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Helpful Health Info

Looking for some important information
about Private Health Insurance?

Below you will find some common questions when it comes to understanding private health insurance.
This will help you with setting up health insurance for the first time or start comparing your current level of cover.
What Is Private Health Insurance?

Depending on the policy, private health insurance can help cover the cost of your medical treatments in or out-of-hospital that Medicare sometimes won’t cover. Out of hospital treatment can include services such as Dental, optical, physiotherapy or even remedial massage.

Private health insurance can help cover medical treatment received when hospitalised. Therefore, it is important to select the right level of cover for the clinical categories that are necessary to you.

Your private health insurance should change as often as needed to ensure you are covered at all the different stages of your life.

Also, private health insurance gives you the ability to choose your own doctor and avoid any public waiting lists for categories covered by your policy.

There are many top competing health funds, however you want to find one that is best suited to your individual health requirements and not just a health fund that is the best in the market.

This can sometimes be a difficult task for individuals, therefore companies like Health.Compare can offer comparisons of different health insurance policies to help you choose a policy that is catered to your health circumstances and budget.

While the average cost of private health insurance adds up to $160 per month per person, your premiums may go up or down depending on the type of cover you choose or the excess amount you agree upon.

So, you have private health insurance and want to know how much you might have to pay for medical treatments out of your own pocket? We’ve got you covered with our easy guide FAQ.

What does ‘no gap’ mean when it comes to private health insurance?

Basically, it means that you won’t have to pay anything out of your own pocket for certain medical services, these are covered by your private health insurance. It’s the difference between what your doctor or hospital charges and what Medicare and your private health fund will pay and it’s known as the ‘gap’. With a ‘no gap’ arrangement, your insurance will cover the full cost of the service.

So, I won’t have to pay anything extra?

That’s right! With the ‘no gap’ arrangement, you won’t be left with any unexpected bills to pay. Your private health insurance will cover the full cost of the medical service, so you can focus on your health and recovery.

How does it work?

To be eligible for a ‘no gap’ service, you’ll need to use a provider who is part of your private health insurance provider’s ‘preferred provider’ network. This means that the provider agrees to charge you a set fee for a particular medical service, and your private health insurance will cover this fee in full. This way, you can be sure that you won’t have to pay anything out of your own pocket.

Can I get ‘no gap’ for any medical procedure?

Unfortunately, ‘no gap’ is only available for some medical services, and only if you use a provider who is part of your private health insurance provider’s ‘preferred provider’ network.

Is ‘no gap’ the same as ‘bulk billing’?

No, they’re not the same thing. ‘Bulk billing’ is when medical providers bill Medicare directly for their services, so you don’t have to pay anything out of your own pocket. ‘No gap’ is a service that’s offered by private health insurance providers, and it covers the full cost of certain medical services.

The starting point for many, is to look at your individual needs, preferences and financial circumstances.

We will help guide you through this conversation by first understanding and then matching your needs to a tailored level of cover. Ultimately, what’s best for you and your situation will be completely different to many others who are eligible for Private Health Insurance.

In Australia, health insurance is not tax deductible however you can receive rebates for your private health insurance. When taking out Private Health Insurance you choose whether or not to claim a rebate from the government. The government rebate is dependent on a number of factors including age and taxable income.

This can be applied to Hospital, Extras or combined products.

Health Insurance works differently for everyone. It is designed to be tailored based to your specific needs. As your life stages change, so should your cover. In general, Private Health Insurance works in a number of ways, including;
  • Potentially reducing your tax
  • Avoiding public waiting lists for in-hospital procedures
  • Reducing costs of common extra benefits, like dental & optical
  • Planning for a family
These will be all specific to your individual needs and should be looked at regularly.
This is dependant entirely on the level of cover.
Hospital comes in many forms but classified into 4 main categories;
  • Basic
  • Bronze
  • Silver
  • Gold
Other services covered could be, ambulance, dental and optical to name a few.

The Australian Government provides a rebate on Private Health Insurance depending on your taxable income*. This can help lower the cost of your premium.

Lifetime Health Cover Loading (LHC) can impact your health premium adversely. LHC is an age based penalty based on not holding hospital cover from July 1st following your 30th birthday.

Lastly, Tax. If you earn over a certain threshold ($90,000 as a single or $180,000 as a couple, family or single parent) you could be paying a Medicare Levy Surcharge if you don’t have an appropriate level of hospital cover.

It will! All funds and levels of cover will cover you Australia wide. This is the case for both Hospital and extras.

A waiting period is a time frame you need to wait before making a claim through your private health. Waiting periods come in different forms. These are different for hospital and extras and vary based on the service. As an example, standard waiting periods apply for health insurance, they are;
  • 12 months for any pre-existing conditions, pregnancy and assisted reproductive services
  • 2 months for new conditions, palliative care, rehabilitation and in hospital psychiatric services

Ambulance cover can vary. Some insurers provide cover for all ambulance travel, while others only provide for ground travel or have other limitations – for example, they may cover you in your state of residence only, or they may not cover ‘call out’ fees (when an ambulance treats you at the scene but does not transport you to hospital).

  • Check with your insurer about which type of ambulance cover best suits your needs.
  • Contact your state or territory government for more information on the arrangements that apply in your state.

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