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Disability and health insurance

Private health insurance can offer more flexibility and coverage for people with disability

A person with disability is defined as someone who has a physical or mental condition that limits their movements, senses or activities. Disabilities can include everything from loss or impairment of hearing, vision, speech and mobility to intellectual and mental disabilities such as Down syndrome, depression and schizophrenia. Sufferers and carers often require financial and community support and this guide looks at how both public services and private health insurance can help those with disabilities.

How can private health insurance help people with disability?

While the government provides some assistance to people with disability both financially and through community support services, private health insurance can also help to relieve the burden for both people with disability and their families. Ways in which private health insurance can help can be seen in the following case studies:

  • Paying for non-PBS medicines. Jay has a debilitating spinal disease that requires regular medication to treat the chronic pain associated with the condition. Jay’s private health extras cover helps him to cover the cost of these medicines, some of which are not listed with the Pharmaceutical Benefits Scheme (PBS) and therefore are not subsidised.
  • Paying for diagnosis of a disability. Peter and Sue’s son Alex exhibited signs of profound deafness at an early age and he was referred for specialist diagnosis and treatment. His parents were able to pay for most of these appointments thanks to government assistance, and their private health extras cover paid for Alex’s hearing aids after an initial waiting period.
  • Paying for hospital treatment of a disability. Karen was badly injured in a car accident and became unable to walk again. She needed extensive follow-up surgery to treat her condition and between Medicare and her no-gap hospital cover, she had no out-of-pocket expenses for any of her hospital visits.

What health insurance options are available for people with disability?

Health insurance falls into two main categories, Hospital cover and Extras cover. Here are the key differences:

  • Hospital cover pays for your treatment and accommodation in a public or private hospital, treatment by a doctor of your choice, the option of a private or shared room and little or no waiting periods for elective surgery.
  • Extras cover helps pay for ancillary services not covered by Medicare such as optical, dental, physiotherapy and chiropractic services.

Both types of health insurance can be taken out separately or, as is more often the case, combined in a single policy. Combined policies are typically offered with a choice of three main levels of cover:

  • Basic covers basic hospital treatment with a lot of procedures excluded and at least one ancillary service included such as general dental or optical.
  • Medium covers more than basic but less than top, offering a mid-range level of protection.
  • Top cover provides comprehensive hospital cover, with most or all services and treatments included and generous extras cover including major dental and orthodontics.

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What to look for in a policy for people with disability

When choosing a health insurance policy for a person with disability, you should consider the main elements:

  • The excess. Are there any excesses or co-payments that you will have to pay? Is the excess affordable and, if so, could you afford to increase it even further to reduce the cost of your premiums?
  • The gap. Are the benefit amounts you will receive high enough to cover the treatments and services you require? Does the fund have a no-gap scheme and is using preferred providers convenient for your situation?
  • The restrictions. Are the waiting periods typical or excessive and what restrictions apply to benefits?
  • The exclusions. Are there too many exclusions or are they typical, such as no cover for cosmetic elective surgery or treatment outside of Australia?

Making a health insurance claim

Most funds will provide their members with a range of claiming options.

Hospital cover


If your hospital treatment is with a preferred provider, the bill will be sent directly to the fund. If you do receive any bills from the hospital, you'll need to claim first from Medicare and then from your fund.

Extras cover


Claiming for ancillary services can be done on the spot (if the service provider has an electronic claiming facility), online via the fund's website or by email, fax or post.

What public assistance is available for people with disability?

Many people with disability are eligible for government assistance. Some of the benefits available include:

  • Disability Support Pension. The Disability Support Pension is a benefit paid to those who are permanently blind or have a physical, intellectual or psychiatric condition that prevents them from working.
  • Sickness Allowance. A Sickness Allowance provides a temporary benefit if you can’t work because of a medical condition or, in some cases, if you are unable to study full time due to illness or injury.
  • Mobility Allowance. Mobility Allowances offer financial assistance to help those with a disability, illness or injury to participate in approved activities (for example, the allowance can help pay for transport costs, etc).
  • Child Disability Assistance Payment. A Child Disability Assistance Payment is an annual benefit paid to assist parents caring for a child with a disability.
  • Youth Disability Supplement. A Youth Disability Supplement provides additional financial support for young people with a disability who already receive income support payments.
  • Continence Aids Payment Scheme. The Continence Aids Payment Scheme is a scheme in place to help people with permanent and severe incontinence pay for their continence-related products.
  • External Breast Prostheses Reimbursement Program. The External Breast Prostheses Reimbursement Program provides a financial reimbursement towards the cost of a new or replacement external breast prostheses for women who have had a mastectomy as a result of breast cancer.
  • Better Start for Children with Disability. The Better Start for Children with Disability initiative provides early intervention services and treatments for children with disabilities.
  • Helping Children with Autism. Helping Children with Autism supports services for children with Autism Spectrum Disorders, their families and carers.

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