Why should Ihave health cover?

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what private health insurance can do for you

Most of us accept paying for car, home and travel insurance. Even though many of us rarely, if ever, claim on it. But we’re not always so accepting of paying for private health insurance. Why is that?

Here are some questions you may be asking, and the facts around each scenario.

Why should I pay for hospital cover when I can get free treatment through Medicare?

It’s a fair question. No one has to have hospital cover.

But – focusing on government incentives – if you earn more than $90k as a single or $180k as a couple you’ll pay more tax if you don’t have it. This is the Medicare Levy Surcharge.

The surcharge is designed to take the strain off the public system so people on lower incomes (including the most vulnerable members of society) can access the care they need. This two-tier structure stacks up pretty well against health systems in many other countries.

The government also rewards people who take out hospital cover by the time they’re 31 by ensuring they pay the lowest amount for their cover (compared to others on the same level of cover in their home state). This is called Lifetime Health Cover. Getting hospital cover later in life means higher premiums.

There’s also the government rebate. The less you (and your partner if you have couple or family cover) earn, the more the government will contribute towards the cost of your cover. You need to be earning well over the national average to get zero rebate.

Public hospitals provide great care – why should I go private?

You’re not just buying insurance, you’re buying peace of mind. The knowledge that if you need treatment you’ll have a lot more control over your care. Which may not sound that important now, but could matter a lot if you need to go to hospital down the track.


It’s highly likely you’ll be able to have a planned procedure sooner. Possibly a lot sooner. This means you can focus on your recovery, rather than sitting on the public wait-list. Learn more about elective surgery wait times.


You’ll also be able to choose your doctor, which you can’t do as a public patient. This can be empowering during what may be a stressful time in your life. Learn more about choosing a specialist and find one that's part of HCF's No Gap and No Known arrangement, so you can pay less in out-of-pocket costs.   


Other bonuses include being more likely to have a private room while you’re in hospital, and, to be honest, better food.

Aren’t people often left with big out-of-pocket expenses for hospital treatment?

We’ve all heard horror stories like this both in person or through the media.

Unless you choose hospital cover with zero excess (which is an option on some levels of cover), you will have to pay an excess. You’ll choose this amount when you select your cover. There are a few exceptions, including if you have an accident (excludes Accident Only cover). Learn more about choosing an excess.

HCF members can lower or avoid other out-of-pocket costs (known as ‘the gap’) altogether by choosing doctors and hospitals in our network. And there are a lot of both across Australia. 

Learn more about avoiding unexpected doctors’ bills, and a range of hospital procedures

Don’t health funds try to avoid paying claims?

We certainly don’t. If you need a treatment or a service that you’re covered for, we want to pay your claim. That’s what your insurance is for. In fact, in financial year 2017-18, we paid $1.7 billion in hospital claims.

Where some people come unstuck is not being clear on what they’re covered for. So it’s really important to understand what your health cover does and doesn’t include.

Another common source of frustration is a lack of clarity around what health funds can and can’t cover. This is down to government legislation and can be confusing. With a few notable exceptions, health funds in Australia can only cover inpatient hospital treatment. Learn about the difference between inpatient and outpatient

One thing you do need to be aware of is pre-existing conditions. There may be waiting periods for certain treatments if you’re new to private health insurance or have just switched to a higher level of cover. Log in to check your cover

We want you to understand and get the most out of your cover – that’s our job. So call us on 13 13 34visit a branch or email us if you have any questions.

Won’t I pay more for my cover if I claim?

No. Health insurance is community rated in Australia. Legally, health funds aren't allowed to charge you more if you claim.

That means no matter how many times you claim you’ll still pay the same amount as someone else in your state on the same level of cover (aside from any differences because of the government rebate and Lifetime Health Cover loading).

Why should I bother with extras cover?

It depends on your needs and priorities, but most of our members who have hospital cover also have extras. This means they can claim on optical, general and major dental, physio, chirop and more.

For example, we know that HCF members who access our More for Teeth program are less likely to need major dental treatment down the track. Who doesn’t want to avoid major dental work? Taking care of your teeth is critical and is often a lead indicator of your overall health. 

If you wear glasses or contact lenses you’re likely to see value by choosing cover that includes optical.

There are also other benefits to having extras cover that you may not be aware of. Like access to free heart health checks at selected HCF branches, Health Management Programs and more.

In financial year 2017-18, we paid $517 million in extras claims for treatments including dental, optical and physio.

Why is it so hard to compare cover across different health funds?

The government has recognised that this can be challenging. To help you make an informed decision, it introduced new Gold, Silver, Bronze and Basic categories for hospital cover, which will come into effect between April 2019 – April 2020.

This categorisation will make it easier for you to judge what’s right for you and what you want to be covered for.

Why should I choose HCF? 

Find out why

Want to know more?

Have a question we haven’t covered off here? If so, please get in touch. Call 13 13 34, visit a branch or email us – we’re here to help.

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