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Top 10 Health Insurance Companies in Australia | 2020 Rated 

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Anneke Van Aswegen Updated: 28 May 2020
Types of Health Insurance

With health insurance premiums set to rise again in April 2020 and many health funds reducing their benefits in response to the government reforms, you might be wondering which private health insurance company is the best in Australia; which one can you trust to protect you and your family from unexpected medical expenses?

There is no ‘one best private health fund’ that will satisfy everyone’s requirements all the time. It’s up to you to compare offerings and premiums from the list of health insurance companies available in Australia.

The private health insurance industry is growing and becoming more competitive. We’ve updated our list of the top 10 private health insurance companies in Australia based on 2019 market share.

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2020 Biggest health funds in Australia

Our top 10 list of private health insurance companies is based on market share. Market share shows the competitive position of an insurer by assessing how many Australians enrolled in a particular health fund. When an insurance provider owns more of the market, it usually means they have sold a lot of policies, which might indicate that more people are drawn to their offering, and trust them with their health protection needs.

According to the Australian Prudential Regulation Authority (APRA), the 5 largest health funds in Australia account for over 5 million health insurance policies.

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

Top 10 private health insurance companies in Australia by market share

  1. Medibank: 26.9% market share. Has over 40 years’ experience delivering health insurance to 3.7 million customers via their Medibank and AHM brands.
  2. Bupa: 26.9% market share. The foreign-owned private company entered the Australian market in 2002 and currently serves over 4 million customers in Australia and New Zealand.
  3. HCF: 10.4% market share. A not-for-profit health fund established in 1932, now covering over 1.5 million Australians in 52 locations across the country.
  4. nib: 8.3% market share. Established in 1952, nib is an international health partner serving over 1.5 million customers in Australia and New Zealand.
  5. HBF: 8% market share. A not-for-profit organisation founded in 1941, providing health coverage to more than 1 million members.
  6. Australian Unity: 3% market share. A mutual company owned by its members established over 175 years ago with 194,000 private health insurance policyholders.
  7. Teachers Health: 2.3% market share. A private health fund exclusively for the education community in Australia with over 156,000 members.
  8. GMHBA: 2.3% market share. Since its beginning in 1934, GMHBA has remained a not-for-profit health insurer, now protecting more than 400,000 Australians.
  9. Defence Health: 2% market share. For over 65 years Defence Heath provides coverage to the Australian Defence Force (ADF) and wider defence community, today with more than 131,000 policies provided.
  10. CBHS: 1.5% market share. Since 1951 CBHS protects the health of Commonwealth Bank of Australia’s (CBA group) employees and families, with over 100,000 members today.

Source: AMA Private Health Insurance Report Card 2018

Average premium increases for the 10 largest health funds

Although price isn’t everything, it’s generally is a big deciding factor. Every year, at the start of April, health insurance premiums rise. Below is a reflection of how the top 10 private health insurance companies in Australia compare regarding premium increases in the past 3 years.

Source: Health.gov.au

2020 Private health insurance reviews Australia

When comparing major private health funds, you might also want to consider how satisfied their customers are with their service and how many complaints the health fund receives on an annual basis.

Health Fund Customer Satisfaction All Complaints
Medibank
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66.8% 46.3%
BUPA
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68.3% 17.6%
HCF
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70.2% 9.7%
Nib
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68.3% 6.1%
HBF
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76.6% 4.4%
Australian Unity
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73.7% 4.8%
Teachers Health Fund
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83.4% 1.5%
GMHBA
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71.3% 2%
Defence Health
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82.8% 0.7%
cbhs
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82.1% 0.6%

Source: Roy Morgan Satisfaction Survey December 2017
Source: AMA Private Health Insurance Report Card 2018

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How many health insurance companies are there?

There are 38 private health insurance companies in Australia for you to choose from. However, not all funds are open to the public; some are restricted to specific groups of people, for example, the Teachers Health fund generally only offers cover to Australians in the education community.

Funds open to the public

Funds restricted to specific members

Source: Private Health Insurance Ombudsman

How to choose the best private health insurance

Private health insurance not only helps you avoid the Lifetime Health Cover (loading) and Medicare Levy Loading (MLS), but it’s also an essential purchase if you have a health condition, are thinking about becoming pregnant, have a family, or are getting to an age where more medical assistance is required.

There are many private health funds in Australia competing for your business. However, to find the best health insurance provider to suit your requirements, you need to be clear about the type of plan you need:

Hospital cover

Covers some or all of the costs for treatments received in the hospital. The protection you’ll receive depends on the level of hospital insurance your purchase: Gold, silver, bronze or basic.

Extras cover

Provides a benefit for treatments and services received outside of a hospital, for example, optical, dental and psychology. Depending on your fund, you generally have a choice between comprehensive, mid or basic extras.

Combined cover

Includes both hospital and extras. Many insurers will allow you to tailor cover to suit your requirements.

Take note: You do not have to buy hospital and extras from the same company. Find what works for you, even if that means buying a hospital policy from one insurer and an extras policy from another fund.

policy from one insurer and an extras policy from another fund.

A checklist to help you find the best health insurance for your requirements

Coverage

To determine who offers the best health insurance, you should first decide on the type of coverage you require, for example, a basic hospital policy will most often cover accommodation as a private patient in a public or private hospital but exclude high-cost services like pregnancy.

Benefits

Your chosen health insurance company might use dollar or percentage amounts or both to show how much you can claim for a specific service, for example, $250 per person or 75% of the total costs.

Annual limits

A limit refers to the maximum benefit payable each year for a specific service/treatment. Annual limits differ between funds and policies, so make sure that you review the company’s Standard Information Statement (SIS).

Co-payments or daily excess

In exchange for lower premiums, hospital policies generally have co-payments, also known as an excess, wherein you agree, up front, what amount you’re willing to pay each day you’re in the hospital. Depending on the insurer you’ll typically have the choice of zero, $250 or $500 excess.

Health Insurance Reviews

Read what customers are saying about the company, how satisfied they are with their service and how many complaints the company annually receive.

Exclusions

Carefully review which services and conditions your provider will not pay benefits towards. With the new health insurance reforms where hospital policies must adhere to a simplified classification system; Gold, Silver, Bronze and Basic, your health fund might decide to exclude or include certain benefits.

Premiums

A cheap policy isn’t necessarily a good policy. Make sure first to compare funds that provide the coverage you require and then review their cost. This way you can generally find a good value policy at an affordable price.

Waiting Periods

It’s vital that you look at the length of time you’ll have to wait before you can claim a benefit, for example when you have a pre-existing condition, you generally have to wait 12 months. Waiting periods can range anywhere from 1 day, two months to a year and are different between insurers.

Market share

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.

Be sure to consider this checklist when comparing health funds so you can find the best health policy suited to you and your family’s requirements.

Frequently asked questions

  • Which health insurance company is the best in Australia?

    There is no best health insurer for every person. As the saying goes ‘you can’t please all people all of the time’. Each person and family unit is different, with specific health requirements and budget. The best private health insurance provider for you should be one that you can afford and provides the type and level of coverage you want.
  • How do health insurance companies work?

    In Australia, residents generally have access to free health care, called Medicare. However, to relieve some pressure off the public health system and shorten waiting times, you are encouraged to take out private health insurance, if you don’t, you’ll usually have to pay an LHC loading and MLS fee. In exchange for paying a premium, the private health insurance company pays a portion of your medical expenses.

    Medicare generally pays up to 75% of your medical treatments under the Medicare Benefits Schedule (MBS). Your private health insurance must then 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%.
  • Can health insurance companies exclude pre-existing conditions?

    No, health insurance companies cannot exclude pre-existing conditions, for example, asthma, cancer, or diabetes, because the Australian Federal Government prohibits it. Private health insurers may not refuse to let you buy health coverage or even to charge you a higher premium because you have a pre-existing condition. They can, however, have strict waiting periods associated with pre-existing conditions.
  • How much does health insurance cost in Australia?

    The premium you’ll have to pay for your health insurance policy depends on various factors, including the state you live in, the type of plan you want (hospital, extras or combined), the co-payments you’re willing to make and the level of coverage you require (comprehensive, medium or basic). Remember, premiums rise every year on the 1st of April.

Health Insurance Quotes

  • Reduce out-of-pocket expenses
  • Keep your family healthy
  • Easy and convenient
  • Free to use

Want to talk to a specialist? Call 1300 743 254

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