Last Updated on 16 March 2021

Guide to Private Health Insurance in New South Wales


Young female hiker looks out over Sydney from the Royal National Park in NSW

Health insurance can be confusing. That’s why we’ve put together this guide to help you navigate the world of health cover for New South Wales residents.

If you’ve ever tried to compare health insurance policies, you’ve probably found it a little overwhelming. Different tiers. Different inclusions. Different costs. There’s even differences between states. 

As Australia’s most populous state, NSW has the most health funds based in that state. So, here’s what you need to know to help you narrow down your search.

Key Points
  • The largest health funds in NSW are Bupa, Medibank, HCF and nib
  • Medicare doesn’t cover ambulance fees in NSW
  • In 2019-2020, around 90% of NSW public patients were admitted for elective surgery within 339 days.

What are the biggest health funds in New South Wales?

Based on market share, the top four providers are:

1. Bupa (24.7% – although they’re part of an international company)

2. Medibank (23.1% – although their head office is based in Melbourne).

3. HCF (19.7%)

4. nib (13.7%)

Larger insurers will generally have a wider network of practitioners and member benefits across all states.

For regional and rural NSW residents it’s worth comparing different size funds who may have specific agreements with hospitals and medical providers in your region. 

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

What are Australia’s top performing help 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)
  • Defence Health (2.1% of complaints versus 1.8% market share)
  • nib (8.1% of complaints versus 9.2% market share)

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

Defence Health also performed well, but as a restricted fund not everyone can join. Of the health funds based in NSW, nib scored the best.

What types of cover can I get in NSW?

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. 

Depending on your income, 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 of Sydney?

Yes, NSW has funds based in regional areas including Westfund in Lithgow and Hunter Health Insurance in Cessnock. 

It’s still worth comparing policies with the bigger players like the Newcastle-based nib to make sure you’re getting a good deal.

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

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 of Sydney. There’s no point having great hospital cover if you have to drive for hours to receive it gap free.

Extras providers are also important. Does the health fund cover 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 ambulance journeys in NSW so take that into account as well.

How much does NSW ambulance cover cost?

NSW emergency ambulance fees start at $401 plus $3.62 per km3, so it’s worth considering ambulance cover as a bare minimum.

In NSW, even a Basic hospital policy will usually include ambulance cover with a one-day waiting period. 

A Basic hospital policy could also help you avoid paying the Medicare Levy Surcharge and Lifetime Health Cover loading.

While a hospital policy may give you better overall value for money, some of the larger health funds also offer ambulance-only insurance for NSW residents.

Are there any rebates for NSW 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 NSW?

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

In 2019-2020, around 90% of NSW public (Medicare) patients were admitted within 339 days. That’s 10% of public patients in NSW who had to wait longer than 339 days for elective surgery**.

How do I find the best health insurance in NSW?

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 a range 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 guide is opinion only, is correct at the time of writing, and should not be taken as medical or financial advice. Check with a financial professional before making any decisions. References below:

*Based on 25,311 customers in 2020.
Commonwealth Ombudsman, 2020 State of the Health Funds Report, March 2021
NSW Ambulance, Accounts and Fees, March 2021
**Australian Institute of Health and Welfare, Elective Surgery, March 2021


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