Health insurance in Queensland

Private health insurance offers cover for a wide range of medical treatments and expenses not covered by Medicare. With private hospital cover in place, you can choose your doctor and hospital, avoid lengthy waiting lists and be covered for theatre fees, intensive care, drugs and more.

If you take out private extras cover, you can be covered for the cost of general treatments such as optical, dental, physiotherapy and chiropractic services.

If you live in Queensland and you want to be able to find out more about health insurance in the Sunshine state, read on for more information on finding the right health insurance policy.

Find out what your policy options are in QLD

Who are the largest funds in QLD?

Use the interactive pie chart below to view which health funds have the largest market share in the state of Queensland. The option to view the largest funds in the other Australian states and territories, along with the national leaders is also available.

How does the cost of health insurance in QLD compare?

Queensland is the second most expensive state or territory for those wanting private health cover. A combined package offering both hospital and extras coverage will set a family back $6,378.54 per year, on average. Hospital cover on its own will cost $4,690.98 per family, per year, while extras cover only will cost $1,874.88.

The cost of private health cover varies from state to state and depends on the claims history of the residents of that state. As health insurance in Queensland is quite expensive when compared with most other parts of Australia, it pays to shop around for cover that offers the best value for your money.

Options from partner brands

Fund	Dental limit	Apply
black 50 saver	$400	Go to Site
Starter Extras	$350	Go to Site
50% Extras	$350
Pulse 50	$500	Go to Site
Starter Extras	$350	Go to Site
Starter Extras	$350	Go to Site
Healthy Start Extras	$500	Go to Site
Basic Extras	$600	Go to Site
Core Extras	$600	Go to Site

^{*Quotes are based on single individual with less than $90,000 income and living in Brisbane.}

How does ambulance cover vary?

The Queensland Government covers the cost of ambulance transportation and treatment for its residents. No matter where they are in Australia, Queenslanders can enjoy the security and financial protection that this state-funded initiative offers, and they don’t need to worry about finding private health insurance that includes ambulance cover.

In most other Australian states and territories, residents need to pay for ambulance costs out of their own pocket or take out ambulance cover through a private health fund or their state-based ambulance service.

Queenslanders have less cover than the national average

According to the APRA statistics as of 31 December 2016, 46.6% of the Australian population held hospital treatment cover, which was a reduction of 0.2% from the September 2016 quarter but an increase of 19,048 people since 31 December 2015.

In Queensland, the percentage was slightly below the national average, with 43.9% having hospital cover as at 31 December 2016. This was the same percentage as Victoria and slightly below Tasmania (44.5%) and South Australia (45.9%).

As at 31 December 2016, 55.4% of the population held general treatment (extras) cover (13,463,257 people), which was an increase of 7,759 people on the September 2016 quarter and 110,093 since 31 December 2015.

In Queensland, the percentage was below the national average, with just 49.8% having extras cover as at 31 December 2016. This was the lowest percentage of all states and territories apart from the Northern Territory, which had the lowest percentage at 44.5%.

The largest health funds in Queensland are Medibank, with a market share of 33.4% and Bupa with 33.3%. The third biggest health fund, HCF, has a market share of just 6.7%.

Out-of-pocket payments in the Sunshine State

According to the statistics, as at 31 December 2016, the average out-of-pocket (gap) payment for a hospital visit was $275, a 5.8% reduction since 31 December 2015, while the average out-of-pocket payment for extras services was $48, a 1.4% increase since 31 December 2015.

The average gap payment across all services was $18.06, which is similar to Queensland’s average gap payment of $18.30.

What's the gender split?

From a gender perspective, more women held health cover than men as at 31 December 2016, with 5,835,238 women having hospital cover vs 5,492,274 men and 6,324,101 women having extras cover vs 5,920,939 men.

In Queensland, this was also true, with 1,106,393 women having hospital cover vs 1,036,169 men and 1,165,596 women having extras cover vs 1,077,093 men.

Hospital vs extras cover

The APRA statistics also show that more Australians hold extras cover than hospital cover (55.4% extras vs 46.6% hospital), but that coverage rates are still quite healthy for both.

This is also true in Queensland, where 49.8% of people have extras cover vs 43.9% with hospital cover.

Who's got cover in Queensland?

The percentage of Australians with private health insurance can be broken down further into the following age groups:

• 0-14 years. Hospital 17.9% and 18.8% extras cover
• 15-64 years. Hospital 65.0% and 66.2% extras cover
• 65+ years. Hospital 17.0% and 15.0% extras cover

The statistics show that the largest net increase in hospital cover was 5,495 people in the 70 to 74 age group and the largest net decrease in extras cover was 15,068 people in the 25 to 29 age group.

This pattern is consistent across all states and territories including Queensland, with the most significant aspect being an under-representation in younger age categories like the 25 to 29 age group.

Changes over time

A comparison of the 2016 and 2015 APRA reports provides us with the following information:

• The number of people with hospital cover has decreased slightly from 47.2% as at 31 December 2015 to 46.6% as at 31 December 2016.
• There is a noticeable difference in claim rates for hospital and extras benefits, with older age groups making more hospital claims than younger age groups, while extras claim rates remain relatively even across all age groups.
• Western Australia and the ACT both have significantly higher participation rates in private health insurance (54.7% hospital and 68.2% extras in WA and 57.7% hospital and 68.4% extras in ACT).
• Health Insurance Business (HIB) premium revenue has increased by 5.5% since 31 December 2015 and total fund benefits have increased by 5.1%.

Compare Finder Partner Health Funds that offer cover in the QLD

Provider	Details	Features
HCF My Family Advanced Silver Plus $250 excess	Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.	Cover from $42.15 per week Pregnancy and birth-related services cover Heart surgery cover 100% cash back on two dental check per year	Go to Site
Silver Advantage Hospital plus Top Extras	Mid to high level hospital and extras cover for a wide range of services both in and out of the hospital.	Joint reconstructions s $1000 general dental annual limit $600 physiotherapy annual limit	Go to Site
Core Hospital with Middle 75 - $500 Excess	Combines High Hospital Cover with its highest level of extras cover.	Cover starting from $52.04 weekly 12 month waiting period for pregnancy 75% back on extras	More info
Ultimate Hospital (GOLD) Plus Advanced 80%	Ultimate Hospital (GOLD) Plus Advanced 80% provides a high level of cover for both hospital and extras.	Claim up to $8500 back on extras Hip and knee replacements General and major dental Physio	More info
Prestige	Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund	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	More info
Bronze Plus Package with AIA Vitality	High level of hospital cover and extras cover for a range of popular services including knee and shoulder reconstructions.	Most comprehensive hospital options Cover for general and major dental Shared or single room in a private hospital Intensive and coronary care	More info

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