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What Is a Health Fund?

In Australia, health funds are the organizations that offer private…
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In Australia, health funds are the organizations that offer private health insurance to help cover medial costs not paid for by Medicare or that offer greater freedom in choosing healthcare options. Medicare is Australia’s universal health insurance which provides citizens, as well as some visitors, with a variety of healthcare services for free or at low cost. Medicare covers doctor visits and hospital care, and it may cover the costs of prescription medication. While Medicare will cover hospital stays and treatment, it’s important to note that it doesn’t provide ambulance cover. Additionally, Medicare typically won’t cover dental expenses, medical exams for life insurance, glasses and contacts, hearing aids, or chiropractic services.

Those who wish to cover gaps left by public health care will need to find additional health resources through a private health insurer.

What Is Private Insurance?

Private health insurance in Australia works similarly to insurance in the United States and other countries where the insured pays monthly premiums in exchange for assistance with health care costs. Private health insurance covers many gaps left by Medicare, including ambulance cover, physical therapy, dental and vision treatment, and maternity care. Approximately 54% of the Australian population has private insurance with the biggest claim rates belonging to those aged 60-79 years old.

Types of Private Insurance


Private health coverage is generally divided into the following three categories.

Hospital Cover: This coverage allows you to be treated as a private patient in any hospital, whether public or private. You’ll receive your own room, have a greater selection of doctors to provide for your care, and costs for necessary surgeries will be covered.

General Treatment: Also called ancillary cover, this coverage helps you pay for treatments not typically covered under Medicare (dental treatment, physiotherapy, etc.).

Ambulance Cover: This covers the costs of treatment by paramedics as well as ambulance transport to the hospital.

Search for health insurance with iSelect to find the health funds that are right for you.

Private Insurance Benefits

Citizens go to private health funds for a variety of reasons, but one of the biggest benefits is having more control over your treatment. With basic hospital cover through Medicare, you won’t be able to choose your own hospital or doctor. With private insurance, you have much greater control, and you can even have a private hospital room.

Those with private insurance frequently enjoy decreased wait times for elective surgeries as well. Private hospitals for patients with private health funds also help to reduce the strain put on the public healthcare system. There are significant financial benefits to having private insurance, as well. The Lifetime Health Cover initiative encourages citizens to take out private insurance before turning 31 so they can enjoy reduced premiums compared to those who sign up later in life. Private health funds also help high-income Australians avoid the Medicare Levy Surcharge on their taxes.

Cons of Private Insurance

While taking out private health coverage can certainly offer benefits for many patients, for some people, those benefits simply won’t be enough to justify paying for a health fund. Private insurance, especially for older people, may simply be too expensive. Even if premiums are affordable, some plans only cover partial costs, and out of pocket expenses may still be too costly. The sheer amount of options on the table with private insurance can also be overwhelming, and some patients find that they actually aren’t covered for procedures they thought they would be.

Insurance for Clinical Research

If you have any interest in taking part in groundbreaking clinical trials, the institution conducting the clinical research usually covers insurance for participants, but it’s always important to ask detailed questions about everything involved. Clinical trials often test new treatments for diseases like cancer, and participation can sometimes be the best option for cancer patients who haven’t seen results with other treatment options. Clinical trials are necessary for medical research, but since each trial is linked to a new study, they can’t be called reliable treatment plans.