurance is to shop around. Comparing policies can reveal a variety of money-saving opportunities. Other ways to save include:.

  • Paying your premium in advance to avoid the administration fees associated with monthly payments
  • Paying by direct debit, which will earn you a discount with some insurers
  • Paying a higher excess to lower your premium
  • Joining a restricted membership fund if you are eligible, as the premiums are usually lower and benefits to members higher
  • Taking out health cover through your super fund, as many negotiate discounts with health insurers.
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Private vs public health insurance comparison

Ambulance

If you live in New South Wales or Australian Capital Territory, you may want to get ambulance cover as the only people that are provided with free ambulance cover are low income earners and pensioners. Emergency ambulance services are provided free by the State Governments of Queensland and Tasmania.

Private or public?Is ambulance covered?
Private health insurance
  • You can get ambulance cover from your health fund
Medicare
  • Not covered

Hospital

Private or public?What is or isn't covered?
Private health insurance
  • Choice of public OR a private hospital
  • Choice of your own doctor
  • Choice of hospital
  • Choice as to when you are admitted to hospital
  • Medicare will cover you for 75% of the Medicare Benefits Schedule (MBS) fee for associated medical costs
Medicare
  • Treated at no charge
  • Treatment in public hospital by a doctor appointed by the hospital
  • Treated as a public patient
  • Private patient hospital costs
  • No choice of doctor or hospital
  • Medical and hospital costs incurred overseas
  • Medical services which are not clinically necessary
  • Surgery solely for cosmetic reasons

Extras (general treatment)

Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist if you visit a doctor outside a hospital. If your doctor bulk bills then you wont pay a cent.

Private or public?What can you get benefits for?
Private health insurance 
    • Acupuncture
    • Chiropractic services
    • Eye therapy
    • Most physiotherapy
    • Speech therapy
    • Home nursing
      • Most dental examinations and treatment
      • Glasses and contact lenses
      • Occupational therapy
      • Hearing aids and other appliances
      • Podiatry or psychology services
Medicare
    • Consultation fees for doctors
    • Most out of hospital surgery
    • Tests and examination
    • Some surgical procedures performed by approved dentists
      • Specific items under the Cleft Lip and Palate Scheme
      • Specific items under the Enhanced Primary Care (EPC) program
  • Other therapeutic procedures performed by doctors

Pharmaceuticals

Thanks to the Pharmaceutical Benefits Scheme (PBS), you only pay for a portion of the cost of prescription medications. The amount varies depending on the medication up to a standard maximum.

Private or public?Are pharmaceuticals covered?
Private health insurance
  • Private health insurance can cover non-PBS prescription medicines but you'll still need to make a co-payment towards the cost
Medicare
  • Only those included listed on the PBS
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Important considerations

Remember it's important to compare your options and other financial avenues before applying.
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Health cover tips

In keeping with the theme of finding the best health insurance* for your needs, here are some tips you may find useful in your search:

  • Review your existing cover at least once a year, as a better deal may have come along in the meantime or your circumstances may have changed
  • Don’t be afraid to switch, as legislation now ensures your benefits and current status will travel with you
  • Mix and match your hospital and extras cover, as two different insurers may have the best* offers on each
  • Select a higher excess if you can afford it and you feel you are unlikely to need hospital treatment in the near future, as this will reduce the cost of your premium
  • If insuring your family, look for a policy with individual benefit limits rather than overall capped limits on extras
  • Avoid hospital cover that has both an excess and a co-payment, otherwise you could end up paying a lump sum on admission and a further amount for every day you are in hospital
  • Make sure your policy includes full ambulance cover, not just emergency ambulance cover
  • To avoid paying a gap, make sure your preferred doctor and hospital both have agreements with your health fund
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Compare your health insurance options online or with help from an adviser

Details Features
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
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Premier Package
Premier Package
Top tier combined hospital and extras policy that covers you for an extensive range of hospital and general treatment services.
  • All the benefits of HCI's Premier Hospital policy
  • All the benefits of HCI's Premier Extras policy
  • Cover for pregnancy and IVF treatment
  • Cover for general and major dental
Get Quote More info
Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
Enquire Now More info
GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
Get Quote More info
Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
Enquire Now More info
Prestige
Prestige
Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund: Only current or former staff (and their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more can join.
  • No excess or co-payments on hospital cover
  • Non-student dependent under 25 can be kept on policy
  • Access to Chronic Disease Management Programs
  • Widest range of extras including orthodontics
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Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
High level of hospital cover and extras cover for a range of popular services including knee and should reconstructions.
  • Most comprehensive hospital options
  • Cover for general and major dental
  • Shared or single room in a private hospital
  • Intensive and coronary care
Enquire Now More info
Premium Hospital and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
Enquire Now More info
Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
Enquire Now More info
Young Couples Combined Cover
Young Couples Combined Cover
Mid-level hospital and basic level Extras package with an excess for young, healthy couples that are not quite ready to start a family.
  • Emergency ambulance cover
  • Cancer-related surgery cover
  • 70% back on extras
  • $300 dental annual limit per person
Enquire Now More info
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* The offers compared on this page are chosen from a range of products finder.com.au has access to track details from and is not representative of all the products available in the market. Products are displayed in no particular order or ranking. The use of terms 'Best' and 'Top' are not product ratings and are subject to our disclaimer. You should consider seeking independent financial advice and consider your personal financial circumstances when comparing products.
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