Putting members’ health before profit

The Australian health system.

How the Australian health system works

Australia has a uniquely mixed public and private health system that provides people with real choice.

Private health care is funded through a combination of private health insurance benefits, the personal contributions of patients and the Government rebate on private health insurance. The Government rebate goes to the policyholder, directly impacting their health insurance premiums.

The private system is designed so that those who can afford it, take personal responsibility for their health through guaranteed fast access to high quality care and doctor of choice.

More than 44 per cent of Australians have private health insurance for hospital cover. As much as 53 per cent have ancillary or extras cover for services such as dental, optical or physiotherapy.

When ranked internationally by the Commonwealth Fund, Australia was found to achieve the best health care outcomes.Health Care System Performance Rankings

Why have private health insurance?

Over 13.5 million Australians benefit from private health insurance cover – a product that provides peace of mind over fast access to the best available health care with doctor of choice.

Having private health insurance means you can take greater control over your own health with fast access to treatment, the freedom to choose your preferred surgeon, and optional coverage for extras like ambulance, dental, optical, physiotherapy, remedial massage or chiropractic treatment.
Public hospital waits can extend well beyond a year for many procedures. So having private health insurance not only means you skip those waits, but also help take pressure off the overstretched public system by freeing up beds for those that need them most.

Having hospital cover also means you could avoid paying both the Medicare Levy Surcharge and Lifetime Health Cover loading, leaving you financially better off than if you didn’t have private cover.

Gold, Silver, Bronze and Basic hospital cover

All hospital insurance policies are classified as Gold, Silver, Bronze or Basic.

What is, and is not, covered in these tiers is based on minimum standard categories of treatment. These standard categories simply represent what hospital treatments are, and are not, covered under each policy. Each standard category—for example, ‘bone, joint and muscle’ category, or ‘heart and vascular system’ category—sets out the hospital treatments that must be covered by your private health insurer. If a policy covers a certain category, then it must cover everything listed in it—not only some things.

To ensure they comply with these new tiers, private health insurers placed their policies into one of these tiers—Gold, Silver, Bronze or Basic. Insurers offer additional coverage above the minimum requirements in Basic Plus (+), Bronze Plus (+) and Silver Plus (+) tiers.