Top 10 Private Health Insurance Companies

Published: January 16, 2018

Before you trust a private health fund to protect you and your family from unexpected hospital costs, you need to make sure you know what you’ll be covered for and whether you can afford it in the long-term. Especially now in 2018, when premium hikes are set to increase by another $200.

The best way to determine if a company will put your health first is to compare their offerings and premiums against other top private health insurance companies. After all, you are paying a monthly fee so that you can avoid costly out-of-pocket medical expenses.

Which is why ComparingExpert insist upon a consultant giving you a call and taking you through the options available to you at your current stage of life, so you can make an informed decision and feel comfortable with your choice.

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The private health insurance industry is growing and becoming more competitive. As such they are fine-tuning their products, striving to provide more value to their customers. Another significant change experienced over the past year is in AIA entering the market with their myOwn health insurance policy, adding their highly coveted AIA Vitality as an incentive.

How to find the best health insurance companies

Medicare pays 75% of privately insured in-hospital medical treatments under the Medicare Benefits Schedule (MBS). Your private health insurer must pay at least 25% of the MBS fee. You are then responsible for the remainder of the costs. However, the private health insurance company you choose can pay more than the required 25%.

According to the March 2017 AMA Private Health Insurance Report Card, health insurance companies pay out different amounts for the same hospital procedures, which might leave you with more out-of-pocket expenses.

Meaning, if the medical practitioner that’s treating you is not able to accept the benefit amount set by your chosen private health insurer, you will have to pay the difference between the doctor’s fees and the Medicare rebate, plus the benefit amount paid by your health fund.

The below table shows some of the most common hospital procedures and the difference in benefit amounts paid by insurers (as of January 2016). It’s also important to note that health insurance funds may have different benefit amounts depending on where in Australia you live.

Source: AMA Private Health Insurance Report Card 2016. AMA (Australian Medical Association) assist consumers in buying the most appropriate health insurance products by providing them with relevant information via a yearly report card.
Procedure MBS Fee HBF BUPA (NSW) Medibank nib GMHBA
Cataract Surgery 760.55 1,242.25 1,184.20 1,126.25 114.90 912.80
Tonsils & Adenoids 295.70 522.05 481.30 472.35 442.65 354.85
Coronary Artery Bypass 2,200.00 3,665.20 3,294.35 3,265.15 3,064.80 2,640.00
Uncomplicated Delivery of Baby 693.95 2,150.35 2,057.05 1,886.95 1,550.60 832.74
Hip Replacement 1,317.80 2,146.75 2,094.35 2,000.75 2,013.85 1,581.40
Knee Replacement 1,317.80 2,146.75 2,094.35 2,000.75 2,013.85 1,581.40

You need to be able to offset the high cost of health care in Australia, especially for those services not covered by Medicare. There are a number of private health funds in Australia competing for your business, making it a daunting task to find health insurance that’s right for you.

That’s why it is so important for you to carefully review each individual health insurance company before making your decision.

A checklist of what to look for in a good health insurance company:

  • Annual limits: A limit refers to the cap on how much you can claim each year for specific services and these differ between policies as well as insurers, so make sure that you check these limits for the treatments and services you’re most likely to use.
  • Co-payments: Look at a health fund’s product features to determine if they require you to pay a small daily ‘co-payment’ when hospitalized. Keep in mind that select companies will offer you the opportunity to decrease co-payments in exchange for a higher premium rate or if you want cheaper premiums you can increase the co-payment amount.
  • Health Insurance Reviews: Read what customers are saying about a company to get a feel for how the insurer deals with claims and communicates with its members.
  • Excesses: Check to see if you are required to pay a single, upfront “excess” fee each time that you are hospitalized and what that amount is. Some insurers let you choose your excess, including a zero excess option. Your excess amount will influence your premiums, for example, if you take a zero excess, your premiums will be more expensive. Check your policy terms and conditions.
  • Product offering: While most insurers offer 1. Hospital standalone plans, 2. Extras standalone plans, and 3. Combination policies, their product benefits, features and exclusion are very different. Carefully read through your policy documents and ask a specialist to explain the differences.
  • Premiums: It’s important to compare premiums to see what you can afford and what value such a policy provides. Get quotes from different insurers and compare their prices and offerings.
  • Benefits: Evaluate the kind of added value an insurer offers. For instance, some will give you access to their exclusive wellness programs, discounts on gym membership fees and shopping vouchers or they might waive the excess for hospital admission for children.
  • Waiting periods: It’s very important that you look at the length of time you’ll have to wait before claiming a benefit, for example when you have a pre-existing condition. These periods can range anywhere from two months to three years and differ between insurers.
  • Market share: This is the portion of a market that is owned by a particular company. If a health fund owns more of the market, it means that they have sold more policies, which could mean that more people are trusting that particular health fund.

Top 10 list of health insurance companies in Australia

Our top 10 list is largely based on market share. There are, of course, many other aspects which you should consider before choosing a health fund, including your unique requirements, health insurance reviews, and what the fund offers you, but this list should provide you with a good starting point.

Market share is one of the simplest and most effective ways to determine the best of the best because it shows the exact portion of the Australian market that is owned by a particular brand. If a health fund owns more of the market, it means that they have sold more policies, which generally means that more people are drawn to their offering, trust them, and have decided to remain with them.

The greater the number of policies sold, the more likely it is that the fund is receiving higher profits, which could, in turn, lead to more benefits for its members, like lower premiums and more discounts. This is especially true if the health insurer is “not-for-profit” because they don’t have to pay dividends to any shareholders. Instead, the profits go straight back into the fund to be used for its members.

The top 10 private health insurance companies in Australia:

  1. Medibank: focuses on adding value to its offering. For instance, with their hospital cover, you get access to around-the-clock advice from Medibank nurses through their 24/7 Health Advice Line.
  2. Bupa: offers added value products like Optional Pharmacy Saver, which gives you 20% off at National Pharmacies for beneficial medications, like medication for disease management or chronic conditions.
  3. HCF: benefits include My Health Guardian chronic conditions program, telephone support from registered nurses, access to health coaches, and SMS/email reminders about screenings and GP appointments.
  4. nib: offers a 30-day guarantee to new customers. If you aren’t happy with your cover and you cancel within 30 days without having lodged a claim, all your premiums will be refunded.
  5. HBF: flexi options give you the freedom to update your extras cover depending on your needs. For example, with their Saver Flexi Extras you can choose four services that you’ll use most, and if your needs change, you can change your extras at any time.
  6. Australian Unity: gives you the freedom to mix-and-match from their hospital and extras covers. You can also choose which health provider you want, so long as they are in private practice and recognised by Australian Unity.
  7. Teachers Health: paid 90 cents in benefits for every dollar received in member contributions (2015). They focus on developing new products to provide you with more cover options, like “rehabilitation at home”.
  8. GMHBA: members have access to several benefits, including the Bowel Cancer Risk Identification Program, Chronic Disease Management Program, Best Doctors Network, New Family Program, and their Midwifery Group Practice Program.
  9. Defence Health: provides members discounts on prescription glasses, lenses, and frames with Defence Health’s optical network partners, as well as a 10% transition discount on the first year of your hospital cover or combined hospital and extras cover.
  10. CBHS: gives you access to their Best Doctors network and their health management programs to support you in improving your health and wellbeing.
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Typically, health funds offer hospital cover only, extras cover only, or a combination of the two. Some even allow you to create your own cover by mixing and matching between hospital cover and extras cover. Depending on your health plan, the insurer will pay for some or all the costs associated with hospital treatments and some extras, like dental and optometry.

Top 10 health insurance reviews Australia

Source: AMA Private Health Insurance Report Card (2017)
The Top 10 Market Share Average Premium
Example p/m (Jan 2018)
What They’re Known For
Medibank 27.6% $116.65 Everyday Starter
$500 Excess
Medibank offers a range of hospital and extras policies, including a policy specifically for single parents. You can also get 100% back on yearly dental check-ups and 100% back on optical items.
Bupa 27% $104.55 Active Saver Bupa offers an extensive range of hospital and extras cover options to singles, couples, and families, which are specially designed to suit a variety of life stages and budgets.
HCF 10.3% $155.05 Young Starter
$500 Excess
Their standalone hospital and extras policies are available at different cover levels to suit a variety of needs and budgets. Their package policies are designed for different life stages and events.
nib 8.1% $108.09 Kickstarter
$500 Excess
nib makes health insurance easy to navigate, offering four levels of hospital cover and two levels of extras cover, and they give you six ways to submit your claim so that you can do things your own way.
HBF 8% $92.05 Super Saver Hospital Cover They offer varying levels of cover depending on your needs and are well known for covering kids on their family policies for no extra charge.
Australian Unity 3.1% $105.30 Care ‘n Repair
$500 Excess
With lifestyle packages to help you stay fit and healthy, a 30-day money back guarantee, and no excess for kids, Australian Unity is known for its simple but value-added offering of hospital, extras, and combination policies.
Teachers Health 2.2% $119.80 StarterPak Best known for exclusively offering great value health insurance to those in the education community and their families, Teachers Health prioritises lower premiums and generous benefits.
GMHBA 2.1% $103.20 Frank Starter Bundle You can choose standalone hospital and extras policies, create your own combination, or choose from four readymade packages. They are well known for their family cover, which gives you three different plans to choose from.
Defence Health 1.8% $124.28 Essentials Hospital 200 and Essentials Extras Aimed specifically at people (and their families) with Defence connections. Their offering includes hospital and extras cover to suit everyone from the young and healthy to those who need comprehensive protection.
CBHS 1.4% $107.42 FlexiSaver
$500 Excess
This restricted private health fund offers comprehensive medical protection exclusively to current and former staff of Commonwealth Bank Group and their subsidiaries, including Aussie, Bankwest, Colonial First State, and more.

Frequently Asked Questions

How do health insurance companies work?

Health insurance companies pay a portion of your medical expenses when you become sick or get hurt or to prevent you from becoming sick. In exchange, you the policy holder pay a monthly premium, which goes into a collective pool. The company then uses the money from the pool to pay the portion of your expenses for which you have cover.

Can health insurance companies exclude pre-existing conditions?

No, health insurance companies cannot exclude pre-existing conditions, because the Australian Federal Government prohibits it. Private health insurers may not refuse to let you buy health cover or even to charge you a higher premium because you have a pre-existing condition, like asthma, cancer, or diabetes. They do, however, have strict waiting periods associated with pre-existing conditions.

Health insurance companies for international students

Health insurance for international students is provided for by the Overseas Student Health Cover (OSHC) and is part of their Visa requirements for the duration of their studies in Australia. It helps international students meet the costs of medical and hospital care that they may need while in Australia. Several private health insurers offer OSHC, including Medibank, nib, and Bupa.

It pays to shop around, so take a few minutes to make sure that you’re getting real value for money. Use our comparison tool to review costs, waiting periods, exclusions, benefits, and much more. It’s simple, quick, and all the hard work has already been done for you!

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Ask an Expert?

19 Comments

  • Marie |

    I am an 83-year-old currently paying over 3,000.00 dollars a year and only getting roughly 200.00 back on glasses and more or less the same with the dentist. I think that this is outrageous as this is the only claims I have had in the last 3 years.

    I have been in this particular medical scheme since 1973 and I have decided that I am going to drop the fund now, especially as premiums are going up again.

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Marie,

      I can understand your frustration and I sympathise.

      I suggest you start comparing private health insurance policies that are specifically tailored toward people over the age of 80.

      More information regarding the best health insurance for seniors over 80 can be found here>>

      In the meantime, you might want a health insurance consultant to give you a call and take you through all your options so that you can feel confident in choosing a policy that suits your current lifestyle and budget. Simply provide your details in the quote form above to get started.

  • Gordon BINDER |

    My 48-year-old daughter suffers from Narcolepsy and has severe anxiety attacks. She does NOT leave the house due to her anxiety.

    I am a widower, aged 77 years, I do ALL the shopping for food. She requires the help of a psychiatrist for her condition, I am prepared to pay for this specialized service.

    Can you please advise me on which medical provider you would recommend?

    Please reply to this request as soon as possible, thank you.

  • Praj |

    My wife is pregnant and we are covered under Medicare. Is it better to take out private insurance and if so which is good and why. Please advice. Thanks

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Praj,
      Thanks for your comment and congratulations!
      Let me start by saying that private health insurance funds generally adhere to a strict 12-month waiting period for pregnancy services, which means you would only be able to access the benefits, like medicines and pre-natal classes, after the birth of your baby, which would obviously not make sense.

      It’s most beneficial to purchase private health insurance 3 months before planning to become pregnant.

      However, you might want to consider purchasing family health insurance. Children can generally remain on your family policy until they are 18 years old, which might help a lot if they need braces, glasses, their tonsils removed or cover for emergency situations.

  • Aisha |

    Hi.

    I am an overseas employee and have been offered a job in Cairns. The employer however is not providing health coverage. I need a basic single health coverage for at least 4 years. I need to know the total yearly cost for this and what is the best option you provide.

    Thanks

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Aisha,

      Thanks for reaching out. You might want to start your search for a 4 year stay by looking at purchasing a working visa health insurance policy type. International workers living in Australia must have private health insurance, because you will not be able to access our public health system.

      There are many private health funds offering such policies, including nib, Frank health insurance, Allianz, Bupa and Medibank.

      Also, you might want to have a look at the private health insurance companies in Queensland.

  • Rody of NZ |

    Hi.
    I’m a New Zealand Citizen and thinking of working in Melbourne, Victoria, Australia. I ‘m 50 years old this November, married and have a 9-year-old son.

    What sort of health insurance should we take?

    I have no existing health conditions. My wife has a cataract operation 3 1/2 years ago and retinal detachment operations nearly 2 years ago on the left eye. Other than that, everything is all good.

    I have checked on the immigration policies and I’m not qualified to apply for permanent residency, more likely because of my age. Can you PLEASE give me an idea of what sort of health insurance we should get?
    Thank you very much.

    Thank you very much.

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Rody,
      Thanks so much for your question.

      Firstly, New Zealand has a Reciprocal Health Care Agreement with Australia, which means you and your family are entitled to free emergency hospital care and you can enrol in our Medicare program.

      Secondly, unlike New Zealand, ambulance services are not covered in most Australian states by public health care. Dental care is also not subsidised by Medicare.

      Private health insurance might be a good option for you, especially with a young child. Please also note that your wife’s pre-existing medical conditions will not prevent you from obtaining private health care. However, she will likely have to wait 12 months before being able to claim benefits associated with her eyes.

      You might want to start your search by comparing the best family health insurance companies in Australia. If you would like a specialist to assist you, please do not hesitate to call 1300 786 328.

  • Sajed |

    Hi there. I have been in Australia for 5 years and have Medicare, but I am looking for a health insurance which covers mega operations, surgeries, specialists and medicines. Can you please advise me on which medical provider you would recommend?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Sajed,
      It sounds like you might be referring to a top private hospital cover policy, which is usually the most comprehensive and expensive cover option. Top hospital cover generally covers a range of services, including major heart surgery, cancer treatments and spinal surgery; all services where Medicare pays a benefit.

      Most private health insurers have a comprehensive hospital cover option. If you would like a quote comparing some of the best health funds available, please fill in the quote form above or for immediate assistance you can call 1300 786 328.

  • Shirley |

    Why isn’t HIF included in your list of not for profit companies?

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Shirley,
      Great question.

      While HIF health insurance is a not for profit company, our list of Top 10 health insurers includes all private health funds in Australia. Our top 10 was determined using the highest market share. HIF’s market share in 2017 was 0.9%, placing them at number 11.

  • Elizabeth |

    Our family is currently paying nearly $300/month for private health cover with extras.

    I recently cancelled a minor gynaecological procedure (that would take approx. 10 mins), due to out of pocket costs totalling $1000! (gap fees totalling $500. Excess for a hospital I knew).

    I figured why are we paying for hospital cover when you still have to pay exorbitant fees? You cannot doctor shop for low fees without actually seeing them first! How do we manage this situation?

  • Linh |

    Which hospital cover is best for oral and maxillofacial surgery?

    • SPECIALIST
      Anneke Van Aswegen |

      Hello Linh.
      For oral and maxillofacial surgery, you might want health insurance for major dental coverage, including wisdom teeth removal, root canal therapy and jaw surgery.

      Take note that hospital only coverage will usually pay for:
      • Hospital accommodation and theatre fees
      • Anaesthetise fees

      However, a hospital only policy does not cover the fees from a surgery specialist. You would need a policy that includes extras coverage to cover the surgeon’s fees. So, you might want to invest in a combined hospital and extras health insurance policy.

      Before you commit to purchasing health insurance, ask your surgeon for all the item numbers (surgery codes) that are included in the surgery you require and ask the private health insurer if they cover the cost of these items and what out-of-pocket expenses you should expect.

      You should also find out your hospital’s preferred health insurance provider because the state you live in might impact on your decision.

      Please remember, you would have to wait 12 months before you can use the private health insurance if surgery is needed for a pre-existing condition.

      If you would like to speak to a specialist to help guide you in the decision-making process, please fill in the form above.

  • James |

    Hi,

    I am looking for a private health insurance which would cover pregnancy related services. The company I am working for has corporate tie up with Bupa. However, I would like to know which would be the most suitable private health insurance for my requirement and also which one provides the better customer care services.

    Thanks.