Think you don’t need health insurance? Australians of all ages prove the value of protection

Sydney, 10 July, 2017 – Today, Australia’s largest not-for-profit health fund, HCF, reveals its members claimed over $850 million ($853.3 million) last year from 48,000 high claims for treatment in hospital – defined as any claim worth $7,500 or more.

Surprisingly, HCF members under 50 accounted for a quarter (25%) of all high hospital claims made. They also claimed a fifth (20%) of the total benefits provided for high claims – totalling over $160 million.

While many young Australians are confident in their health and don’t think they need protection from unexpected health issues,1 HCF’s data shows over $19 million in benefits were provided in 2016 for high claims stemming from unpredictable health concerns such as infections, injuries and poisoning that can strike at any age.

Injuries accounted for the majority of high claims derived from unpredictable causes (85%), with members making high claims for everything from fractures and sprains to dislocations requiring surgery. The average fund benefit provided to HCF members for each treatment for unpredictable health issues of this nature was nearly $16,000 ($15,485).

HCF’s Chief Benefits Officer, Cindy Shay, explains ‘‘While infrequent, younger Australians are still at risk for unpredictable medical issues such as sudden illness, disease or injury. What Private Health Insurance is all about is being covered when those unexpected health events like needing surgery arise. It protects people from the sometimes-high cost of care required when one of these events happen, and gives you peace of mind.”

“Despite a common view that health insurance may not deliver as much value when you’re younger, our data reflects that the benefit of health insurance is for all age-groups,” continued Shay.

Hospital cover is the element of health insurance especially beneficial for younger Australians, since members under 30 with high claims spent the highest average amount of days in hospital compared to every other age group – nearly three weeks (16 days). This was due in part to common high claims at these ages for treatments related to giving birth (40% of all high claims from 20-39-year-olds) and mental health (20% of all high claims from 10-19-year-olds). In comparison, Australians aged between 30-79-years-olds only spent an average of 12 days in hospital.

Clearly, the question of investing in health cover is not just a concern for the baby boomers.

Additional data:

  • 26 HCF members under 40 had to get a hip or knee replacement in 2016, with five of the cases from members younger than 30. These 26 cases amounted to a significant half million ($575,823) in benefits.
  • Unsurprisingly, many of the top high claims made in each age group were for surgery (6 of the 10 age groups’ highest claim).

Examples of high claims:

  • One newborn member was hospitalised for more than 70 days after being born prematurely, ultimately needing to claim nearly $200k in benefits for the family.
  • A teenage HCF member spent over 100 days in hospital for dystonia, a neurological movement disorder syndrome, claiming over $130k in benefits. 
  • An HCF member in their twenties spent over a month in hospital for a vascular procedure, claiming over $140k in benefits. 
  • An HCF member in their thirties spent six months in hospital with lung inflammation, claiming over $100k in benefits. 
  • A member in their forties spent more than six months in hospital to treat a fracture of the lumbar spine and pelvis, claiming nearly $200k in benefits.


Notes to editors: The HCF high claims data reflects claims made over $7,500 between 1 January 2016 and 31 December 2016 for hospital treatment.

Issued on behalf of HCF by WE Buchan. Media inquiries to:

About HCF

HCF, largest not-for-profit health fund protecting Australians since 1932, covers over 1.5 million members with health and life insurance, community care, travel and pet insurance. On average over the last five years, HCF has paid out more cents in every dollar in premiums to members as benefits than the industry average. With over 35,000 specialists participating in its Medical Gap Cover Scheme and approximately 10,000 providers participating in its 100% back More for You programs, HCF gives members access to quality health care with no gaps or minimal costs compared to non-participating providers. To empower members to put their health first, HCF also offers a range of health and lifestyle services including its My Health Guardian health management program, mobile Victor Chang Health Checks and My Global Specialist second opinion service. HCF’s national network of retail outlets and Australian-based call centres have earned multi-award winning status. HCF members also have access to low cost, high quality services at HCF Dental Centres and HCF Eyecare Centres. Having contributed $50 million to support the health services research funded by the HCF Research Foundation, HCF is devoted to investing in the future of Australia’s health. To learn more about HCF go to

1 Australian Prudential Regulation Authority. Private Health Insurance Membership and Coverage, March 2017