Last Updated on 12 February 2020

Health Insurance: Victoria

When you shop for health insurance, it is helpful to understand how the market works.  Throughout Australia, there are over 30 health funds providing health insurance to consumers who want broader cover than is offered by Medicare.  Over half of Australians have purchased some type of health insurance and in 2015, this equated to more than 12 million Australians.

Although some health funds offer policies to members throughout the entire country, there may be major differences in insurance markets from state to state. Residents of Victoria should be aware of the market conditions in their home location so they can make informed choices when comparing policies and shopping for cover.

Who Are the Biggest Health Funds in Victoria?

Within Victoria, there are over 20 open membership funds providing health cover, and there are 11 different restricted membership funds.  However, there are only two health funds which have a substantial portion of the market share.  BUPA has 24.3 percent of the local market share within Victoria and Medibank has 35.2 percent of the market share.  HCF, AU, GMHBA, and NIB each have somewhere between 5.7 and 8.1 percent of the market share. All other open membership fund providers have less than one percent of the share of the market.

Big health funds can provide broad and comprehensive cover, but some small health funds have almost all of their business centered within Victoria and may also have large local networks within the state. For example, 85.5 percent of membership for MDF is within Victoria.  You should carefully comparison shop among both large and small health funds in order to determine which cover is best for you.

How Does the Cost of Health Insurance in Victoria Compare?

In Victoria, the 2015 average annual premiums for family cover with obstetrics was $4,366 and $3,988 without it. This was a similar cost to equivalent cover in other states but was towards the upper end of the scale for family cover without obstetrics.

While the costs in Victoria may be higher than for people in some other states, this does not mean individual policies have to be expensive. Shopping around and comparing policies among different insurers can help you to get the best overall deal, so you get the most bang for your buck.

How Does Ambulance Cover Vary?

Ambulance cover varies substantially from state to state. For example, in Queensland, the government provides ambulance cover to residents. QLD residents nationwide can count on the government paying for service. In Victoria, however, cover must be obtained through Ambulance Victoria or through a health fund if you wish to ensure you have your ambulance ride paid for in the event of an emergency.

How Profitable Are Insurers in Victoria?

130603-Competition-in-the-Australian-PHI-market-RP1-1In Victoria, the gross profit margin for hospital treatment is 9.6 percent and the gross profit margin for general treatment is 21 percent according to Competition in the Australian Private Health Insurance Market. Across the state as a whole, the average is 12.3 per cent; compared to an average of 12.4 percent nationally.

While for-profit insurers need to make money, larger profit margins can sometimes mean consumers are being charged too much or insurers are underpaying claims.

When you shop for a health fund, be sure that they have a good reputation for the needs of their members and for paying claims.  By looking for a policy with expansive cover and reasonable premiums, you can have the peace of mind of knowing your family is taken care of whenever health issues arise.


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