When to review your health insurance

Updated June 2026 | 5 min read
Expert contributor: Belinda Williams, General Manager, Contact Centre Operations, HCF
Words by Angela Tufvesson

From growing families to evolving health needs, there are key times to review your cover – and update your health insurance to better suit your needs.

Whether it’s a long-term relationship, a growing family, a health condition or a new job, changes in your life can affect what you need from your private health cover.

With the rising cost of living, regularly reviewing your cover allows you to tailor your policy to suit your needs and budget. This can help you avoid paying for services you rarely or no longer use while making sure you’re protected for the treatments you’re more likely to need. This balance can make a real difference in managing out-of-pocket costs and getting better overall value from your cover.

“It’s wise to review your cover every two years, as individual circumstances can change,” recommends Belinda Williams, General Manager, Contact Centre Operations at HCF.

When should you review your policy or consider changing private health insurance?

There are several key moments in life when it’s worth reviewing your private health cover to make sure it still meets your needs.

Your relationship changes

If you’re in a long-term relationship and you’re both on separate policies, you may want to consider taking out couples cover (or family cover if one or both of you already have kids). If either of you has Lifetime Health Cover (LHC) loading, it gets averaged between you both. But if you have different healthcare needs, sticking to two singles policies can be a better option.

If your relationship has ended, you’ll need to separate your cover from your ex-partner and possibly take out a singles policy or single parent cover instead.

You’re planning to have children

There’s a 12-month waiting period for pregnancy and birth-related services until your baby is born for pregnancy and birth-related services on hospital cover, and this is usually included in higher-tier hospital policies.

So, if you’re thinking about having a baby, and want to go to a private hospital, you’ll already need to be on – or upgrade to – a policy that covers pregnancy at least 3 months before falling pregnant.

“The medical cover itself kicks in only at the point you’re admitted to hospital to deliver the baby,” says Belinda. “Private health insurance can’t cover outpatient services like doctors’ visits, ultrasounds or anything that happens outside the delivery.”

You or your family’s health needs change

If you or someone in your family is diagnosed with a health condition, your private health cover could help with the costs, give you more choice of hospitals and doctors and get you treated sooner. Depending on your current hospital cover and new care needs, you might want to upgrade your policy, which could mean serving a 12-month waiting period – particularly for pre-existing conditions, which may not be covered straight away.

Your financial situation changes

If you’ve reached a new income level, it’s important to know that as your salary increases, you may need to pay an extra Medicare Levy Surcharge (on top of the 2% levy you already pay) if you don’t have an appropriate level of private hospital cover. It may be cheaper for you to pay for hospital cover than to pay the extra tax.

You can work out your income for Medicare Levy Surcharge purposes with this income test calculator.

You’re reaching retirement age

Retirement is a milestone in your life that may merit a health cover review. It’s a good time to think about your changing health needs and priorities, and what you may need down the track as you get older.

While your financial circumstances may be shifting – and it can be tempting to reduce or drop cover – it’s important to review your options carefully before making changes, as you may need cover for procedures like joint replacements or other age-related conditions later on.

“When you’re older, you may need things like hip replacement coverage, cataract removal or coverage specific to kidney issues,” says Belinda.

So, it may be worth considering a higher level of hospital cover.

What to consider when reviewing your cover

The level of cover you need

In Australia, private hospital cover falls under one of four tiers:

• Gold
• Silver
• Bronze
• Basic

The tiers reflect the level of cover provided, with Gold offering the most comprehensive cover. The government sets out which treatments and services each category needs to include as a minimum. At HCF, we’ve chosen to cover additional services on most of our hospital products, which is why they include ‘Plus’ in the name.

Examples of what the different tiers of HCF hospital cover include:

• HCF Hospital Optimal Gold: pregnancy and birth, assisted reproductive services including IVF and more. This cover must be taken out with Top Extras cover.
• HCF Hospital Silver Plus: heart and vascular procedures, back, neck and spine procedures and more.
• HCF Hospital Standard Silver Plus: heart and vascular procedures, hearing devices, rehabilitation and more.
• HCF Hospital Bronze Plus: ear, nose and throat, digestive system procedures and more.
• HCF Hospital Basic Plus: gastrointestinal endoscopy, gynaecology, joint reconstructions and more.

Some Silver Plus covers may be more suitable if you’re planning to grow your family or have complex health needs, while Basic cover may be sufficient if you’re younger and relatively healthy – perhaps when you’re getting started with your own cover after coming off your parents’ policy.

Whether to include extras

Extras cover can help you stay on top of your health, giving you access to services like dental check-ups, eye tests and physio appointments, as well as holistic health programs like mental health and weight management support.

HCF’s Choose My Extras allows you to select and swap^* your unused extras services as your needs change, so you only pay for what you intend to use.

With Flex My Extras, spend on the services you’ll actually use with a flexible $650 single limit plus $175 optical limit and $100 remedial massage and myotherapy limit per person, per calendar year^*.

Waiting periods

Waiting periods must be served before you can claim for a service, and there are waiting periods for both hospital and extras services. If you’ve upgraded your cover, you’ll only need to serve waiting periods for services you weren’t previously covered for.

If you have a pre-existing condition, you may have a 12-month waiting period before you’re eligible for any benefits for hospital treatment. But for psychiatric care, rehabilitation and palliative care, you only need to wait two months.

Your budget

Choosing a higher excess can help lower your monthly premiums. A higher excess can be a good option if you don’t expect frequent hospital visits.

FAQs: Changing private health insurance policies

Can you change health insurance mid-policy?

You can switch health insurers at any time that suits you during the year.

Do waiting periods apply when changing private health insurance policies?

If you switch to HCF within 30 days of leaving your previous health fund, you won’t have to re-serve any waiting periods for benefits you were previously covered for.

If you’re switching and upgrading your hospital cover – for example, switching from a Silver policy to a Gold – you’ll need to serve the relevant waiting periods for your higher entitlements.

How does changing your excess affect your policy?

If you choose a product with a lower excess, you will normally have to serve waiting periods before the lower excess applies. Get in touch to discuss your options.

Does switching policies affect your LHC loading?

Transferring between health insurers will not affect your LHC loading entitlements, provided you keep your hospital cover.

How can you change health insurance?

Updating your policy is easy.

1. Compare health insurance options and chat with our team to find the right cover for your needs.
2. We’ll handle the paperwork and waive any waiting periods previously served.
3. Start using your new cover.

What other inclusions should you consider when changing health cover?

HCF health cover offers a range of programs and support to help you stay proactive about your health – and the health of your loved ones.

This includes joint health programs, mental health support and heart health and diabetes programs. HCF also gives eligible members access to digital tools and resources to support your health, like the HCF Healthful app^{^}, which tracks your health and wellbeing in real time, and a 12-month subscription with the Sleepfit app⁺, designed to help improve your sleep.

Plus, the HCF Thank You app^# makes it easy for members to browse and access personalised offers and discounts, earn rewards and track your savings. From big brands to local favourites, you can unlock more ways to benefit from the brands you love, plus you can use your HCF dollars to reduce your premium payments^**.

These are just some of the ways we help you get more value from your cover and support your health and wellbeing every day.

Get in touch

Want to learn more about HCF health cover, update your current policy or become a member? Don’t hesitate to contact us and we can talk through your options. Either chat with us online or call 13 13 34 and speak to our team.