What Is Health Insurance?

19 October 2016
Health insurance is a complex financial product, so we’ve created this guide to help you understand what you need to know.

What is health insurance?

Health insurance is a type of insurance that helps cover the cost of medical and surgical expenses. In Australia, the public health system Medicare, which is a Commonwealth Government funded program, covers most Australian residents for health care. However, Medicare does not cover everything and you can choose to take out a private health insurance policy in order to give yourself a wider range of health care options and more comprehensive cover.

Two types

There are two main types of private health insurance available to you, and they are:

Hospital cover

Hospital policies help cover the cost of the in-hospital treatment by your doctor, and hospital costs such as accommodation to stay in a ward and theatre fees for surgery.
Generally, medical services listed under the Medicare Benefits Schedule (MBS) are covered by private hospital insurance. However, make sure you read the Product Disclosure Statement (PDS) and the terms and conditions of your policy.

Extras cover

Ancillary or extras cover provides benefits for non-medical health services such as dental, optical, physiotherapy, and chiropractic treatment.

You can buy them separately or in a combined Hospital and Extras package policy (with most funds). There will be limitations on what you can claim and when you can claim it (waiting periods) with any policy you buy.

You can view the health insurance options available in the table below. Please note that this table has been sorted by star rating (highest to lowest) and was formulated based on a single male seeking hospital and extras health insurance based in NSW born in 1987:

How to claim on health insurance

Once you’ve received medical treatment or made a purchase covered by your policy, the next step is to make a claim.

With the daily introduction of new technologies, there are now several ways you can lodge a claim. Double check that your health insurance provider before lodging a claim using one of these methods.

  1. On the spot: Around 20,000 Australian specialist medical services providers have the HICAPS electronic claim system available at reception. Just make sure you remember to bring your health fund membership card with you to your appointment so they can process your claim immediately.
  2. Mobile app: Many insurance companies now have a mobile app that you can download for free. Simply take a photo of your receipt using your smartphone, and submit the claim instantly using the app (requires an internet connection via mobile data or WiFi).
  3. Online: Log into your insurance account to make your claim online. Simply enter the details found on your receipt, and have your BSB and bank account number ready so you can register to receive an immediate transfer of the benefit into your bank account.
  4. In person: Many health insurance companies have walk-in branches, where you can make a claim in person. Just don’t forget to bring a copy of your health fund membership card and your receipt for the medical services you are claiming.
  5. By post: If you don’t have easy access to the internet, phone reception, or a branch, you can always fill out a paper claim form. Attach your invoice and receipt from the medical services provider, and post this paperwork to your health fund. Your health fund will then arrange the payment of your benefit, either by bank transfer or by sending you a cheque.

What companies offer health insurance?

The health insurance providers that CANSTAR has assessed for its latest star ratings report are listed below:

You can compare features and price of health insurance policies using our website, to find the right one to suit your needs. CANSTAR regularly researches and rates hundreds of private health insurance policies in an easy-to-use comparison table, so there’s plenty to choose from.

Investigate your health insurance policies options now:

Learn more about Health Insurance

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