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About Private Health Insurance

What is Private Health Insurance?Health Insurance Star Rating

Private health insurance allows the policy owner to be treated in the private hospital system and covers a variety of healthcare options and medical expenses. Australians can choose between hospital and/or extras cover, with some hospital expenses covered such as medical treatments, hospital bills and ambulance costs.

The public health system in Australia is generally covered by the Medicare scheme for most residents, but private health insurance is popular, with almost half of all Australians having hospital cover and more than half of all Australians having extras (or general treatment) cover.

  • Some of the benefits of Hospital Cover include medical expenses such as hospital bills, medical treatments and ambulance costs. Learn about Hospital Cover here.
  • Some of the benefits of Extras Cover include the cost of medical services or complementary treatments such as dental, optical, chiropractic, physiotherapy, and more. Learn about Extras Cover here.

Compare health insurance options using the comparison selector at the top of this page.

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How you can compare health insurance

Comparing private health insurance involves working out what policy factors are important to you. Health insurance has different levels of cover suited to different life stages and needs. For example, you may choose to compare extras cover to cater to your lifestyle or specifically want a policy that covers a pre-existing condition.

  • What level of health insurance do you want?
  • What health insurance life stage are you? (e.g. single, couples, families)
  • Do you want extras cover?
  • Do you or your family have any pre-existing conditions that need cover?
  • What is your budget for premiums and excess?

It’s also important to understand the Medicare Levy Surcharge, Lifetime Health Cover benefits and loading and Health Insurance Rebates that may apply.

Once you know what policy inclusions are important to you, the excess you are comfortable with and the premium price (net of rebate) you can afford, it’s time to compare your options. Canstar can help you compare health insurance providers and make a shortlist of policies that could suit your needs, based on features and price to suit your needs.

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How does Canstar compare health insurance?

It can be tempting to simply choose a cheap health insurance policy and ignore the policy features. But we know there’s so much more to getting good value health insurance than the price.

Canstar has compared tens of thousands of quotes from over 600 eligible health insurance products. Every year, we perform a detailed analysis to help you to choose a health insurance policy that include hospital cover, extras cover, or hospital and extras cover to suit your household needs and budget.

Whether you’re looking for singles health insurance, couples health insurance, student health insurance, family cover or even overseas visitors health insurance, CANSTAR can help.



Written by: TJ Ryan and Tim Smith

These are a general explanation of the meaning of terms used in relation to health insurance.

Policy wording may use different terms and you should read the terms and conditions of the relevant policy to understand the inclusions and exclusions of that policy. You cannot rely on these terms to the part of any policy you may purchase.

Refer to the product disclosure statement and CANSTAR’s FSCG.

Annual Limit: The maximum benefit payable for a particular service within a 12-month period.

Benefit: The dollar amount paid to you by your health fund when you make a claim with your hospital cover or extras cover.

Benefit Limitation Period: Benefit limitation periods are a period of time after taking out your health insurance policy where you will only be able to claim a restricted amount of benefit for nominated conditions. This time period usually commences after standard waiting periods have been served.

Claim: When you request that your health funds contributes to the cost of health services provided by a hospital, doctor, or other healthcare provider. If you have already paid the invoice in full, you can make a claim with your health fund afterwards and they will reimburse you with some or all of the cost via a direct payment such as electronic funds transfer or cheque. If the invoice has not yet been paid, the health fund will pay this invoice in full, and then request that you pay them the balance owing (the difference between the actual bill and the amount the health fund will cover).

Compensation or Damages: Fund benefits are not payable when compensation and/or damages may be claimed from another source, such as Workers’ Compensation, Compulsory Third Party (CTP) car insurance, Common Law, Sports Insurance, Travel Insurance, Litigation, or Crimes Compensation.

Co-payment: An agreed amount paid by the member towards the cost of daily hospitalisation.

Default Benefits: The minimum level of benefits private health insurers must pay, as set down by the Government. These cover claims for treatment provided in public hospitals, non-contracted private hospitals and day surgeries.

Elective Surgery: Surgical treatment of a condition that, according to your doctor, does not require immediate attention. Elective surgery waiting lists are one reason why it’s great having health insurance.

Excess: Much like with a car insurance policy, your health insurance policy charges an excess when you make a claim. It is an amount of money you agree to pay for hospital admission or medical services before you can claim anything back from your health fund. An excess does not apply to extras cover. Learn more about the health insurance excess.

Exclusions: Any medical procedure, treatment, or health service that is not covered by your policy. You cannot make a claim for these items with your health insurance.

Gap: The ‘gap’ is also referred to as ‘out-of-pocket expenses’. A gap occurs when doctors charge more than the amount covered by Medicare, so that the patient is forced to pay what’s left of the medical bill after Medicare and their health fund pay a benefit towards the cost. Learn more about gap payments and gap cover.

Medicare: The public health system by which the government provides free healthcare to Australian residents. It covers public hospital treatment, doctor services, medications, and other medical treatments. It is partly funded by the Medicare Levy on taxable income and the Medicare Levy Surcharge for high income earners. Learn more about what Medicare covers.

Pre-existing condition: An ailment, illness, or health condition is considered to be pre-existing if, in the opinion of a doctor appointed by the health fund, it existed at any time during the 6 months prior to the member joining a hospital cover or upgrading to a higher level of cover. Health funds can impose a maximum 12-month waiting period for hospital treatment for ailments, illnesses, or conditions that are considered to be pre-existing. Learn more about health insurance pre-existing conditions.

Premium: The annual payment or monthly payment (or other regular periodic payment) that a policyholder makes to a health insurance company to pay for having health cover.

Restriction: Some hospital cover policies have procedures that are restricted, meaning they will only pay the Public Hospital Benefit for that procedure. Policyholders would pay a considerable gap fee if they chose to be treated for a restricted procedure.

Waiting periods: The time you need to wait after buying health insurance, before you can start claiming benefits on the policy. Learn more about health insurance waiting periods.

To view the full Health Insurance Glossary of Terms, click here.

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