Health Partners hospital cover

Find out more about Health Partners' bronze, silver and gold hospital plans, and see if one is right for you.

Health Partners is a members’ health fund for South Australia, operating since 1937. It’s the largest dedicated South Australian health fund with hospital and extras cover, and counts more than 80,000 individuals among its members.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

What hospital cover options are available?

There are several hospital plans available to help you find an affordable balance between cost and cover to suit your needs:

  • Bronze
  • Silver
  • Gold Value, with or without maternity cover
  • Gold
BronzeSilverGold ValueGold
Excess$500$500$500None
No excess for kids
  • no
  • yes
  • yes
  • yes
No excess for accidents
  • yes
  • no
  • no
  • yes
All non-excluded Medicare procedures
  • yes
  • yes
  • yes
  • yes
Tonsil and adenoid removal
  • yes
  • yes
  • yes
  • yes
Appendix removal
  • yes
  • yes
  • yes
  • yes
Wisdom teeth removal
  • yes
  • yes
  • yes
  • yes
Cataract surgery
  • no
  • no
  • yes
  • yes
Cardiac procedures
  • yes
  • yes
  • yes
  • yes
PsychiatricRestrictedRestricted
  • yes
  • yes
RehabilitationRestrictedRestricted
  • yes
  • yes
Accident cover
  • yes
  • yes
  • yes
  • yes
Joint replacements
  • no
Accidents only
  • yes
  • yes
Joint reconstruction
  • yes
  • yes
  • yes
  • yes
Chemotherapy
  • yes
  • yes
  • yes
  • yes
Pregnancy
  • no
  • no
With maternity cover
  • yes
Assisted reproduction
  • no
  • no
With maternity cover
  • yes
Sterilisation reversal
  • yes
  • yes
  • yes
  • yes
Dialysis for chronic kidney failure
  • no
  • no
  • yes
  • yes
Weight loss procedures
  • no
  • no
  • yes
  • yes
Home nursing
  • no
  • no
  • no
  • yes
PBS prescriptions
  • yes
  • yes
  • yes
  • yes
Non-PBS prescriptions
  • no
  • no
  • no
  • yes
Emergency ambulance
  • yes
  • yes
  • yes
  • yes
Non-emergency ambulance
  • no
  • no
  • no
  • yes
Home sleep studies
  • no
  • no
  • no
  • yes
Health coaching
  • no
  • no
  • no
  • no

Why should I consider Health Partners for hospital cover?

Gold level cover is comprehensive, even compared to comprehensive plans from other providers, in that it includes a range of benefits typically found with extras policies and carries no excess, while Gold Value is generally equivalent to many top-level hospital plans with the additional advantage of being able to opt in or out of pregnancy cover to balance cost and cover in a way that works for you.

Some additional “extras type” benefits are also available with other cover levels.

  • Health coaching, available with Gold Value and Gold: Phone-based support program for management of chronic health conditions.
  • Newborn support program, available with Silver and higher: Professional support for pregnancy and early childhood, and access to a range of related services and programs.
  • Home health partner, available with all cover levels: Hospital and rehabilitation services provided in the comfort and privacy of your home, sometimes letting you leave hospital sooner or avoid hospitalisation entirely.
  • Non-emergency ambulance, available with Gold Value and Gold: Cover for medically required ambulance transport for non-emergency situations and when no transport is required, in addition to emergency transport.

Although this health fund is for South Australians, the agreement private hospital network expands all around Australia.

All hospital plans here include the Access Gap Scheme, which lets you eliminate or reduce out-of-pocket expenses with participating providers. The “gap” is the difference between a service provider’s fee and the amount covered by Medicare plus your health insurance. With this you can know ahead of time whether there will be any gap costs, and what they will be.

As an added bonus, Health Partners members can also receive a range of discounts. With only hospital cover you can get:

  • 30% off sunglasses at Health Partners optical centres
  • Discounts on Allianz travel insurance, purchased through Health Partners
  • 20% off stocked oral health products at Health Partners dental centres
  • Other changing discounts, like cheaper cinema tickets, sports store and gym membership discounts, adventure park discounts and more

What limitations and waiting periods should I be aware of?

Some services are restricted, specifically psychiatric and rehabilitation under Bronze and Silver plans, although others may apply as well. For these you are unable to receive full benefits in private hospital and will incur significant out-of-pocket costs. However, when covered under Medicare, you are still covered for these as a private patient in a public hospital.

For surgically implanted prostheses you are not restricted to those available in the Commonwealth Prostheses list, but the maximum benefit payable for unlisted items is $1,500.

For podiatric surgery, from an accredited provider at an agreement hospital or surgery, you are only covered for 85% of the provider’s fee, and are not covered at all for any accommodation or facility fees.

These hospital plans only cover you as an inpatient, when formally admitted to a hospital for either day surgery or overnight stays. If you, for example, came in through the emergency room and were asked to stay overnight for observation, then you will not generally be covered under these plans.

Waiting periods apply as follows:

  • 12 months: Pregnancy, fertility and birth-related services, home nursing, home sleep studies, certain health appliances, all pre-existing conditions except psychiatric, rehabilitation and palliative care.
  • 2 months: All other procedures.
  • None: Accidents, except when related to a pre-existing condition.

How can I pay my premiums?

When joining you can select one of the following options:

  • Direct debit: Automatic bank account or credit card deductions, for a 3% discount on premiums.
  • Account notice: You receive an account notice and can then pay with BPAY, online, over the phone or in person with credit cards.
  • Payroll: Payroll deductions, available only for groups registered with Health Partners.

Premiums can be paid fortnightly (payroll or direct debit only), monthly (direct debit only), quarterly, half-yearly or yearly.

How do I make a claim with Health Partners?

When providers participate in the Access Gap Scheme bills will be sent directly to Health Partners. You will then receive quarterly notices on claims paid and any outstanding amount if any needs to be paid by you.

Otherwise you can send in a claims form, supported by itemised accounts or Medicare statements, to receive reimbursement.

Andrew Munro

Andrew writes for finder.com, comparing products, writing guides and looking for new ways to help people make smart decisions. He's a fan of insurance, business news and cryptocurrency.

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