health.com.au (HEA)
We’re the first new health fund in Australia for quite a long time. We looked at the health insurance industry and thought ‘there’s a better, simpler way to do this’. We offer innovative policies in an honest, uncomplicated way. And we do it through a world-class website. Standing in queues is definitely not in our nature.
Though in one way we are just like all the big insurers. We’re fully registered and regulated by the Australian Government. We also have the same high capital standards — as high as the largest funds with international parents or government support. We can proudly say we’re Australian owned.
Agreement Hospitals
This fund has agreements with some private hospitals or day surgeries to provide services at low or no out-of-pocket costs. You can see Agreement Hospitals for this insurer
Business Structure
This insurer operates on a for-profit basis.
health.com.au operates in all states and territories.
Performance
The Private Health Insurance Ombudsman prepares an annual report on the service delivery and performance of Australian health insurers. The following is a selection of statistics about this health insurer - the full report and an explanation of these figures is available from the Ombudsman's website. Please note information is not provided for some insurers in some states, as there are insufficient numbers reported to APRA for states in which the insurer does not have a large membership.
| Performance | Insurer | Industry |
|---|---|---|
| Benefits as a % of contributions | 88.6% | 86% |
| Management expenses (% cont) | 6.2% | 9.1% |
| Management expenses (average policy) | $199 | $350 |
| Surplus | 5.2% | 4.9% |
| Member retention (%) | 70% | 82% |
| Coverage | ACT | NSW | VIC | QLD | SA | WA | TAS | NT |
|---|---|---|---|---|---|---|---|---|
| Hospital Related Charges Covered | 74.8% | 81.5% | 83.2% | 83.5% | 84.9% | 82.9% | 87.2% | 79.3% |
| Industry Result | 83.8% | 90.4% | 92.2% | 90.8% | 94.6% | 93.0% | 93.9% | 90.2% |
| Medical Services with No Gaps | 70.1% | 86.1% | 85.3% | 88.2% | 84.4% | 83.5% | 86% | 94.7% |
| Industry Result | 78.5% | 88.9% | 85.6% | 88.4% | 87.3% | 85.0% | 88.6% | 84.2% |
| Medical Services with No or Known Gaps | 90.5% | 95.6% | 97.8% | 96.6% | 97% | 95.3% | 97.7% | 98.4% |
| Industry Result | 91.0% | 95.5% | 94.7% | 94.5% | 95.1% | 96.4% | 96.0% | 94.0% |
| General Treatment (extras) Covered | 55.1% | 55.4% | 56.8% | 55.8% | 57.9% | 57.3% | 56.7% | 56.4% |
| Industry Result | 48.1% | 50.7% | 52.4% | 54.3% | 57.4% | 57.5% | 54.3% | 59.1% |
| Private Hospital Agreements | 6 | 79 | 67 | 42 | 26 | 18 | 8 | 1 |
| Industry Maximum | 9 | 110 | 83 | 61 | 33 | 31 | 8 | 2 |
| Day Hospital Agreements | 6 | 72 | 57 | 38 | 22 | 16 | 3 | 1 |
| Industry Maximum | 6 | 98 | 78 | 57 | 29 | 23 | 5 | 2 |
| Share of PHIO complaints | Compared to insurer's market share | |
|---|---|---|
| Benefit Complaints | 1.8% |
0.6%
|
| Service Complaints | 0.4% | |
| All Complaints | 1.3% | |
| Investigations | 3.3% |
Abbotsford
VIC 3067