Choosing a health fund

It is important to understand what you are covered for and what your entitlements are under the policy you have chosen so that you can receive the treatment you want, when you need it.

A strong health insurance sector benefits members through access to care when they need it, and all Australians by easing pressure on public hospital waiting lists.

More than 13.5 million Australians have some kind of private health insurance, with close to two thirds of non-emergency surgery in Australia funded through private health insurance.

When choosing a level of cover, assess your needs and discuss these needs with your health fund so they can help you choose the right cover for you. Transparency is an important part of a health fund’s commitment to its customers, making it easier for Australians to choose their health insurance, through common terminology, clear information and engagement with members. Always contact your preferred insurer if you have specific questions about your insurance needs.

Private health fund premiums may vary in accordance with the cost of health care and the type of cover you have so it’s important to look at your individual health cover requirements.

What health cover do you need?

Before you select an insurer and a level of cover, it’s important to think about your health cover needs. Things to consider before deciding what cover is right for you include:

  • age,
  • relationship status (Single? Couple?, Family on the way?),
  • lifestyle, and
  • budget

Singles: Many funds offer basic cover for singles at lower premiums or extras cover tailored to your specific needs.

Couples: Health funds can offer basic cover or lower level of extras cover to suit your budget. Families can tailor their own policies to meet their specific needs or upgrade to include services such as orthodontics.

Seniors: The older you are the greater your health needs may be, so it’s smart to choose a package that covers the widest range of medical services. This is where comprehensive insurance with extras cover and fewer exclusions is important.

Questions to ask yourself before choosing private health insurance

  • Do you have children or are you thinking of starting a family in the near future?
  • Do you need ambulance cover?
  • Do you want physiotherapy cover for sports injuries etc?
  • Are you happy to pay an excess in exchange for lower premiums?
  • Do you want to use alternative therapies?
  • Will you need dental cover?
  • Do you want a package that will help pay for prescription glasses or contact lenses?

Questions to ask health funds when shopping for a policy

  • Which hospitals have agreements with this fund?
  • Can I choose my own doctor?
  • How long do I have to wait before I’m covered?
  • What will this give me that Medicare won’t?
  • What level of hospital and medical benefits are paid under this cover?
  • What out-of-pocket expenses will I have to pay for?
  • Is ambulance cover included in the hospital cover?
  • Can I take out, say, dental cover for my children and not for my partner and myself?
  • Does the fund offer protection against increases in rates?
  • Do special limits apply to my general treatment cover?

Find a fund

Once you’ve considered the questions above, use our find a fund page to help you find a fund that provides the right cover for you.