Apia Health Insurance Review

Published: May 28, 2017

Whether Apia Health Insurance is a good option for you and your family, depends on your specific needs and circumstances. As one of Australia’s top-class insurance companies, Apia caters specifically for what 50 pluses may need, without any unwanted expenses.

Why Apia?

  • Best suited for
  • Tailor your cover
  • Range of options

Hospital cover

  • Dental treatment
  • Cancer Treatment
  • Avoid Excesses

Extras cover

  • Extras options
  • Annual limit
  • Waiting periods

Apia is a subsidiary of Suncorp, Australia’s largest general insurance group, and is known as a health insurer that strives to be the best service provider for people over the age of 50.

ComparingExpert does not currently have access to this provider. Visit www.apia.com.au to request a quote and compare their price and benefits to the Australian private health insurance companies we have access to.

Is Apia Health Insurance a good fund?

Apia health insurance might be a good fund for you if you’re looking for affordable cover and are older than 50. Apia takes care of its older customers, whom might experience more frequent health care needs by drawing on the funds from its growing pool of members younger than 40.

People under the age of 40 generally claim less frequently than people over the age of 50. These funds then balance the funds from the 50 plusses, which usually means they’re also able to afford hospital cover.

Apia hospital cover options

Apia is one Australia’s top health insurance funds for 50 pluses. Specializing in offering cost-effective services, Apia covers what is most important to you without you having to pay for unwanted extras.

Essential Hospital Cover

Apia Essential Hospital Cover the cost-effective, basic cover option.

Premium Hospital Cover

Apia Premium Hospital Cover is the more comprehensive option, covering extras like eye treatment, eye surgery and renal dialysis.

APIA Hospital Benefits

Apia Health Fund helps you afford the best possible treatment. Not only do you avoid public hospital waiting lists, but you are able to afford private hospital benefits. You may decide when you’ll be treated, with the benefit of choosing which specialist or doctor will treat you. Choosing from their Agreed to Private Hospitals you are often able to stay in a private room.

Dental Treatment in hospital

Apia covers all dental treatments approved by the Australian Dental Association. This includes teeth extractions and dental procedures that require a general anaesthetic. The appointed Dental Practitioner must be recognised as a registered dental practitioner under the law of a state or territory.

It is recommended that you obtain a quote before undergoing any major dental treatment. Cosmetic treatments, like teeth whitening, are not covered.

Cancer Treatment in Hospital

Apia covers cancer treatments approved under the Pharmaceutical Benefits Scheme (PBS). Procedures may include surgery, radiation and chemotherapy. However, due to the high cost of drugs routinely requested for the treatment of some cancers, Apia Health Insurance will only cover the portion of costs related to the admission to hospital.

This is because the PBS considers many cancer drugs still to be under clinical trial and therefore experimental treatments. Experimental treatments are excluded from cover. Specialist or other outpatient fees outside of hospital with regards to radiotherapy and chemotherapy are also not covered.

Apia Hospital Excess 

Whenever you make a claim, an excess fee is usually required. However, to avoid these fees becoming a burden to you, Apia hospital policies carry a once-off annual excess payment of either $250 or $500, depending on the option you decide to choose.

As an Apia member, you will need to check whether your policy will cover your procedure, before being admitted to hospital. At this point, you will be given advice on how best to avoid potential out-of-pocket expenses. By going to an Agreement Private Hospital, hospital charges, such as accommodation and theatre fees, are reduced.

If you have already served the required waiting period and your policy fees are up to date, and other conditions for the claims have been met, you will be covered too.

Using your hospital excess

If you’re planning to use an Apia Hospital Excess option, you need to arrange this before being admitted to hospital. Hospital excess is the amount you pay towards the cost of your stay in hospital. This is done before any benefits are paid. The higher your excess, generally the lower your premiums will be.

An excess is only payable once per person per calendar year. While the excess for dependent children under 21 may be waived, an excess will apply should the policy holder, irrespective of the product held.

Also, if you decide to change to a new hospital product with a new policy and higher excess, the higher excess will be payable immediately. However, if the new hospital excess is lower than the previous cover, the previous hospital excess will apply for the duration of the standard hospital waiting period that applies to that benefit.

Out-of-pocket-expenses

Out-of-pocket-expenses are costs for services that your hospital cover does not generally pay for. This means that you are personally liable for these costs. Apia does not pay for:

  • Medical treatments that do not require
  • Investigative procedures and surgeries.
  • Any cosmetic procedures not medically necessary, including dental implants.
  • Luxury rooms, TV hire, phone calls not directly related to your care and treatment.
  • Booking or admission fees charged by specialists or hospitals.
  • Medications already covered by PBS (Pharmaceutical Benefit Scheme).
  • Blood drawing and storage, although necessary blood tests are paid for.
  • Outpatient services performed by a doctor or specialist.
  • Allied health services, for e.g. physio and occupational therapy.
  • Ward drugs and sundry medical supplies, for e.g. bandages and painkillers.

Apia Extras Cover 

Apia Extras cover helps with everyday health services like visits to the dentist or physio or purchasing a new pair of prescription glasses. Extras cover also provides coverage for your older children, up until their age 25. You have 4 Extras Cover Options to choose from:

  1. Apia Essential Extras
  2. Apia Essentials Plus Extra
  3. Apia Advanced Extras
  4. Apia Premium Extras

The first three Extras Cover Options will give you 60% of the cost back annually, according to your limit. Apia Premium Extras provides a 75% cost returned on the annual limit.

Essential Extras

What’s coveredAnnual LimitWaiting Period
Preventative Dental Treatment: Including selected examinations, scale, and cleaning fluoride treatments.No limit2 months
General Dental Treatment: Fillings, basic tooth extractions and x-rays.$6002 months
Major Dental Treatment: Root canal, crowns, bridges, dentures and oral surgery.$60012 months
Optical: Prescription glasses and contact lenses.$2506 months
Physiotherapy$3502 months
Ambulance: Emergency ambulance transport paid at 100% of the cost.No limit1 day

Essential Plus Extras

What’s coveredAnnual LimitWaiting Period
Preventative Dental Treatment: Including selected examinations, scale, and cleaning fluoride treatments.No limit2 months
General Dental Treatment: Fillings, basic tooth extractions and x-rays.$7002 months
Major Dental Treatment: Root canal, crowns, bridges, dentures and oral surgery.$1 30012 months
Optical: Prescription glasses and contact lenses.$3006 months
Physiotherapy$4502 months
Ambulance: Emergency ambulance transport paid at 100% of the cost.No limit1 day

Advanced Extras

What’s coveredAnnual LimitWaiting Period
Chiropractic and Osteopathy$3002 months
Podiatry: Consultations only$2502 months
Pharmaceutical Prescriptions: Benefits only payable for non-PBS items.$30012 months
Healthier Lifestyle Benefit: Approved weight management programs, quitting smoking, first aid, gym, etc.$2506 months
Preventative tests: Thin prep, bone density tests, bowel screening, etc.$2006 months
Hearing Aids$80036 months
Eye therapy$2002 months

Premium Extras

What’s coveredAnnual LimitWaiting Period
Preventative Dental Treatment: Including selected examinations, scale, and cleaning fluoride treatments.No Limit2 months
General Dental Treatment:Fillings, basic tooth extractions and x-rays.$1 0002 months
Major Dental Treatment: Root canal, crowns, bridges, dentures and oral.$1 30012 months
Orthodontia:Starting Limit of $800 and increasing by $100 per calendar year to a lifetime limit of $2 60012 months
Optical: Prescription glasses and contact lenses$3506 months
Physiotherapy$6002 months
Exercise Physiology$3002 months
Chiropractic and Osteopathy$8002 months
Natural therapies: Remedial massage, acupuncture, naturopathy, herbalism, myotherapy, shiatsu.$4002 months
Podiatry: Consultants only$4002 months
Eye therapy$2002 months
Dietary Advice: Consultants only$6002 months
Home nursing services$2002 months
Occupational Therapy$4502 months
Speech therapy$4502 months
Pharmaceutical Prescriptions: Benefits only payable for non-PBS Items.$5002 months
Psychology$2502 months
Hearing Aids & Speech Processors$1 20036 months
Health Aids: Nebuliser, peak flow metre, spacers, surgical stockings, CPAP machine, CPAP parts, pressure garment, walking frame, blood pressure monitor, hip protector, etc.$30012 months
Healthier Lifestyle Benefit: Approved weight management, quitting smoking, first aid, gym, etc.$2506 months
Preventative tests: Thin prep, bone density tests, bowel screening, etc.$2006 months
Ambulance: Emergency ambulance transport paid at 100% of the cost.$80036 months

What is the Australian Government Rebate on Private Health Insurance?

If you are wondering whether Apia is an affordable option, here are some examples of Apia’s cover and costs:

Policy optionRebateFor who?
Apia Essential Hospital$250 excess – one adult -$182.99 before any rebate or loading.Single adult
Apia Essential ExtrasTwo adults - $72.09 before any rebate or loading.Couple
Apia Premium ExtrasTwo adults and any dependentsFamily
Apia Premium Hospital$500 excessTwo adults & dependents
Apia Essential and Advanced ExtrasTwo adults and any dependentsFamily
Apia Essential Plus and Advanced ExtrasTwo adultsCouple
Apia Essential Plus and Advanced Extras$211.15Two adults & any dependents

Each policy can be tailored to add specific types of cover without you having to pay for the extra treatments you’ll never use. In this way, Apia health cover can accommodate pre-existing conditions and other health challenges faced by the elderly.  With reduced hospital costs and low premiums, Apia helps you find quality health care almost anywhere in Australia.

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6 Comments

  • Arthur John Charles Beacroft |

    My loved one passed away and had Apia funeral insurance. Can you tell me if they cover the costs of a headstone plaque?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Arthur,

      My sincere sympathies for your loss.

      Funeral insurance generally pays out a lump sum when a loved one passes away. This lump sum can be used to cover any funeral expenses, including a headstone plaque. The lump sum is dependent on the amount of coverage purchased.

      If your loved one took out a funeral policy through us, please give us a call on 1300 135 2015 and our dedicated claims team will assist you.

      Alternatively, you can contact Apia directly and lodge a funeral claim. You can call them on 1800 608 549. Make sure you have your loved one’s funeral policy number on hand when you make the call.

      All the best.

  • Izzabella Brookes |

    How does Apia compare to Australian Unity for a 65+-year-old?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Izabella,

      When comparing two health funds, it’s important to first know exactly what you want covered. For example, do you want a policy that will cover a wider range of medications and also provide Extras such as hearing aids and osteopathic services or are you looking for a policy that will provide more coverage for possible hip replacements and cardiac surgery OR perhaps you want both Extras and Hospital cover.

      Have a look at what private health insurers generally offer senior Australians. When you’re ready to have a specialist give you a call and guide you through all your options, please fill in the quote form above.

  • maryanne dwyer |

    We have an Apia essential plus cover, it has 100 per cent cover on ambulance. Is that for a trip to Melbourne as well?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Maryanne.

      According to the Apia information booklet, they cover emergency ambulance services that are provided by a state or territory ambulance service, in most circumstances. Ambulance cover will not be provided to residents of Queensland and Tasmania who have ambulance services provided by their state ambulance schemes.