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Apia Health Insurance Review

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.
Fact Checked

Updated: 22 May 2024

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:

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:

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.

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 option
Rebate
For who?
Apia Essential Hospital
$250 excess – one adult -$182.99 before any rebate or loading.
Single adult
Apia Essential Extras
Two adults – $72.09 before any rebate or loading.
Couple
Apia Premium Extras
Two adults and any dependents
Family
Apia Premium Hospital
$500 excess
Two adults & dependents
Apia Essential and Advanced Extras