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10 ways to take control of your private health insurance

Blog post | 14 Mar 2018

If you’re one of the 13 million Australians who have private health insurance, you should expect an increase to your premiums on April 1.

Health insurance premiums go up every year on that date, and this year they will rise, on average, by 3.95%. (In other words, some health insurers will raise their premiums by more, and others less.)

Following the increase, a family will pay an average of around $2.75 extra a week, while for a single person the average will be around $1.40 more. 

Although this increase is the lowest in 17 years, it’s almost twice the rate of inflation and wages growth, which is currently under 2%.

The increase comes as the Australian Government’s Private Health Insurance Ombudsman identified a steep rise in complaints about health insurance funds. So, it’s a good time to reassess your private health insurer, if you have one. 

Top tips for handling your health insurance

The Private Health Insurance Ombudsman recommends the following 10 ways to avoid problems when it comes to private health insurance.

  • Review your cover regularly. Over time, you may find that your cover policy changes; check it regularly and know that you can usually switch funds at any time with no waiting period if you’re taking on the same level of cover.
  • Keep up to date with payments. Some insurers won’t pay benefits unless your premiums are up to date.
  • Do read written information from your insurer. You will be notified of changes to your cover, so make sure you read and understand any information you’re sent.
  • Let your fund know of changes to your circumstances. For example, where you live or changes to your family circumstances.
  • Get an estimate of fees before a consultation. Ask your doctor about how much appointments cost, including what is or isn’t covered in gap payments.
  • Contact your fund before treatment in hospital. Ask what is covered by the fund and what will need to be covered by out-of-pocket payments.
  • Know the limits for benefits. Ask your fund about the maximum payments for treatments; some funds have annual limits.
  • Make claims promptly. There may be a time limit for the payment of some benefits; check with your fund to see if there’s a deadline for making claims.
  • Note down any advice your fund gives you. If you contact your insurer for advice on your cover, write down what they tell you – with the time, date and the name of the person you spoke to or a reference number. Better still, ask the person for the advice in writing.
  • If you change funds, make sure you understand the new product. Read all the documents the new insurer gives you, and if there’s anything you don’t understand, call them.

A word on Medicare

Private health insurance can be prohibitively expensive for some people. Luckily, all Australians are automatically covered by public health insurance through the Medicare system, but understanding how Medicare works can be complicated. Learn more about how public health insurance works here

Want help making the switch?

Leaving a fund that’s too expensive, or doesn’t provide the services you need, to join another one can be daunting. Make sure you have all the information you need before you make the decision. There are a range of health insurance comparison sites available online, such as

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