What percent of your premiums are you getting back from your health fund?

Posted: 20 April 2018 7:12 am

See which health insurers return the most on average to their members.

Deciding which health fund is right for you is difficult. There is so much choice, so many cover options, opinions, ad campaigns and myriad metrics that it can be enough to make you want to pull your hair out.

Each year the Private Health Insurance Ombudsman (PHIO) releases its State of the Health Funds Report, which looks at a range of metrics including complaints, member retention and benefits paid as a percentage of contribution. While these figures on their own can't provide a picture about whether or not a health fund is right for you, it can help you assess the pros and cons of a fund you are looking at.

Benefits paid as a percentage of contribution metric looks at the premiums paid by its members and the percent that it paid to its members in the form of benefits. While looking for the fund that returns the most to its members may seem like the easy way to choose a fund, it's actually more nuanced than that.

"A very high percentage of contributions returned as benefits may not necessarily be a positive factor for consumers, particularly if it means that the fund is making a loss on its health insurance business. This indicator should therefore be considered in conjunction with other factors, such as the Surplus (-loss) and Management Expenses ratings," the PHIO report read.

Take the fund CDH for example. While it returned 99.2% of contributions, the fund saw a surplus (-loss) of -10.8%. Whereas, Onemedifund only returned 77.2% to its members, its surplus (-loss) was 14.9%.

Benefits as % contributions 2016-17

FundBenefits as % contributions
ACA (Restricted)83.6%
Australian Unity82.4%
CBHS (Restricted)91.2%
CUA Health85.2%
Defence Health (Restricted)97.2%
Doctors' Health (Restricted)82.9%
GU Corporate80.4%
Health Partners91.7%
Navy Health (Restricted)92.6%
Police Health (Restricted)90.3%
Reserve Bank (Restricted)83.5%
RT Health Fund (Restricted)84.3%
Teachers Health (Restricted)87.2%
Transport Health85.9%
TUH (Restricted)89.9%

While the benefits as a percent of contributions may not be a great indicator all on its own, it is interesting to see the fluctuations in contributions being returned to members year-on-year.

If you're in the market for a new health fund make sure you've compared all your options before jumping in. Use our comparison engine below to help you find the fund that's right for you.

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