The Ultimate Guide to Comparing Private Health Insurance in Australia

1. Determine your coverage needs: Consider factors such as the number of family members to be covered, pre-existing conditions, type of care required, etc.
2. Gather information from different insurance providers: Look for providers that offer family health insurance policies and get information on coverage, premium costs, and other details.
3. Compare premium costs: Premiums can vary widely, so compare the monthly or yearly costs of each policy.
4. Compare deductibles and copayments: Deductibles are the amount you pay before insurance kicks in, while copayments are the amount you pay when you receive care. Consider how these costs compare between policies.
5. Look at the provider network: Consider whether the insurance company's network of healthcare providers is adequate for your needs and accessible in your area.
6. Check for additional benefits: Look for policies that offer additional benefits, such as preventive care, wellness programs, or telemedicine services.
7. Read the policy details carefully: It is important to understand the terms, conditions, and limitations of each policy before making a decision.

By considering these factors, you can compare family health insurance policies and choose the one that best fits your needs and budget.

Private health insurance provides financial cover for all or part of the cost of various health-related treatments and services. Depending on the policy, it can provide cover for treatment as a private patient in a public or private hospital, allowing you to choose both your doctor and hospital, at a time that suits you. Additionally, it can provide cover for health services not covered by Medicare (such as physiotherapy, optical, and dental). It functions similarly to other types of insurance, such as home and contents or car insurance, although rather than being risk-based, it’s community-based. This means that everyone is eligible to receive the same base price for the same policy from any single provider, rather than being rated on their individual health concerns. There are two main types of policies you can take out: Hospital Cover and Extras Cover. These can be purchased separately or combined into a single policy with your health provider. One of the biggest benefits of health insurance is choice and flexibility. For example, as a private patient, you’re given the choice of doctor, the choice of agreement hospital or clinic, and you have flexibility over the time of your appointments. In comparison, when you’re treated as a patient in the public system, the appointment times, doctors, and hospitals are typically inflexible, determined by your location and your health concern. Health insurance can also help you avoid long waiting lists for treatments (provided you’ve served the necessary waiting periods) which exist in the public system.

A health insurance waiting period is the period of time at the start of your membership before you can claim some benefits and services of your policy1. The period of time you will wait will depend on the procedure, type of cover (like extras cover or hospital cover), and your health fund.

Let’s say you’re looking to start getting regular dental checkups. You might take out extra cover to help pay for these checkups. But before you can start to claim these benefits, you’ll likely need to wait an average of two months. Now let’s imagine you need a more complicated dental procedure, like braces or a crown. The waiting period for a service like this can usually be at least 12 months.

In Australia, it’s illegal for insurers to charge you a higher premium because you’re more likely to need a procedure2. But if everyone only signed up for private health care when they required a serious treatment, health insurance premiums would go through the roof. To keep costs low for everyone, providers use waiting periods to encourage consumers to purchase private insurance before they actually need it.

Generally, signing up for new coverage or increasing your level of cover will trigger the start of the waiting period for the additional items covered.

The answer will depend on your insurance provider, as well as the type of cover. For hospital cover, the government has set maximum waiting periods that health insurers are allowed to apply to your plan. Let’s take a look at those maximum waiting periods.

These are the maximum waiting periods insurers can ask you to wait before receiving different types of hospital cover.

12 months for pre-existing conditions: defined as conditions, illnesses, and ailments that you’d had signs or symptoms of for the 6 months before your policy started.

12 months for pregnancy cover (obstetrics): to be covered, you must be admitted to the hospital after the 12 months waiting period.

2 months for psychiatric care, rehabilitation, and palliative care, even for a pre-existing condition.

2 months for new conditions and accidents.

Waiting periods for extras cover:

For care that falls under extra covers, like dental care or visits to the physio, waiting periods are decided by health insurance providers. These are some typical waiting periods for extra cover2:

2 months for general dental benefits and physiotherapy

6 months for optical items, like glasses or contact lenses

12 months for major dental procedures, like crowns or bridges

Up to 3 years for some high-cost procedures such as braces and other orthodontics

Some providers will even have no waiting periods for certain treatments, which means you can start using your benefits straight away. For example, some insurers won’t make you wait for treatments like a dental checkup.