Research & Insights

Do you need to update your private health insurance?

Get the most out of your cover by making sure your private health insurance is right for you and your life stage. 

Bonnie Bayley
June 2019

Whether it’s a long-term relationship, growing family, a health condition or the kids leaving home, a change in your lifestyle or life stage can change what you need from your private health cover.

Even if your circumstances haven’t changed for a couple of years, your health needs might’ve.   

“It’s a good rule of thumb to review your cover every 2 years,” recommends Caeden Kalen Zaine, business improvement consultant at HCF.

Here are some key times in life when your health insurance might need a review.

You’re now in a long-term relationship

If you’re both on singles policies you may want to consider taking out couples cover. The benefits are less paperwork and access to each other’s information (handy if one of you goes into hospital). Plus, if either of you has lifetime health cover loading, it gets averaged between you.

But if you have different healthcare needs (for example, one of you enjoys using extras and the other doesn’t), sticking to 2 singles policies can be a better option so you can tailor your policy to your individual needs.

“We’d suggest you to come into a branch or call us together, so we can find out what your needs are, and recommend something that will suit you both,” says Zaine.

You’re planning a family

There’s generally a 12-month waiting period for pregnancy and birth-related services on hospital cover and this is usually included in gold policies.

The recent industry changes mean that all private health insurance hospital cover will be ranked into categories: gold, silver, bronze and basic, where gold is the top level of cover. Find out more information about these industry reforms.

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 3 months before falling pregnant.

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

If you want your baby covered from birth, notify your insurer within two months of their arrival.

As your kids grow

As your children move into primary school and become teenagers, their health needs can change too.

“You might find initially that you want to use your cover for things like swimming lessons for a younger child with asthma; then, when they move to secondary school, they might need orthodontics,” explains Zaine.

Health services that may be included in extras cover, such as dental, speech therapy, podiatry, physiotherapy and prescription glasses, are all things to consider, depending on your kids’ needs.

From kids to adult independants

When your children turn 22, they need to be single and studying fulltime to stay on your HCF family policy for no extra cost. If they’re not studying fulltime, they can stay on your policy with Extended Family Cover (this costs an extra 25% on a family’s current premium).

When they turn 25, they’re not eligible to be on an HCF family policy anymore. At this point, get in touch so we can help you, and them, find the right cover.

You’re getting older

Getting older, or retiring, are other milestones that may merit a health insurance review. It’s a good time to think about your changing health needs and priorities, and what you may require down the track.

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

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

You have a health condition

If you’re diagnosed with a health condition, your private hospital insurance could help cover the costs, give you more choice of hospital and doctor 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 waiting period.

But, if you’ve just been diagnosed with a health condition and aren’t eligible for immediate cover, it’s still worth calling your health fund to discuss your needs.

“Even if we can’t cover any initial procedures, we may be able to help with subsequent procedures, and it may be that you need ongoing medical care,” says Zaine.

Waiting periods

Waiting periods must be served before you can claim for a service – and there’s waiting periods for both hospital and extras services.

They apply if you’re a new member or if you rejoin after a break in cover. They may also apply if you’re an existing member and you upgrade your cover. If you’ve upgraded your cover, you’ll only need to serve waiting periods for services you weren’t previously covered for.

If you switch to HCF cover from another fund where you held an equivalent level of cover within 30 days, you won’t have to re-serve any waiting periods (except for hearing aids). 

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 2 months.

To check your cover is right for you, call us on 13 13 34.


We can help you find the right cover for you. Call us on 13 13 34 or visit a branch.

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