New South Wales Private Health Insurance

Published: August 23, 2017

As a resident of NSW, you might be investigating the different private Health Insurance options available in your region.

NSW has a large network of hospitals and clinics throughout the region. In fact, there are 84 private hospitals, 210 public hospitals, 500 early childhood centres and 280 community-run health centres.

With such a variety of options available you might want to start by comparing your private health insurance options.

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The cost of NSW Health Insurance

Private health insurance offers you various types of cover options, so you’re able to choose the one most suited to your specific needs and circumstances: Hospital only, Extras only and Combined hospital and extras, as well as Ambulance cover.

  • Hospital Cover allows you to choose your doctor and medical centre, without having to be placed on a waiting list. All doctors’ fees, theatre costs, hospital accommodation, intensive care and medicines are generally covered.
  • Extras cover refers to the day-to-day treatments normally not covered by Medicare, for example general dentistry, glasses and contact lenses, acupuncture, etc.

Health insurance premiums may vary considerably according to the state or territory you live in. Contributing factors that will affect your premium include:

  • Local rules and laws;
  • Cost of doing business;
  • Community Statistics;
  • Level of competition between health funds;
  • Cost of living;
  • Health trends in your area and
  • Demographics in your state

Which companies provide the cheapest health insurance in NSW?

Below table refers to the expected average monthly premium for an adult without dependents, living in New South Wales and seeking a combined hospital and extras cover policy. Please note the premiums were based on the most affordable policy available from each specific health insurer.

Company Health insurance policy Excess amount Average monthly premium Description
HCF Young Starter $250 to $500 $155.05 Receive cover for hospital treatments, accommodation, doctors’ bills and comprehensive Ambulance Cover as a private patient in a private or public hospital, is covered.
Bupa Active Saver $0 $104.55 This is one of the top low-cost health cover packages if you are young and active. Includes private hospital cover and day surgeries for selected commonly treated services.
Teachers Health Insurance Hospital Cover and Basic Extras $300 $115.05 Exclusive to current or former education community of NSW. Members can access discounted dental and optical services from specialist Teachers Health Centres. Receive discounts from Voice Care for Teachers, AOK Health and Jenny Craig are health funds that teachers can access discounts from.
Medibank Everyday Starter $250 to $500 $116.65 to $122.25 Offers unlimited emergency Ambulance services Australia-wide. You get 100% back on optical at all recognised providers.
nib Kickstarter $500 per claim $108.33 Specifically geared toward young and fit. Singles. You can get 60-70% back on a range of services, including optical, dental and physio.
Ahm Black+White Starter $500 $102.65 Your annual flexi limit increases after one year’s membership, rising by $50 per year till it caps at $750.

Exclusions and waiting periods

Exclusions refer to those medical benefits that the health insurer will not pay or reimburse you for. For example, most private health insurers will not cover the costs of plastic and reconstructive surgery. It’s important that you check your policy terms and conditions to know and understand which exclusions may apply to you.

A waiting period is the length of time you have to wait before claiming on a benefit. These periods are dependent on the specific policy you have and the insurance company. General waiting periods usually include:

  • 12 months for treatment related to a pre-existing ailment.
  • 12 months for obstetrics and pregnancy related services.
  • 6 months for optometry.

Examples of waiting periods

Extras treatment nib Bupa GMHBA Medibank
Physiotherapy, chiropractic and osteopathy 2 months 2 months 2 months 2 months
Major dental procedures 12 months 12 months 12 months 12 months
Eye-care (e.g. prescription glasses) 6 months 2 months 6 months 6 months
Certain high-cost procedures(e.g. orthodontics) 12 months 12 months 12 months 12 months

 

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Health Cover for police residing in NSW

Police Health Insurance is a private comprehensive health option run by police for police. Operating for over 80 years on a not-for-profit basis. Eligibility is restricted to:

  • Current employees of a State, Territory or Federal Police Department, Union, Association or Service
  • All employees of SAPOL prior to 2001 are eligible to join.
  • Partners, whether spouse or de facto, former partners, dependent-and-adult children are also eligible.

Police health insurance cover options

Cover optionDescription
Top Hospital
  • Hospital only cover without any exclusions, excesses or co-payments.
  • You can choose when, where and by whom you want to be treated.
SureCover Extras
  • 80% of the cost of the majority of services is covered.
  • Covers all non-hospital paramedical services not covered by Medicare like dental, glasses, contact lenses, physiotherapy and other therapies.
Platinum Health
  • Known as the all-in-one money-saver health package.
  • Combines the benefits of Top Hospital and SureCover Extras, but at a lower contribution rate.
  • 80% of the cost of the majority of services is covered.
Platinum Plus
  • There are no exclusions, excesses or daily co-payments.
  • Provides the same benefits as Platinum Health but suits families with older children.
  • Includes unmarried non-student children from 21 to 25, unless they are in a defacto relationship.

Health insurance levy and rebate

Health insurance can play a significant role in your annual taxable income. By purchasing private health insurance, you reduce the burden on the public health care system and avoid having to pay the 1.5% Medicare Levy Surcharge (MLS) and 2% Lifetime Health Cover loading.

The Australian Government created the private health insurance rebate as an incentive for Australians to purchase private health cover. The percentage of your premiums you get back is based on your taxable income, your age, and how many dependent children you have, but generally you can claim up to 34.579% through either reduced premiums or paying less on your annual income taxes from the ATO.

FAQs about NSW health insurance

No, ambulance cover is not free for people living in NSW. A call-out fee with a per-kilometre-rate is charged. Only pensioners and concession card holders are exempt from having to pay this fee. However, as a NSW resident, you will only be billed for 51% of the actual charge. This is because the NSW government subsidises Ambulance Cover for its residents.

While Medicare alone is a popular choice, many mothers-to-be opt to add private health insurance. Having private health cover ensures that you get a higher standard of medical care which includes the benefits Medicare does not cover only provides restrictive cover. For example:

  • Obstetrician appointments
  • Ultrasounds and blood tests.
  • In-hospital costs like baby delivery and anaesthetics fees.
  • Paediatric and post-natal check-ups (e.g. by a midwife)

This service promotes oral hygiene by offering dental care to NSW residents with a valid Medicare card. Adults issued with a Pensioner Concession Card, Commonwealth Seniors Health Card or Health Care Card are also eligible. All children under the age of 18 are entitled to receive free treatment at NSW public dental clinics.

When taking out private health insurance you protect yourself from any unexpected out-of-pocket-costs. We help you compare the different options available, so you can choose the best cover that suits your unique requirements.

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Ask an Expert?

2 Comments

  • Leonard LoVullo |

    Please contact me in the USA at 71686*****
    Thank you.
    Leonard LoVullo

    • SPECIALIST
      Anneke Van Aswegen |

      Hi Leonard,

      To find the best private health insurance for non-Australian residents visiting from overseas, it is best to contact the companies directly:
      Australian Unity
      GMHBA
      HCF
      Nib
      AHM
      Budget Direct
      MyOwn