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Tips for buying health insurance

Confused about cover? Handy hints if you’re looking for private health insurance.

Private health insurance gives you the freedom to access the medical treatment you need whenever you need it. If you’re thinking about getting private health insurance, finding the right fund and policy is crucial. We’ve put together this list of health insurance tips to help.

See what's available on the Australian health insurance market

Details Features
High Hospital with $0 / $250/ $500 Excess Options
High Hospital with $0 / $250/ $500 Excess Options
Provides a high level of cover for hospital including pregnancy cover and assisted reproductive services.
  • Cover starting from $36.22 weekly
  • Two month waiting period for wisdom teeth
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
Enquire Now More info
Premier Hospital
Premier Hospital
This top hospital policy covers you for a multitude of services as well as 100% of the cost of hospital accommodation and theatre fees in all HCI agreement hospitals and day surgery facilities.
  • Cover for pregnancy and IVF treatment
  • 100% back on surgically implanted prostheses
  • 100% back on hospital prescriptions
  • Access Gap Cover
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GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
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Top hospital 500
Top hospital 500
Top hospital 500 provides cover for a comprehensive range of services from psych to obstetrics to the removal of tonsils.
  • Spinal fusion
  • Weight loss surgery
  • All joint replacements
  • Rehabilitation
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Mid Hospital with Pregnancy
Mid Hospital with Pregnancy
Mid Hospital with Pregnancy covers you for pregnancy and related services in addition to what the standard Mid Hospital policy covers.
  • Pregnancy and related services
  • Nine month waiting period for pregnancy in public hospital
  • 12 month waiting period for pregnancy in private hospital
  • Day surgeries
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Premium Family Package
Premium Family Package
This is GMHBA's most comprehensive policy and providing a range of benefits including a pregnancy option.
  • Pregnancy and birth related services
  • Assisted reproductive services (IVF)
  • No hospital excess for kids
  • 100% back on optical
Enquire Now More info
Premium Hospital Cover
Premium Hospital Cover
Comprehensive hospital protection with complete cover including pregnancy.
  • No excess for kids
  • No excess for accidents
  • Cover for pregnancy, heart surgery, joint investigations
  • Free access to health and wellbeing programs
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Top Hospital Cover
Top Hospital Cover
NIB's premier Hospital protection with cover for pregnancy and birth services, obesity surgery and all other benefits covered across other policies.
  • $250 / $500 excess
  • Pregnancy and birth services cover
  • Infertility Investigations cover
  • Renal dialysis cover
Enquire Now More info
Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
Enquire Now More info

How to find the right health insurance policy

  • Consider your cover needs. Ask yourself, “What do I need in a health insurance policy?” Do you want basic cover to help minimise your tax bill, mid-level cover for your growing family, or comprehensive cover for an extensive range of health risks? The type of cover you need will be affected by your stage of life and the type of medical expenses you need covered. Once you have a rough idea of what you want in a policy you can start comparing your options.
  • Consider your budget. Cost is always an important factor when choosing a health fund, so work out how much you can afford to pay in premiums each month before going any further.
  • Ask your GP. Your GP will hopefully know your medical history inside out and be able to advise on the important features you should look for in a policy.
  • Compare several policies. Don’t settle for the first policy you come across. Compare cover options from a range of funds to find the one that’s right for you. Look at the covered procedures and treatments, benefit limits, waiting periods and excesses.

Features to look for in a health insurance policy

  • What’s covered. Does the policy cover all the services and treatments you want or need cover for? Make sure you’re aware of exactly which medical and general treatment services are included before you make a final decision.
  • What’s not covered. The list of excluded and restricted procedures in a health insurance policy is a must-read. Basic policies exclude or restrict a number of high-cost treatments. This results in more affordable cover but could also leave you with expensive medical bills if you suffer an unexpected medical condition.
  • How much you can claim. Check the benefit limits on each policy you are comparing to see how much you can claim back each year. While some benefit limits are annual, other funds may have a lifetime benefit limit (the total amount you can claim for one service over a lifetime). If you need a family policy, it’s also worth checking whether the benefit limits listed apply per person or per policy.
  • Waiting periods and excesses. When you first take out a health insurance policy you’ll need to serve a waiting period before you can receive any benefits. These waiting periods vary depending on both the service and the policy you choose, so check the fine print before signing up. It’s also important to understand whether or not you will have to pay an excess or a co-payment if you end up in hospital.
  • Ambulance cover. Medicare doesn’t cover ambulance treatment and transportation in Australia, so you may want to look for a policy that includes ambulance cover. However in some states, such as Queensland, ambulance costs are subsidised by the state government.
  • Gap cover. If you undergo a procedure covered in a private or public hospital, Medicare pays 75% of the Medicare Benefits Schedule (MBS) fee and your health cover takes care of the remaining 25%. However, sometimes your doctor or specialist may charge above this amount – this is known as the gap. To avoid paying the gap out of your own pocket, check out the details of your health fund’s gap cover scheme.

How to save money on health insurance

  • Compare a range of policies. The easiest way to save money when buying health insurance is to compare a number of policies before you buy.
  • Don’t pay for things you don’t need. If you’re young, it’s unlikely you’re going to need a hip replacement anytime soon. By choosing a policy that excludes services you are not likely to use you can save a substantial amount.
  • Choose the right level of cover. The higher your level of cover, the more you will have to pay in premiums. With this in mind, consider whether you really need the ultimate peace of mind offered by high-level cover or if you might be better off with a mid-range policy.
  • Choose a higher excess. If your hospital cover policy includes an excess, the insurer will probably offer you the option of choosing a higher excess. This allows you to pay cheaper health insurance premiums.
  • Review cover regularly. Your lifestyle and personal circumstances are ever-changing, so a policy that was perfect for you 12 months ago may now be inadequate for your needs. At the same time, the competitive nature of Australia’s private health insurance industry means that there are new products and cover features available all the time. Review your policy regularly – once a year is a good idea – to see whether you might be able to find a better deal with another fund.
  • Take advantage of discounts. From multi-policy discounts to single-parent reductions and even cheaper premiums when you pay annually in advance, keep an eye out for any discounts offered by your insurer. These savings can quickly add up and boost your bank balance significantly.
  • Get government help. Private health insurance helps reduce the burden on Australia’s public healthcare system, so the federal government has a range of initiatives in place to encourage taking it out. The Private Health Insurance Rebate entitles you to cheaper premiums, and if you take out cover before your 31st birthday you can avoid paying more for cover due to the Lifetime Health Cover loading.
  • Mix and match. Your hospital cover and extras cover don’t necessarily need to be held with the same health fund. By splitting your policies between health funds you could enjoy substantial monthly savings on premiums.
  • Join a restricted membership fund. Funds that restrict membership to Australians from particular occupations, for example transport employees or teachers, tend to offer cheaper cover than open funds. If you’re eligible to join such a fund, consider the cover options it offers.

Speak with an adviser and compare health insurance quotes

Picture: Shutterstock

Richard Laycock

Richard is the senior insurance writer at finder.com.au and is on a mission to make insurance easier to understand.

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