AIA health insurance review

Overview

AIA is an Australian private health insurer with a particular focus on health and wellbeing, on a mission to make Australia one of the healthiest nations in the world.

All AIA health insurance products include access to their AIA Vitality program, designed to provide members with the tools and support they need to improve their health. Members are rewarded for their healthy choices through incentives such as discounts and cashback deals with a range of major retailers.

Hospital 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.

AIA offers 7 types of hospital cover, ranging from Basic Hospital Accident to cover you for the unexpected to Silver Plus Hospital Ultimate for their most comprehensive cover.

Basic Hospital Accident

An ideal option for young and healthy people looking for the lowest premiums, covering accidents only.

Key inclusions:

• Emergency ambulance cover

• Private hospital cover for accidents only

• Public hospital cover for psych., rehab. and palliative care.

Basic Plus Hospital Starter

Budget hospital cover suitable for people seeking cover for accidents and private hospital cover for some common treatments.

Key inclusions:

• Dental surgery

• Tonsils, adenoids and grommets

• Joint reconstructions

Bronze Hospital Essential

An affordable level of private hospital cover for accidents and a decent range of common procedures.

Key inclusions:

• Ear, nose and throat

• Gastrointestinal endoscopy

• Chemotherapy, radiotherapy and immunotherapy

Bronze Plus Hospital Everyday

Bronze cover with some extra inclusions, such as Lung and Chest and Plastic Surgery (medically necessary).

Key inclusions:

• Lung and Chest

• Plastic and reconstructive surgery (medically necessary)

• Dental surgery

Silver Hospital Classic

A high level of hospital cover, with key inclusions such as heart and vascular system and back, neck and spine.

Key inclusions:

• Heart and vascular system

• Back, neck and spine

• Podiatric surgery (provided by a registered podiatric surgeon) 

Silver Plus Hospital Advantage

A high level of hospital cover with some more major inclusions, including insulin pumps and joint replacements. 

Key inclusions:

• Joint replacements

• Sleep studies

• Insulin pumps

Silver Plus Hospital Ultimate

Comprehensive cover which only excludes weight loss surgery, and the only cover option which covers pregnancy and birth-related services.

Key inclusions:

• Pregnancy and birth

• Assisted reproductive services

• Joint replacements

Ambulance Cover

While ambulance cover varies depending on which state you live in, AIA offers emergency ambulance transport (air, land and sea) with every product.

Accidental Injury 

All AIA hospital policies also cover you to be treated in an agreement private hospital for injuries sustained through an accident, provided that the service is covered by Medicare.

For an accident to be covered, treatment must be sought through a Doctor or an Emergency Department within 48 hours of sustaining the injury. Conditions apply.

Extras Cover 

AIA's extras reset on January 1 every year.

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%.

While we’ve summarised the key points of AIA extras policies below, it’s always worth digging 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.

AIA does not offer standalone extras policies - they must be combined with a hospital product.

Lite Saver Extras

Under Lite Saver Extras, you will receive a fixed benefit amount on all services as well as 50% back on all smile.com.au dental treatments.

Key inclusions:

• Acupuncture, massage therapy, physiotherapy, chiropractic and osteopathy ($200 annual limit)

• General and Preventative Dental ($300 annual limit)

Lite Extras

Lite Extras is another budget option for those just looking for the basics. You will receive 50% back as a minimum and will also get an additional 10% back on dental treatments from a smile.com.au provider, as well as all non-dental treatments when you receive AIA Vitality Silver Status or above.

Key inclusions:

• General and Preventative Dental ($500 annual limit)

• Optical ($150 annual limit)

• Physiotherapy, including hydrotherapy and myotherapy ($250 annual limit)

Healthy Saver Extras

Healthy Saver Extras offers higher fixed benefits and covers a broader range of services, making it an ideal option for those with an active lifestyle. You also receive 50% back on all smile.com.au dental treatments.

Key inclusions:

• General Dental, Preventative Dental and Major Dental ($500 limit)

• Optical ($200 annual limit)

• Wellness benefits, which include weight management programs and health checks ($200 annual limit, sublimits apply)

Standard Extras

Standard Extras includes higher standalone limits on more services, an ideal option for people looking for more back on the services they’re most likely to use.

Key inclusions:

• General and Preventative Dental ($600 annual limit)

• Major Dental ($600 annual limit)

• Massage therapy ($100 annual limit)

Active Saver Extras

Active Saver Extras is a mid-range extras policy which covers a number of important services such as orthodontics and podiatry. You receive a fixed benefit amount on your extras treatment as well as 60% back on all smile.com.au dental treatments.

Key inclusions:

• General and Preventative Dental ($600 annual limit)

• Major Dental ($700 limit)

• Hearing aids ($300 annual limit)

Lifestyle Extras

Lifestyle Extras offers 60% minimum benefit back on all services, as well as an additional 10% on dental treatments by a smile.com.au provider and all non-dental treatments when you achieve AIA Vitality Silver status or above.

Key inclusions:

• General and Preventative Dental ($800 annual limit)

• Orthodontics ($600 annual limit, $2,400 lifetime limit)

• Physiotherapy, including hydrotherapy and myotherapy ($400 annual limit)

Enhanced Extras

Enhanced Extras is top-tier cover with no exclusions and higher benefits and annual limits on a wide range of services. You receive a minimum of 70% back on extras and can get an additional 10% back on dental treatments provided by a smile.com.au provider and all non-dental treatments when you achieve AIA Vitality Silver Status or above. This is also the only product available that covers occupational therapy and speech therapy.

Key inclusions:

• Antenatal and postnatal and physiotherapy ($600 annual limit)

• Audiology ($200 annual limit)

• Eye therapy ($200 annual limit)

Waiting 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 AIA from another provider, you won’t have to serve new waiting periods, unless your new policy covers something you didn’t have before.

Hospital Waiting Periods

• 12 months for pre-existing conditions

• 12 months for pregnancy and birth

• 1 day for accidents and emergency ambulance

• 2 months for rehabilitation, hospital psychiatric services, palliative care, even if pre-existing

• 2 months for all other services

Extras Waiting Periods

• 2 months for General and Preventative dental

• 6 months for optical

• 12 months on major dental, orthodontics and hearing aids

• 2 months on all other services

Member Benefits

All hospital products include membership to the AIA Vitality program, a personalised, science-backed health and wellbeing program that supports you to make healthier lifestyle choices.

You can learn more about your health through online health assessments as well as improve your health through discounted gym membership and fitness devices, quit smoking programs and nutrition consultations.

Members can also earn up to 50% cash back on eligible domestic and international flights, discounted movie vouchers and up to $500 to spend at a range of major retailers, including MYER, Rebel Sport and Woolworths.

How to claim

Hospital

Simply tell the hospital you are a member of an AIA policy. Your hospital account will be sent directly to AIA for them to assess on your behalf. If you’re billed directly via your provider, you can also claim via your MyGov account or by going into a Medicare office.

It is recommended you call your fund before your admission date to check what benefits you are entitled to and if any out-of-pocket expenses or excess will be payable on the day,

Extras

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

Members can also claim after the treatment via the AIA online claiming portal or through email, post and over the phone.

Hospital agreements

AIA has agreements with a large number of 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 Compare Club can do this for you.

Customer Service

AIA received 1.6% of all private health insurer complaints in 2021. They have a market share of <0.5%.

FAQs

1. Is AIA a not-for-profit fund?

No. AIA operates on a for-profit basis.

2. Who can apply? Are there restrictions? 

There are no restrictions - AIA is open for all to join.

3. Is it easy to switch to AIA?

AIA isn’t on our panel so you’ll need to contact them directly to switch. We’re confident the Compare Club team can find you a great deal from the insurers on our panel.

4. Do I need to re-serve waiting periods?

You can switch to an equivalent or lower level of cover without serving new waiting periods. You’ll need to serve new waiting periods if you have upgraded to a higher level of cover.

5. Can I change my level of cover?

Yes, you can modify your cover with AIA directly. 

6. Do I get the government rebate?

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, read our rebate guide.

7. Do I have to pay the Lifetime Health Cover loading?

If you’re 31 or over, you usually need to pay 2% loading for each year you’ve gone without hospital cover since the 1st July following your 31st birthday. You can find out more here.

8. What age are children covered up to?

Children are automatically covered under family cover until the day before they turn 23. 

If they are full-time students, they’ll be covered for no extra cost until the day before they turn 25 or cease full time study (whichever comes first).

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.