6 Important checklist items to consider while buying health insurance plans


  • Australia has a system of comprehensive public healthcare with all residents reserving the right to healthcare provided by the government-run organisation, Medicare.
  • Apart from covering all public hospital services, Medicare also covers general practitioner visits and almost 85% of the fee for specialists and 75% of the total cost of private hospital services.
  • But there are few services not covered by the Medicare. Therefore, getting a private insurance plan along with the Medicare coverage is what most of the Australians do.


Australia has a comprehensive public healthcare system with the government-run organisation, Medicare, covering all services offered by public hospitals. Medicare also offers a decent level of coverage, involving general practitioner visits and almost 85% of the fee for specialists and 75% of total cost of private hospital services. All Australian citizens reserve the right to access the Medicare scheme.

Services like eye tests, few dental services and part of the cost of prescription drugs are also included in the Medicare. However, few essential services like ambulance are not included in Medicare.

Therefore, getting a private insurance plan, one can supplement the existing Medicare coverage.

Also read: How do Financial Planners Pick the Best Health Insurance for You?

6 Important checklist items to consider

Now, choosing a private health insurance can be a little taxing. But with some research and planning, one can select a cover that works. Here are a few must-see tips to assist you in finding an apt insurance.

  1. Find a policy that you will actually use

Once you have shortlisted the policies, you need to rethink. Ideally, the decision should be based on which policy you will be able to use in future. Australia provides four-tier health insurance categories under private hospital cover, which have made it quite simple for all citizens to get informed about details like which treatments and services are offered by which private hospital insurance policy and also what will not be covered under those.

  1. Find out how much you can claim and when

Every medical policy is subject to waiting periods. This is basically to prevent people from claiming their policies right after signing up and then cancelling before they pay any premiums. Therefore, considering a few points under this section is very important.

  • Time between two and 12 months for maximum additional products
  • 12 months for any pre-existing condition
  • 12 months in case of services related to pregnancy and birth
  • Two months in case of rehabilitation, palliative care, and psychiatric care


  1. Find out discounts and rebates

The Federal government wants you to buy health insurance as it reduces the burden on the public healthcare system if you are getting treated in a private hospital. And to support this, there are numerous attractive plans to help you make up your mind for getting a private coverage. Do not miss plans like ‘private health insurance rebates’ and ‘age-based discounts’ while opting for a policy.

Many people in Australia who go for a hospital cover or extras or combined policy, are entitled to a rebate from the government to help pay for premiums. Furthermore, the rebate is also income tested. It either gets deducted from the premium or as a tax offset when filing tax return. Moreover, Australians aged between 18 and 29 can receive discounts on hospital policy premiums for just taking out the cover when they are younger.

Related Read: Australian Health Insurance Got Expensive in October; How can you save?

  1. Learn how private health insurance can impact tax

Equally, there are various levies enforced on people who do not have proper levels of cover.

For instance, people who do not take out private hospital insurance before 1 July after their 31st birthday will have to pay more for the same when they take it out. Also, people with high income are subjected to pay a surcharge of up to 5% on top of their income tax if they do not hold a valid hospital cover. This is termed as ‘Medicare levy surcharge’ or MLS.

  1. Think about which stage of life you are at when choosing health insurance

There are some questions that you should ask yourself before investing in a private health cover. Things like – ‘any pre-existing condition that may require treatment in near future’, ‘any hereditary health condition that could impact’, ‘any plan to start a family and will you be requiring access to obstetric cover (this cover is subject to 12-month wait)’, ‘is the health insurance needed for spouse or children too?’ among others should be necessarily taken into consideration.

  1. Alter your private health policy to make it more affordable

The facets of a private health policy can often be tweaked in such a way that the premiums can be made more reasonable. For example, if you go for a higher excess (what you agree to pay if you make a claim and are cured in hospital), it will eventually cut down your premiums. As the excess is a fixed amount, it won’t change. Secondly, you should always choose for a co-payment option. A co-payment is what you decide to pay for every day you are admitted in the hospital. Now, if the co-payment is less than what the excess amount would come to be and if you know the approximate time you will have to stay at the hospital, it could be a rather inexpensive option.

Bottom Line

After you have taken out a policy, it does not have to be forever like that. You can and should always keep reassessing it. There are various tools present online to compare healthcare policies.

Secondly, keep your premium payments up to date. Let your health fund know about any changes in your conditions that can affect your cover. This can be even your address. And, always ask the doctor for an estimation of fees before starting to get treated.   

Also Read: Who are Pharmacy Benefit Managers?





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