Private health insurance is provided by Australian registered health insurers. Some insurers are not-for-profit (mutual) or return a profit to shareholders. Some insurers provide restricted membership, for example to employees of specific industries, while others are available to all consumers.more
Private health insurance is provided by Australian registered health insurers. The financial performance of registered health insurers is monitored by the Australian Prudential Regulation Authority (APRA), an independent Australian Government body.
Have different business structures - if a health insurer is listed as 'not-for-profit', it is a mutual organisation, with the premiums paid to the insurer used to operate the business and cover benefits for members. 'For-profit' insurers aim to return a profit to their owners (which may be another health insurer or corporation) or shareholders. Both are still required to maintain sufficient funds to operate the company and pay benefits to their members.
Offer insurance under brand names - insurers can sell private health insurance through other organisations, such as QANTAS and Kogan, by underwriting their policies.
Only offer membership to certain individuals - a health insurer is registered as either an 'Open' or a 'Restricted' membership organisation.
Offer corporate policies - some health insurers provide health cover policies tailored for specific companies or organisations, which may be part of the company's benefits package.
Operate in one, some or all states or territories - many insurers operate mainly in a particular state or region. This means they may have a wider network of Agreement hospitals and gap cover doctors within that state or region. This is very important, because you are more likely to be covered for hospital fees, medical gap fees, and pathology and diagnostic imaging fees if your provider has an agreement with your insurer.
It is important to note that even if your hospital stay is covered by your insurer, you may have out-of-pocket expenses. This is because many doctors charge more than the scheduled fee and sometimes in-patient pathology and diagnostic imaging services in private hospitals are not covered.
Most larger insurers will offer different policies for different states or territories, or the same policies at different premiums. Differences in price are based on the variations in cost and benefit between states, and in some cases state government health arrangements.
Not refuse you health insurance - private health insurance is 'community-rated'. This means that everyone is entitled to buy the same product, at the same price (except for Lifetime Health Cover - see below), and is guaranteed the right to renew their policy. A health insurer cannot refuse to insure you or refuse to sell you any policy you want to buy on any basis, regardless of your health or how likely you are to claim.
Lifetime Health Cover (LHC) is an exception to community rating - you will have to pay a higher premium if you have a LHC loading. The cost of premiums for similar cover may vary between insurers.
Private health insurance is different from life, trauma and disability insurance. These insurances are 'risk-rated' rather than 'community-rated' and generally offer lump-sum payments in the event of specific illness or loss. They are not a substitute for private health insurance.
Change their premiums and rules - if your health insurer changes your policy, they are required to tell you about any change that might be detrimental to your interests; and they must update the policy's Private Health Information Statement.