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Health Insurance SA

Are you an SA resident looking for health insurance? Compare policies and find out what options are available.

Having private health insurance might not be a "must" but it is a "nice to have". It can protect you against a range of medical cost and is generally split into three cover types:

  • Hospital cover. Covers you for treatments and services incurred in the event you are admitted to a medical facility.
  • Extras cover. Covers you for non-hospital related services such as optical and dental.
  • Ambulance cover. Pays for the expense of emergency ambulance transport.

Find out what your policy options are in SA

Who are the largest health funds in South Australia?

You can use this interactive chart to view the largest health insurance providers in South Australia by market share. Additionally, it can also display who the top performers are in every other state and territory as well as nationwide.

Are premiums in South Australia cheaper or more expensive?

Health insurance premiums fluctuate by state and territory, usually depending on the level of benefits and quality of healthcare available. The average policy in South Australia costs:

  • Hospital only: $4,383.51 for families and $2,043.57 for singles
  • Extras only: $1,910.01 for families and $868.24 for singles

What ambulance costs are covered?

Like most other states, emergency ambulance transport is not a free service in South Australia. The costs for emergency ambulance transport are as follows:

ServiceCost
  • Provision of retrieval team
  • Emergency call out
  • $3039
  • $934
Non-emergency call out$208
Treat no transport (flat rate)$208
Plus kilometre charges$5.40

The only persons exempted from this are holders of a valid Department of Veterans Affairs Gold Card.

The South Australian Ambulance Service also offers its own ambulance cover policies. These are available in three types:

  • Single cover
  • Family cover
  • Pensioner cover (discounted price)

How many South Australians have private health cover?

The statistics in the APRA reports show that as of 31 December 2016, 46.6% of the population held hospital treatment cover, which was a decrease of 0.2% from the September 2016 quarter, but an increase of 19,048 people since 31 December 2015.

In South Australia, the percentage was slightly below the national average, with 45.9% of the population holding hospital cover as at 31 December 2016. This was similar to most other states and territories, apart from WA and ACT, which were significantly higher than the rest with 54.7% and 57.7% respectively.

At 31 December 2016, 55.4% of all Australians had general treatment (extras) cover of some kind, which was 7,759 more people than in the September 2016 quarter and 110,093 more than at 31 December 2015.

In South Australia, the percentage was above the national average, with 59.5% of the population having extras treatment cover as of 31 December 2016. This was similar to NSW (57.4%), but again significantly less than WA and ACT, which were both well above the national average at 68.2% and 68.4% respectively.

The largest health fund in South Australia is Bupa by a long margin, with a market share of 51.3%, followed by Medibank with 22.2% and Health Partners a distant third with 7.5%.

Out-of-pocket payments

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

The average gap payment across all services was $18.06, compared with South Australia, where it was considerably less at $6.67.

Men vs women

Comparing gender, the statistics show that more Australian women had health insurance than men as of 31 December 2016. According to the report, 5,835,238 women held hospital cover compared with only 5,492,274 men, and 6,324,101 women held extras treatment cover compared with only 5,920,939 men.

In South Australia, this was also true, with 407,693 women having hospital cover compared to only 377,924 men, and 499,910 women having extras cover compared to only 458,466 men.

Hospital vs extras treatment cover

The APRA statistics also revealed that more Australians have extras cover than hospital cover (55.4% extras vs 46.6% hospital), although rates are still fairly healthy for both.

This is also the case in South Australia, where 59.5% of people have extras cover compared with only 45.9% of people with hospital cover.

Who has health cover in SA?

Those with health cover can be broken down further into age groups as follows:

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

This age distribution is consistent across all states and territories including South Australia, with the stand-out aspect being an under-representation in younger age categories such as the 25 to 29 age group.

How have cover levels changed over time?

When you compare the 2016 report with the 2015 report, you can find the following information:

  • The number of people with hospital cover has reduced slightly from 47.2% as of 31 December 2015 to 46.6% as of 31 December 2016.
  • There is a noticeable age difference in claim rates for hospital benefits, with older age groups making claims more often than younger age groups, while extras benefit claim rates remain more evenly spread amongst the age groups.
  • While South Australia’s health fund membership is around the national average, Western Australia and the ACT have much higher participation rates (54.7% hospital and 68.2% extras in WA and 57.7% hospital and 68.4% extras in the ACT).
  • Health Insurance Business premium revenue has risen by 5.5% since 31 December 2015 and total fund benefits have increased by 5.1%.

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