Health Fund Rebates

Choosing the Right Policy

With a wide array of insurers, and a bewildering number of policies out in the marketplace, making a simple comparison of private health insurance policies can seem all but impossible. So how do you work out which policy is the right one for you?

You will find it effective to visit the government website privatehealth.gov.au which offers a detailed, expansive and unbiased comparison of the many products available.

Looking to get private health insurance for the first time or considering a switch in your policy?  Download our fact sheet and ask yourself these essential questions.

Private health insurance is confusing.  Understand more before you make any decisions by reading through the fact sheet for frequently asked questions and answers.

Rebates & Gap Payments

When you first take out private health insurance, the expectation is that you will receive rebates that cover a sizeable proportion of your expenses. But the reality is that rebates for dental services, which fall under what's known as “extras” cover, rarely cover anything like the full cost of a treatment. Despite claims of 'no gaps', many funds only cover on average about half the cost, leaving you to cover the gap that remains. This is most evident in your annual cap limits which are quickly exhausted and don't come close to covering the full amount you’ve spent on dental treatment.

The gap between what you pay for treatment and what you receive back from your fund is largely-influenced by the rebate percentage set by the funds. Yes, dental fees are a factor but only in so far as fees vary between dentists, meaning that the set percentage you receive back will also naturally differ. Also it matters whether your dentist works in an independent practice, as the majority do, or whether they are in a contractual relationship with your insurer. By and large your dentist has no control or visibility over the rebate amount you receive. So when your insurer tells you that you are getting back such-and-such an amount solely because of the fees charged by your dentist, you should treat this reasoning with the healthy degree of scepticism it deserves.

If you feel like you are being short-changed in some way by your private health insurer then you should check out other funds as well as making a complaint to the Private Health Insurance Ombudsman.