How to choose private health insurance

Questions to ask to find the right health insurance policy for you

When choosing a private health insurance policy, it pays to do your research and understand whether a policy will actually serve your needs.

Consider the following questions:

Who do you need cover for?

•  Single – one adult
•  Couple – 2 adults in a relationship, living together
•  Family – 2 adults plus dependants
•  Single Parent – one adult plus dependants
•  Overseas Visitor
•  Overseas Student

Health insurers offer different policies for each of these categories.

A child dependant is a child under the age of 18 who is single and living in your home (or in the home of your co-parent).

Learn more about the types of adult dependants eligible for cover.

What type of cover do you need?

•  Hospital Cover 
•  Extras Cover
•  Combined Hospital and Extras Cover
•  Ambulance Only Cover

Hospital Cover

When you buy Hospital Cover, it does not automatically mean all your expenses are covered if you go to hospital and make a claim.

Generally, the higher your premium, the more benefits you can claim, but this is not always the case.

When deciding on your policy, always balance your needs against your budget.

What are your needs?

There are 38 clinical categories that fall under Hospital Cover.

The Australian government specifies that insurers must offer Hospital Cover policies within 4 levels or tiers:

• Basic
• Bronze
• Silver
• Gold.

The more hospital clinical categories you select, the higher the tier of insurance you require.

For example, if you want most of the clinical categories that fall into Bronze or Silver Cover but also want cover for Assisted Reproductive Services or Pregnancy and Birth, you need to move up a tier and take out Gold Cover, unless an insurer offers a Bronze Plus or Silver Plus product with these inclusions.

Select the clinical categories you need

Restricted cover pays part of the costs of hospital cover.

Unrestricted cover pays all costs of hospital cover, other than any agreed excess or co-payments.

What policy do you need?

Review your selections in the table above and choose your level of cover:

•  Basic
•  Bronze
•  Silver
•  Gold

What is your budget?

Do you want a higher premium or higher excess/co-payment?

Do you want to pay lower premiums and pay an excess or co-payment if you go to hospital?

This may be a good option if you are younger and do not expect to need to go to hospital.

or

Do you want to pay higher premiums and reduce your excess or co-payment?

This may be a good option if you are older and have health issues that make it more likely you will need to go to hospital.

Extras Cover

What are the benefit limits for each treatment?

Before buying Extras Cover, check the benefit limits for specific services on the Private Health Information Statement.

Are benefit limits a fixed dollar amount per year?

Are benefit limits a percentage of the actual cost of the service?

Most often, your insurer lists benefits as a fixed dollar amount for the year.

Occasionally, the benefit is listed as a percentage. This means your insurer gives you a percentage of the actual cost of the service (e.g. 50% on your dental bills).

What are annual limits for each treatment?

Check limits per person and per family for the services you use most, such as Dental, and whether they apply on a calendar year, financial year or policy year basis.

In some policies the family limit is only twice the per-person limit. In other policies, the family limit is 4 times the per-person limit.

Does the Extras Cover policy have lifetime limits?

Does the policy have lifetime limits for some services?

Some health insurers have lifetime limits for services such as Orthodontics.

Does the Extras Cover policy have combined annual limits?

Does the policy have combined annual limits for a range of services?

For example, a $500 limit over a 12-month period for Physiotherapy and Chiropractic. Once you have claimed $500 for Physiotherapy, you cannot claim for the other therapies in that 12-month period.

Does the insurer impose a waiting period on Extras Cover before you can make a claim?

 What waiting periods does the insurer impose for Extras Cover?

Generally, the waiting periods for Extras are:

• 2 months for most services
• 12 months for Major Dental
• 36 months for Hearing Aids.

Use our healthslips.com.au Calculator to find the best Hospital Cover and Extras Cover for you

Unlike other comparison tools, our healthslips.com.au Calculator compares all health insurers and policies.

You can also calculate whether you are entitled to the Private Health Insurance Rebate or the Age-based Discount or will have to pay the Lifetime Health Cover Loading.

Use the Calculator to find the right health insurance for you.