Private Health Insurance In Victoria

Health insurance can be confusing.

That’s why we’ve put together this guide to help you navigate the world of health cover for Victorian residents.

There’s plenty of options available to Victorians, and some of Australia’s biggest funds are based in the state, as well as a few expensive pitfalls to avoid.

Here’s everything you need to know if you live and work in Victoria.

Key Points

The largest health funds in Victoria are Medibank, Bupa, nib and HCF.
Medicare doesn’t cover ambulance fees in Victoria so a trip can cost at least $1,260.
In 2019-20, around 90% of Victorian public patients were admitted for elective surgery within 161 days.

What are the largest health funds available to Victorian residents?

Based on market share, the top four providers are: 1. Medibank (33%) 2. Bupa (23%). Also operates overseas. 3. nib (8.6%) 4. HCF (7.6%)

Victorian-based insurer GMHBA is also a popular choice, with a market share of 5.7% in the state.

While a larger insurer will generally have a wider network of practitioners and member benefits, it’s worth comparing with smaller providers, especially if you’re based in regional Victoria.

Once you determine your specific needs, you’ll be in a good place to weigh up which fund is best for you.

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What are Australia's top performing health funds?

So, you've potentially found a great health policy at a great price that fits your specific needs.

But you want to make sure you're also getting good customer service.

Here are the health funds that received the least complaints nationwide.

HBF(received just 4.0% of complaints versus their 7.3% market share)
Medibank(22.8% of complaints versus 26.9% market share)
Bupa(21.5% of complaints, versus 25.4% market share)
Defence Health (2.1% of complaints versus 1.8% market share)
nib(8.1% of complaints versus 9.2% market share)

HBF stands out as a top performer for customer service.

That's not surprising given it has a high retention rate for hospital cover at 86%.

Of the big four, Medibank and Bupa scored well.

Defence Health also performed well, but it's a restricted fund and not everyone can join.

Of the open funds based in Victoria, Medibank scored best.

What types of cover can I get in Victoria?

All health funds offer a range of policies.

There's hospital cover offered as Basic, Bronze, Silver and Gold tiers.

Buying hospital cover could also help you avoid paying the Medicare Levy Surcharge at tax time.

The majority of Australians opt for a combined package with hospital cover and extras, which gives you benefits on everyday treatments like dental, optical and chiro.

You can also choose ambulance-only cover to avoid paying a hefty bill in an emergency.

Are there regional health insurers outside Melbourne?

Yes, Victoria has funds based in regional areas.

These include Geelong-based GMHBA, which also owns smaller health funds Frank and health.com.au, Mildura Health, and Latrobe Health, which are based in the Gippsland region.

It's still worth comparing policies with the bigger players to make sure you're getting a good deal.

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What do I need to consider for health cover in Victoria?

With a wide choice of funds, it helps to start working out the inclusions you need along with your budget.

Do you want to see your regular practitioners or are you happy to use the fund’s dental and eyecare centres? Do you want access to reward programs?

Check the fund’s hospital agreement includes your local hospital, particularly if you live outside Melbourne or Victoria’s other major cities.

There’s no point having great cover if you have to drive for hours to receive full coverage for your hospital costs.

It's also important to consider a fund's gap fee arrangements with hospital cover. This is where health funds have arrangements with hospitals, doctors, and other healthcare professionals to reduce or eliminate out-of-pocket expenses for patients.

Some funds have better statewide no gap coverage in Victoria than others. The NSW-based CDH (also known as HHI, for example, only has 60% gap coverage in Victoria.

This means CDH members in the state may be more likely to face out-of-pocket costs for medical care while in hospital.

Weigh up the pros and cons of the big names and smaller funds.

And remember, Medicare doesn't cover ambulance fees in Victoria.

How much does ambulance cover cost in Victoria?

Emergency ambulance fees in Victoria aren't covered by Medicare and come in at a whopping $1,265 for metro patients and $1,866 for regional patients, so it's worth considering ambulance cover in victoria.

In Victoria, most Basic hospital policies will usually include ambulance cover with a one-day waiting period.

It could also help you avoid paying the Medicare Levy Surcharge.

Some of the larger health funds also offer ambulance-only insurance, while you can also take out Ambulance Victoria Membership to protect yourself from high call-out costs.

Are there any rebates for Victorian residents?

Yes. From 1 April 2021, government health insurance rebates for Australians under 65 years range from 8.202% for a single earning $105,001-$140,000 (and couples/families earning $210,001-$280,000), to 24.608% for singles earning $90,000 or less (and couples/families earning $180,000 or less).

How long do I have to wait for elective surgery in Victoria?

In 2019-20, around 90% of Victorian public (Medicare) patients were admitted within 161 days, although this may increase once data on the effect of COVID-lockdowns on elective surgery is published.