Last Updated on 31 March 2021

Guide to private health insurance in South Australia


Health insurance can be confusing. Different tiers. Different inclusions. Different costs. There’s even differences between states. 

That’s why we’ve put together this guide to help South Australian residents navigate the world of health cover.

South Australia only has a handful of local health funds, but you still have a great range of national funds to choose from. Here’s what you need to know to help you narrow down your search.

Key Points
  • The South Australian market is dominated by Bupa and Medibank.
  • Medicare doesn’t cover emergency ambulance in SA and the fee is $1,044 plus mileage.
  • SA residents who live outside of Adelaide should check if their local hospital has an agreement with their chosen private health fund.

What are the largest health funds available to SA residents?

Based on market share, the top four providers are::

  • Bupa (46%). Also operates overseas.
  • Medibank (22.3%)
  • HCF (8.5%)
  • Health Partners (7.5%)

Health Partners are South Australia’s only non-restricted fund.

While a larger insurer will generally have a wider network of practitioners and member benefits, it’s worth comparing with smaller providers, especially if you’re based in regional SA. 

Once you determine your specific needs, you’ll be in a good place to weigh up which fund is right for you.

What are South Australia’s top performing health funds?

So, you’ve potentially found a great health policy at a great price that fits your specific needs. 

But you want to make sure you’re also getting good customer service. Here are the health funds that received the least complaints nationwide.

  • HBF (received just 4.0% of complaints versus their 7.3% market share)
  • Medibank (22.8% of complaints versus 26.9% market share)
  • Bupa (21.5% of complaints, versus 25.4% market share)
  • nib (8.1% of complaints versus 9.2% market share)
  • Health Partners (0.7% of complaints versus 0.7% market share)

HBF stands out as a top performer for customer service. That’s not surprising given it has a high retention rate for hospital cover at 86%. Of the big four, Medibank and Bupa also scored well. 

Local South Australian fund Health Partners received an average score.

What types of cover can I get in South Australia?

All health funds offer a range of policies. There’s hospital cover offered as Basic, Bronze, Silver and Gold tiers, based on your specific needs. 

Taking up hospital cover could also help you avoid paying the Medicare Levy Surcharge at tax time. 

The majority of Australians opt for a combined package with hospital cover and extras, which gives you benefits on everyday treatments like dental, optical and chiro. These policies tend to give you the best value.

You can also choose ambulance-only cover to avoid paying a hefty bill in an emergency.

Are there regional health insurers outside Adelaide?

No, but most funds offer health insurance to South Australian residents.

What do I need to consider for health cover in South Australia?

With a wide choice of funds, it helps to start working out the inclusions you need along with your budget. Do you want to see your regular practitioners or are you happy to use the fund’s dental and eyecare centres? Do you want access to reward programs?

Check the fund’s hospital agreement includes your local hospital, particularly if you live outside Adelaide. There’s no point having great hospital cover if you have to drive for hours to receive full coverage for your hospital costs.

Extras providers are also important. Does the health fund provide maximum benefits for treatments at your local dentist or optometrist?

Weigh up the pros and cons of the big names and smaller funds. And make sure you’re not going to get hit with hidden costs or excessive gap fees. 

Medicare doesn’t cover ambulances in South Australia, so take that into account as well.

How much does ambulance cover cost in South Australia?

Emergency ambulance fees in SA come in at $1,044, plus $6.00 per km2, so it’s worth considering ambulance cover. 

In South Australia, even an eligible Basic hospital policy will usually include ambulance cover with a one-day waiting period. It could also help you avoid paying the Medicare Levy Surcharge.

How much does ambulance cover cost in South Australia?

Emergency ambulance fees in SA come in at $1,044, plus $6.00 per km2, so it’s worth considering ambulance cover

In South Australia, even an eligible Basic hospital policy will usually include ambulance cover with a one-day waiting period. It could also help you avoid paying the Medicare Levy Surcharge.

Are there any rebates for South Australian residents?

Yes. From 1 April 2021, rebates for Australians under 65 years range from 8.202% for a single earning $105,001-$140,000 (and couples/families earning $210,001-$280,000), to 24.608% for singles earning $90,000 or less (and couples/families earning $180,000 or less).

How long do I have to wait for elective surgery in South Australia?

It will come as no surprise that COVID-19 has had a big impact on waiting times for elective surgery.

In 2019-20, around 90% of public (Medicare) patients in SA were admitted within 278 days.

How do I find the best health insurance in South Australia?

The best way to find good value health cover is to compare health insurance providers.

Health Insurance Comparison does all the hard work for you by evaluating hundreds of policies from our panel of insurers, taking into account inclusions, benefits, premiums, waiting periods and more. We’ll even take care of the paperwork.


We saved Australians an average of $312 when they compared and switched with us in 2020*
. Why not see how much you can save?

This article is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

References:
Private Health Insurance Ombudsman, 2020 State of The Health Funds Report.
South Australian Ambulance Service, Ambulance Fees.
Australian Institute of Health and Welfare, Elective Surgery Statistics.
Australian Tax Office, Income Thresholds and Rates For The Private Health Insurance Rebate.
*Based on 25,311 customers in 2020.


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