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Ambulance Chasing: How to Get the Best from the Ambulance-Cover Market

Jonathan December 15th, 2014 0 comments
prim-ambulance

Ambulance cover is something most Australians will have to deal with at some point, since treatment and transport by ambulance is not covered by Medicare. And depending on where you live you will at some point in your life be forced to decide whether you need it and how to get covered for it.

Although each state either runs its own ambulance services or contracts to private companies like St. John’s Ambulance, charges and cover for the service vary significantly (see table).

First, here’s the good news. Although ambulance fees charged to the uninsured can be frighteningly expensive (up to $5,000 per trip in some states), ambulance cover can be bought surprisingly cheaply. Depending on the state you live in, you can buy yearly ambulance cover directly from the provider or indirectly through a private health fund for about $100 per family. And that’s before the rebate paid by the government on all health insurance policies.

The Lucky States

As with most aspects of Australian life, geography is everything. If you live in either Queensland or Tasmania, you do not have to think about ambulance cover. State taxpayers pick up the tab for state-run ambulance services for all residents.

That is generous considering the cost of an ambulance ride can climb up to more than $10,000 for some ambulance services. Air ambulance services – a more familiar sight in rural Queensland than most other parts of Australia – cost $5,000 per trip upwards.

The Not So Lucky Six

Residents of the other four states and two territories face a mixed bag of ambulance cover choices and regulations. The good news for pensioners and other government-benefit recipients is that in all six jurisdictions they receive free ambulance transport and services courtesy of the state taxpayer.

The Somewhat Lucky Two

In both New South Wales and the Australian Capital Territory, all health insurance policies must include ambulance cover, funded by a levy. Residents of these two states essentially get ambulance cover automatically whenever they buy their hospital or combined cover. However, you need to check on what each policy allows and excludes.

The Other Four

In Western Australia, South Australia, Victoria and the Northern Territory, the government does not mandate that ambulance cover is included as part of regular private health insurance. So customers who want it must either shop for a policy that includes it, buy it separately or subscribe directly to either the state-run ambulance service or private contractor.

Private Ambulance Cover: The Four Things to Watch For

  1. Emergency Vs. Non-Emergency

    Ambulance services charge more for call outs to emergency vs. non-emergency cases, charging fees ranging from $205 for non-emergency in SA compared to up to $1,690 for an emergency in Victoria.  Air ambulance charges in Victoria start at just over $2000 for fixed-wing aircraft and over $10 000 for helicopter transport.

    Despite this, some private health funds actually charge a co-payment for non-emergency ambulance services while fully covering emergency services. For example, HIF covers 100% of emergency ambulance cover, whereas it requires a co-payment of $50 if the case is deemed non-urgent.

  2. Exclusions

    In nearly all private ambulance policies, some ambulance transport is not covered. For example, policies may exclude ambulance transportation between hospitals and other health-care facilities or from hospital to the patient’s home. Others will also put a cap on how many ambulance visits a policyholder is allowed per year. Most private ambulance policies also have a seven-day waiting period.

  3. Out-of-State Cover

    Whether policyholders are covered when interstate depends on whether there is a reciprocal arrangement between the state the transport occurred in and the state the patient is a resident of. Non-pensioner residents of NSW, for example, are not covered in Queensland and South Australia unless the ambulance ride returns them to NSW, but are covered by reciprocal arrangements with the other states and territories. In NSW, for example, these arrangements mean patients will be charged for 51% of the actual ambulance cost so they will need cover for the remainder as well. Check these arrangements before buying a policy.

  4. Air Ambulance

    Australia’s outback-based air ambulance service is iconic but national symbols don’t come cheaply. Most such services fly patients from remote outback locations to local hospitals, but in recent times the more common usage has been flying patients by helicopter onto rooftop landing pads of major city hospitals.

    Air ambulance charges in NSW for both fixed wing aircraft and helicopters are capped at $5,715 per call-out. In Victoria, smaller in both area and population, the charges can rise to over $2700 per fixed-wing aircraft transport to a hospital and over $17,000 for helicopter transport.

Ambulance Only Cover

Since Medicare doesn’t cover ambulance charges, Australians who rely only on Medicare can buy ambulance-only cover. This is, in effect, a subscription fee to the state-run or state-contracted ambulance service and can be bought purchased directly or through a health fund. In NSW and the ACT ambulance cover must be purchased with all private cover whereas in VIC, WA, SA and the NT it can also be bought directly from the ambulance service itself (see chart 1)

The typical cost of an ambulance-only policy in most Australian states on average is surprisingly cheap – often around $50 per person or $100 per couple. Private ambulance-only cover is priced similarly to the direct subscription fees to the ambulance service.

Table 1: Ambulance Charges By State

Call fee Transport fee per km.
Emergency Non-Emergency Emergency Non-Emergency
NSW $357 $281 $3.22 $1.74
VIC $1146-1690 $309-523 N/A N/A
SA $918 $205 $5.30 $5.30
WA $916 $492 N/A N/A
NT $600-$800 $285 $4 $4
ACT $904 $646 $12 $12

Table 2: Ambulance coverage by Australian state

Full by state? Incl. in private cover? Direct subscription?
NSW If on benefits Yes Not available
VIC If on benefits Depends on fund Available (state)
QLD All residents N/A N/A
SA If on benefits Depends on fund Available (state)
TAS All residents N/A N/A
WA If on benefits Depends on fund Available (St. John’s)
NT If on benefits Depends on fund Available (St. John’s)
ACT If on benefits Yes Not available

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

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