What to look for with private health?

My current employer pays for top level Bupa hospital but my new one doesn't.

<30 years of age and earn <$90k.

I'm now looking at basic level/mid level as I never used much of my cover before, just basic things like colonoscopies etc.

I don't know what to look for when it comes to all the different providers, they all just have a tick or a cross next to what they pay.

I'm unsure if Bupa is a good provider or if I can get better value elsewhere.

Looking for some help and guidance on what to look for when taking out private health.

I've looked at providers such as GMHBA and CUA as people seemed to speak highly off them but they're about $100 more than Bupa.



    Look at the extras and see what you need.

    Me it was optical, osteo and physio stuff, so generally look for the best bang for back in terms of limits and weigh it up with the monthly premium.

    Personally i'm with one of the Member Benefit funds - https://phoenixhealthfund.com.au/ Youngsavers plan (combined with my wife). Its basically, basic hospital with mid-tier extras.

    But yeh - see what your needs are.

    If you are just looking at hospital though, just look for whatever really - top tier really gets you all the pregnancy stuff and heart health - so most of the time top hospital isn't really needed.

    Just my two cents.

  • +3 votes

    <30 years of age and earn <$90k.

    Don't waste your money.
    The public system is good enough.

    Private Health is charging you more and giving you less now.
    Even for a Colonoscopy, you have to fork out $500 fee from a Private Health Insurance provider - even with Top Hospital where is may cost $1500 … outright. But then you have the option to pay less at other places
    But also factor the yearly premium is ~ $1800+



      Agreed. At your age if you are in good health it is unlikely you will get any net benefit from your insurance greater than what you are paying. Wait until you earn over $90k so you will have a tax benefit from signing up.

      • +1 vote

        Wait until you earn over $90k so you will have a tax benefit

        More like a rort IMO.

        Get over $90K .. and pay tax otherwise "it's your choice" go to on private health system and spend $2K+ PA on premiums and still pay out of pocket massively when you claim.

        No point to sign up on Basic "junk" plans just to get out of extra tax where you get jack if you ever claim.

        Their PDS is also complicated and clear as mud.



      I'm a huge believer in the public system (I'd actually prefer to pay the money to medicare over paying a private health insurer) but I've had a few procedures this year where if I had to pay out of pocket for it, it would have cost more than PH and the public system wait is 1 - 2 years.

      Most providers ii've found charge about $1200 - $1300 for a plan suitable for what I need. I'm just not sure which provider is better.


    It's all extremely confusing.

    It's bamboozled me so much I don't have any private health insurance coverage so I will rely on the public system with it's long waiting lists for elective surgery.

    In the past 45 years of my life I have never had an elective surgery anyway. I've had plenty of medical emergency visits to the hospital which has been fully covered by Medicare and as the issues I've had have been an emergency there is no waiting list.


      @mysterytal I'm amazed at how confusing it is.

      They give you a basic PDS but it's hard to see which surgeons/specialist their aligned with and how much they pay for items/condtions when looking at hospital cover. For extras it's a bit easier but I know in Bupa case they'd say we give you $600 in physiotherapy but you'd had to find 1 of their physios to use the full amount.


    Have a good look at your family history. Is there anything there that is likely to bite you soon? Also, do you have something that is likely to be expensive like dodgy teeth or play a sport where you are likely to get an injury?

    We had very basic for a long time and it can be useful if you want your own doctor in a public hospital - we ramped up now we are in our 50s and it has been really useful for my other half.


    BUPA is generally a poor value provider.

    You basically want to check that you have coverage for the "most-likely" elective procedures you would need. And that any combined extras are things you can benefit from without having to pay too much for them.

    Check HIF and HCF generally well received funds with fair options when it comes to policies.

    Realistically though at your age/income it is not worth having unless you have sporting injuries etc.


    If you don't have private health cover, can you still undergo surgery as a private patient, and just pay the full amount? Or do some doctors refuse you if you're not covered?


      A few years ago my other half looked at getting an angiogram in a private hospital and paying for the procedure so he could get the refered cardiologist to do the procedure. Although we were willing to pay for the procedure, the problem was that, if something had gone wrong, then they would need to admit him to the private hospital and we would be up for those bills until he could be discharged or transferred. Instead he refered us to a cardiologist who worked in the public system. Nothing went wrong, and we weren't delayed by much time, but it is something to keep in mind.


    What makes health insurance really hard to compare is what you're out of pocket or gap expenses are when you claim.

    I personally found that extras was not worth it and it was better to self insure.


    Please allow me to suggest suppose keep of waiting till the Internet Of Things get popular in the medical devices and its open-source-application of its big data. Lett the data centre A.I. to keep your healthy performance update. It's still a little bit earlier to use, will be very soon, it can start more and more success to stories about such I.O.T. for the personal health.


    You need to make a distinction between the hospital cover and extras cover, as they are very different products. I’ve never believed I could claim back enough of the extras cover to make it worthwhile (i.e. cheaper to self insure for physio, dentist, optical). YMMV.

    While hospital cover rarely covers you for the full cost of a private hospital SURGICAL procedure, it does reduce it to a fraction of the full cost. People who believe they can self-insure for this [usually] don’t realise the true cost of healthcare (since it is generally hidden from us in our pretty awesome single-payer universal public system).

    The main benefits of going private are choice of specialist, and speed of access for anything that isn’t an emergency. Whether this is worthwhile compared to public depends, as waiting times vary HUGELY between different public health services, so it’s hard to make a general recommendation as to whether it’s worthwhile for you.

    I have life and income protection insurance, although neither is cheap, and I am [hopefully] less likely to ever claim on them than health insurance.

    When it comes to providers of hospital insurance, be very clear about what they cover. Some of the biggies no longer cover the gaps for pathology and radiology, which can quickly add up.

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