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Last Updated on 21 November 2019

A Guide to Health Insurance in South Australia


Key Points
  • Recent APRA statistics show that 44.7% of the South Australian population has private hospital cover, and 59.1% has extras cover.
  • There are three main types of cover available in South Australia: hospital cover, extras cover, and ambulance cover.
  • The health funds with the largest market share in South Australia are BUPA, Medibank and Health Partners.

 

Are you a South Australian resident looking for private health insurance? Health insurance is not a one-size-fits-all solution. Just like no two people are the same, every state and territory in Australia is slightly different when it comes to health cover.

Finding health cover that suits you is part of getting the most out of your cover. This is why using a comparison service like Health Insurance Comparison is so beneficial towards making a final decision.

It’s also helpful to know how fellow South Australians are getting their health insurance. In this guide, we’ll go into detail on who has health insurance, the top performing funds, and the types of cover available in South Australia.

Who has private health insurance in South Australia?

The current APRA report from December 2018 shows 44.7% of the South Australian population were covered by hospital treatment cover. That’s approximately 779,203 South Australians.

The total percentage of people in Australia covered by hospital treatment was 44.6%, making South Australia 0.1% above the national average.

Compared to the other states and territories, South Australia scored fourth in the percentage of residents covered, behind Western Australia, the ACT, and New South Wales. Tasmania, Queensland, Victoria and the Northern Territory followed behind South Australia in the percentage of residents covered.

If we break down South Australians by policy, family policies are slightly more common than singles:

  • Family policies 51.9%
  • Single policies 48.9%

Looking at the statistics by gender, 31,443 more females are covered than males:

  • 405,323 females
  • 373,880 males

 

 

 

 

What types of cover can I get in South Australia?

Like most private health insurance cover in Australia, there are three different types of cover available in South Australia.

Hospital Cover, which covers you for treatments and services if you are admitted to a hospital.

Extras Cover, also known as ancillary or general treatment cover, which covers you for non-hospital-related services such as dental and optical.

Ambulance Cover, which covers expenses related to emergency ambulance transportation.

Hospital Cover

Private hospital insurance helps cover some of the additional costs associated with being a private patient at a public or private hospital.

In general, Medicare will cover 75% of the Medicare Benefits Schedule (MBS) fees for private medical services you receive in hospital while private hospital insurance can cover some or all of the remaining 25%.

Here are the key benefits associated with hospital cover (subject to holding the appropriate level of cover):

  • Choose a hospital of your choice from a list of approved hospitals. The right to choose your own doctor
  • Avoid public hospital waiting lists by being admitted to a private hospital
  • Theatre costs covered
  • Accommodation expenses covered
  • Doctors, surgeons, and anaesthetist fees covered

Just like any insurance policy, you can adjust your cover by choosing the level of cover that is most relevant to your needs. The more comprehensive a policy, the higher the premiums. However, you can always shop around to find a better deal.

Your hospital cover may come with limitations, including:

  • Long stay: If you are in hospital for more than 35 consecutive days, you are considered a long stay patient. Unless your doctor certifies your continuing need to acute care, you may be required to pay for the costs of hospital accommodation after the 35 day period.
  • Single vs shared rooms: Some hospital policies cover the full costs of a shared room, but not a private room. If you are admitted to a private room but your policy does not cover the costs, the hospital should inform you if you are required to pay the difference.
  • Non-Medicare covered surgery of hospital treatments: Medicare contributes towards medically necessary services, but does not cover optional treatments such as cosmetic surgery.
  • Exclusions: Some services may be excluded from your policy, so be sure to understand your hospital cover and know what you’re covered for.
  • Restrictions: Some services may come with restrictions and provide limited coverage, making your out-of-pocket expenses larger.

Extras Cover

According to the latest APRA report from December 2018, 59.1% of people in South Australia have extras cover.

Extras cover, otherwise known as ancillary or general treatment cover, provides insurance for non-hospital-related services.

Depending on your policy this may include:

  • Dental treatment
  • Chiropractic treatment
  • Home nursing
  • Podiatry
  • Physiotherapy, occupational therapy, speech and eye therapy
  • Optical treatment
  • Hearing aids

Generally, all services under extras cover come with limitations. Depending on your policy, you may be limited by how often you can claim for a certain service, and by how much you can claim in a period of time.

Ambulance Cover

Medicare does not cover the costs of emergency ambulance transportation.

The costs associated with this service vary by state and territory. South Australian residents who are after ambulance cover have two options;

  • Purchase cover from a private health fund (ambulance cover is often included with most levels of hospital cover)
  • Purchase subscription cover through the state ambulance service.

Top performing funds in South Australia (past and present)

There are 38 different private health funds registered in Australia under the Private Health Insurance Act 2007.

These health funds register themselves as either open or restricted. An open membership is private health cover that’s available for application to the general public.

A restricted membership is only offered to those who are part of a specific professional association, union or employment type. These memberships are sometimes extended to family members of eligible individuals.

Teachers Health, Navy Health, Police Health and Defence Health are all considered restricted membership funds.

Whether you are eligible to join a restricted membership fund or not, it’s important to compare your options before making a decision.

It’s also helpful to know where fellow South Australians are getting their health insurance.

Top Performing Health Funds in SA

According to the latest Ombudsman report, BUPA holds the highest percentage of market share in South Australia with a whopping 50.4%. Looking at BUPA’s market share in Australia (26.9%) compared to their complaints (17.6%), BUPA comes out with a score of 9.3% of customers less likely to complain.

While Medibank comes in second with 21.9% of market shares in South Australia, their staggering amount of national complaints (46.3%) vs. market share (26.9%) suggests Medibank members are more likely to complain than the average of all fund members.

Looking at the top 10 health funds with the largest market shares in SA from 2014 to 2017, the top five market share holders are; BUPA, Medibank, Health Partners, HCF and NIB.
 

 

 

Why get private health insurance in South Australia?

Private health insurance gives you more control over your health care. It gives you expanded choice of services and doctors, can reduce waiting times, cover access to private rooms, and other benefits.

But most importantly, private health insurance gives you peace of mind knowing you are covered if anything were to happen. Even if you are fit and healthy or have no family history of serious illness, you can never be certain when you may need specialist care or services.

If you’re a South Australian resident shopping for great value health care, we can help! Use our comparison tool to get a quick, simple quote on cover in your area.

Disclaimer: The above information is correct and current at the time of publication


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