Help Center (8am-7pm Mon-Fri) 1300 761 491

Health Insurance by State: NSW

Jonathan August 13th, 2015 0 comments

Throughout Australia, over 12 million people have private health insurance to provide cover for hospital and/or Extras services to pay for things like dental treatment, optical services, and routine care. Nationwide, there are over 30 major insurers vying for business among the millions of people in Australia covered by some kind of private health insurance policy.

Although many insurers operate throughout all of Australia, there are some significant differences in policies and cover among the states. It is important to understand what your own state’s insurance market is like, and to be prepared to learn about other markets if you are moving to a different location. Those in New South Wales, for example, should know the major health funds in the area as well as the differences in average premiums by state and the variations in cover options.

Who are the Biggest Insurers in New South Wales?

Within New South Wales, the largest insurance companies include:

  • HCF, which has 20.2 percent of the market share.
  • BUPA, which has 25.2 percent of the market share.
  • Medibank, which has a 24.5 percent market share.
  • NIB, which has 13.9 percent of the market.

While some health funds do not have as large of the market within New South Wales, they do focus their business almost exclusively on individuals within this state. For example, CHD has a market share of less than 0.5 percent, but over 89 percent of the fund’s membership is within New South Wales.

Choosing larger health funds can sometimes provide benefits to consumers because they may have a larger network of providers in connection with the insurer’s more substantial size and negotiating leverage. However, bigger is not always better. You should shop around among both large and small health funds to determine whose offerings are best for your specific needs.

How Does Market Concentration Vary from State to State?

More insurers and broader competition in the market can help to hold down premiums. New South Wales is the least concentrated of insurance markets across the jurisdictions in Australia but is the most heavily contested market. BUPA and Medibank Private account for almost 50 percent of policies and over 82 percent of the insured have policies with the four largest insurance companies in NSW. By contrast, South Australia and West Australia have the most heavily concentrated markets.

How Does the Cost of Health Insurance in New South Wales Compare?

There are significant variations among insurance policy costs as you move from one state to another. Average premiums for a family package can vary a lot depending on the area you live in.

For a package with both hospital and extras cover, 2015 research from CANSTAR found that the average cost of family cover in NSW was $4178 for a policy excluding obstetrics and $3834 with obstetrics. This was slightly less expensive than many of the other states but was a little higher than WA.

Obviously you cannot move states simply to alter your average health insurance premium costs or to get a better value for your premium dollars. However, you can shop around with health funds in New South Wales in order to find the best deal.

How Does Ambulance Cover Vary?

Health insurers offer different levels of ambulance cover depending upon the state where you live. Bupa, for example, explains that NSW residents who have a concession card in New South Wales or Australian Capital Territory or who have eligible hospital cover with a private health fund are covered for ambulance service within NSW as well as within all states except for South Australia and Queensland. If you don’t have a concession card or eligible hospital cover, you will  need to pay for emergency ambulance services.

How Profitable Are Insurers in New South Wales?

For-profit insurers aim to make money off of policy premiums and to pay out less in claims than they take in. However, profit margins can vary significantly for health funds from state to state. In New South Wales, for example, insurers had a gross profit margin of 9.1 percent for hospital treatments, while they had a 21.0 percent profit margin for general treatments. In Northern Territory, insurers had the highest gross margins for general treatment, with a profit margin of 30.5  percent. Northern Territory insurers also had a profit margin of 26 percent for hospital treatment.

Health funds  should not charge premiums that are significantly higher than the cost of claims, because this can result in consumers overpaying for policies. A very substantial profit margin can also mean insurers are denying lots of claims. When you shop for cover, be sure to check whether the health fund has a good reputation for paying claims made by policyholders.

You want your insurance costs to be affordable while still providing the cover you need. Shop carefully to determine the best deal within New South Wales.

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

Still have questions? Let's talk!

Confused? Not sure if this applies to your situation? Phone us on 1300 643 355 for some free, no obligation advice!

Or want to Compare Health Insurance Policies Now?


This field is required
This field is required
This field is required
Please select lifestage