Health.com.au overview

fund-iconOverview

When health.com.au established their “online only” health fund in 2012, they were the first new private health insurer in the Australian market since 1976. In 2015, they were acquired by GMHBA.

Thousands of Australians are currently covered by health.com.au’s hospital and extra policies. Their 24/7 chat function saw them win the ServiceRage Happy Customers Award for two years straight in 2014 and 2015.

fund-iconKey features

  • Age-based‌ ‌discounts‌ ‌on‌ ‌Gold‌ ‌plans‌
  • Hospital‌ ‌plans‌ ‌that‌ ‌are‌ ‌easy‌ ‌to‌ ‌understand‌
  • In‌ ‌the‌ ‌market‌ ‌since‌ ‌1952‌

fund-iconHospital cover

Nobody chooses to go to hospital. But when you do, appropriate hospital cover will help you get the treatment you need, where and when you want it. It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, you could avoid paying the Medicare Levy Surcharge.

Health.com.au offers four hospital policies, ranging from no-frills Entry Hospital cover to comprehensive Core Plus Silver cover.

All hospital policies include:

  • Emergency ambulance transport‌
  • No excess to pay when kids are admitted to hospital
Entry Hospital
(Basic+)

This is health.com.au’s budget option. All covered same day and overnight admissions are limited to public hospital cover. This cover does allow you to avoid the Medicare Levy Surcharge.

Key inclusions:

  • Avoids the Medicare Levy Surcharge
  • All covered services are restricted and you may incur costs in a private room or a private hospital.
Base Hospital
(Bronze +)

The Base Hospital plan covers a range of standard hospital services. It’s available with a co-payment, a $500 excess or $750 excess.

Key inclusions:

  • Dental surgery
  • Joint reconstructions
  • Digestive system
  • Gynaecology
Bronze Plus Essential Hospital

This plan provides Bronze cover with a few added items that aren’t in the Base Hospital plan. It’s available with a $500 or $750 excess.

Key inclusions:

  • Lungs and chest
  • Pain management
  • Chemotherapy, radiotherapy and immunotherapy
  • Kidney and bladder
Core Plus

Health.com.au’s Core Hospital cover is their most expensive hospital cover. It’s a Silver Plus policy and doesn’t cover pregnancy services or weight loss. If you want top tier Gold cover with these items included, you’ll need to compare other insurers.

Key inclusions:

  • Joint replacements
  • Sleep studies
  • Cataracts
  • Palliative care

fund-iconAmbulance cover

Every health.com.au policy includes emergency ambulance cover, meaning you are covered when you could not have been transported to hospital any other way.

You may also receive additional cover depending on which state or territory you live in. For example, in NSW and the ACT you are covered for all ambulance services, whilst in VIC, SA, WA and the NT, you are only automatically covered for emergency ambulance transport.

Read our ambulance cover guide for a state-by-state breakdown of how ambulance services work across Australia.

fund-iconExtras cover

extras-coverExtras reset

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments that aren’t covered by Medicare.

While we’ve summarised the key points of each plan below, it’s always worth digging a little deeper into any gap fees, how much you can claim back, and whether your preferred healthcare provider, such as your local dentist, is recognised by the health fund.

Take the time to work‌ ‌out‌ ‌what‌ ‌you‌ ‌need‌‌ and what you’re prepared to pay. If this feels a bit overwhelming, you can speak to one of our experts.

With the health.com.au extras plan, you have the freedom to choose your own provider and still receive the same benefit. Health.com.au currently has one open extras plan, which we’ve detailed below, and the Pulse 50, Pulse 60 and Active 60 extras plans. At the time of writing, these are all closed to new customers.

Extras 50

Health.com.au’s Extras 50 cover will cover you for a wide range of treatments, including dental, orthodontics, optical, non-PBS pharmacy, dietetics and psychology. Podiatry, hearing aids and blood glucose monitors are not included.

Customers get up to 50% back on all treatments. They also offer 100% back on single vision and multi focal lenses and frames, up to a $200 limit per policy.

fund-iconWaiting periods

Waiting periods are there to stop people from signing up, claiming and then cancelling their cover. It means once you take out a new plan, you may have to wait a certain amount of time before receiving your benefit.

When you switch to health.com.au from another provider, you won’t have to re-serve your waiting periods, unless you have upgraded to a higher level of cover.

Hospital Waiting Periods
  • 1 day – For treatment in hospital as a result of an accident
  • 2 months – For treatment in hospital as the result of a new condition
  • 12 months – For treatment in hospital as a result of a pre-existing condition and for pregnancy related services
Extras Waiting Periods
  • 1 day – For Ambulance Cover
  • 2 months – For General Extras
  • 12 months – For Major Dental and Orthodontics
  • 12 months – For Health Appliances

fund-iconHow to claim

Hospital
Simply tell the hospital you are a member of a health.com.au policy. Your hospital account will be sent directly to health.com.au for them to assess on your behalf.

However, health.com.au members might be sent invoices for any specialist services such as anaesthetists or assisting surgeons. These services have a separate claims process.

Extras
You can swipe your membership card to claim directly on the spot with your provider’s HICAPS or iSOFT terminal.

You can also receive a copy of the invoice and claim online through your member portal. Usually, you can do this without having to take a photo or scan your invoice.

fund-iconHospital agreements

Health.com.au has agreements with most hospital and day surgery providers across Australia.

When comparing policies, it’s worth checking if your preferred local hospitals and clinics are covered. Our specialists at Health Insurance Comparison can do this for you.

fund-iconCustomer service

According to privatehealth.gov.au, this fund had 1.8% of complaints from a 0.6% market share, suggesting that health.com.au’s customer service may be below average.

fund-iconFAQs

No, health.com.au is a for-profit fund. However, their parent company GMHBA is not-for-profit.

Health.com.au is an open fund, so anyone aged 16 or over can apply.

Health.com.au is not on our panel of insurers, so you’ll need to contact them directly to switch.

If you’re still interested in exploring your options, it’s free to compare a range of funds with Health Insurance Comparison and we’re confident we can get you a great deal.

You can switch to an equivalent or lower level of cover without re-serving waiting periods. You will only be required to serve waiting periods if you have upgraded to a higher level of cover.

Yes, you can modify your cover with health.com.au directly.

If you’re thinking of switching to a new provider, Health Insurance Comparison can compare quotes for you and take care of the entire process, free of charge.

For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income). To learn what you’re entitled to, use our rebate calculator.

The easiest way to claim the rebate is to ask health.com.au to provide you with a premium reduction. You could also claim the rebate at tax time.

Perhaps – but you can avoid the LHC if you take out eligible private health insurance hospital cover before your 31st birthday.

Dependent children are covered until 21 years of age – or between the ages of 21 and 25 if the dependent is studying full time.

Health.com.au which is owned by GMHBA.

You can get in touch with health.com.au any time through the live chat function on their website.
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