5 Private Health Insurance Hot Tips from iSelect

Many people find health insurance a confusing topic so we have decided to reveal our top 5 hot tips for health insurance. These hot tips should be things you consider when purchasing a policy and they may even save you money!


1. Excess or Co-payments, will you be hit twice?

Excess or Co-payment options vary from Health fund to Health fund. We suggest you be careful of policies that contain an excess and co-payment for hospital admissions. Generally an excess is paid on admission into hospital no matter how long you stay, and co-payments are paid for each day you spend in hospital.

If your policy has an excess and co-payment you could end up paying a lump sum on admission and a further amount for each day you spend in hospital!

2. Making your Limits and Benefits work for you.

Health funds vary in the benefits they pay on ancillary/extras services. Some may offer a % rebate on the total cost of treatment, whilst others may pay a set $ amount. When choosing a health fund, be sure to check the benefits you will receive on the services you use regularly.

Depending on your status (Single/Couple/Family) you should also check the limits for the services you/your family will use.

If you are single or couple a capped limit (a maximum limit that can be claimed for the whole membership) may be the way to go.

For families who use extras regularly, you could consider looking for a policy with per person limits (a maximum that can be claimed by each person on the membership) as these often have no family caps. Please check the policy for details and restrictions.

3. Ambulance cover – will you be covered?

Most funds offer some sort of Ambulance transport cover, but will differ in the amount of cover provided. Some will include Ambulance cover under hospital cover, others under the extras, the main question is does my fund provide Full Ambulance or Emergency Ambulance cover?

  • Full Ambulance cover will give you 100% cover Australia wide for air, land and sea transport.
  • Emergency cover will only rebate the cost of your ambulance if the paramedics classify the call out as an ‘emergency’. If they do not classify it as an emergency, and you only have emergency ambulance cover, you will not be rebated for the cost of the ambulance

4. Avoiding the GAP

One health insurance myth is having Private Health Insurance means that should you be admitted into a private hospital for treatment you will not have any out-of-pocket expenses. This is not always the case. If you are covered for a treatment, your Health fund will cover 25% of the Medicare Scheduled fee whilst Medicare will pay 75%. However, if your doctor/specialist charges above this amount you will in all likelihood incur a GAP.

To help avoid incuring an unexpected GAP you should ask your doctor if they participate in your chosen funds GAP cover and explain all costs prior to being admitted, and then make sure you confirm this with your fund. Also ensure prior to admission that the hospital you are intending on using has an agreement with your fund.

5. To have an excess or not to have an excess, that is the question.

When comparing Health Insurance some people may overlook excess and co-payments, however these play a crucial part of your premium. Whilst having a Nil Excess policy may save you having to pay a lump sum on admission into hospital, your annual contributions will reflect this and generally be HIGHER.

An excess can be an effective way for some people of reducing your premiums, however if you would prefer, some funds offer co-payments (a per day of admission in a private hospital) instead. If you have no admissions in a year, you will not pay the excess or co-payment, and in all likelihood you will have also saved on the cost of your premium.

*Remember, if you choose an excess with a one off payment of $500 or higher for a single ($1000 for couples and families) you may incur the Medicare Levy Surcharge.