Apia Health Insurance Review

Overview

Apia Health is a health fund specifically designed for over 50’s, offering tailor-made policies for medical services and treatments that members are likely to require, so that members won’t have to pay for unnecessary medical services.

Apia (Australian Pensioner’s Insurance Agency) is a subsidiary of nib Health Funds Ltd. (NIB), who is one of Australia’s fastest-growing funds and provides health cover to over 1 million people nationwide.

Health Fund Key Facts

Founded: 2014

For-Profit or Not-For-Profit?: For-Profit

Private Hospital Agreements Nationwide: 288

Day Hospital Agreements Nationwide: 275

Head Office: Melbourne, VIC

Health Deal Represented?: No

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Apia Health Insurance Hospital Cover

Apia Health’s Silver Essentials policy takes care of the basics of many commonly claimed services for over 50’s like nervous system services as well as gastrointestinal endoscopy. The second Hospital policy provides cover for more services such as cataracts and dialysis.

Apia Health’s two Hospital policies:

  • Silver Essentials Hospital Plus
  • Silver Premium Hospital Plus

Apia Health Insurance Extras Cover

Extras Cover takes care of the everyday healthcare service expenses that are not typically covered under Medicare such as dental visits, prescription glasses and remedial massage.

Apia Health Extras cover:

  • Essential Extras
  • Classic Extras
  • Premium Extras

CBHS offers 3 Extras policies beginning with their Starter Extras, which provides cover for preventative dental, optical and physiotherapy services. The remaining level of Extras Cover provides a wider coverage of medical services such as audiology and midwifery. The 3 Extras Cover options CBHS offers are:

  • Starter Extras
  • Value Extras
  • Premier Extras

Apia Health Insurance Wait Periods

Apia Health recognises the waiting periods you may have already served with a previous health fund. For first-timers taking out a health fund plan, the waiting periods below will have to be served before members can benefit from their health scheme. However, if members are switching health funds, waiting periods will not need to be re-served unless you are upgrading your policy.

The standard hospital wait periods are:

  • Ambulance services: 1 Day
  • Accidental Injury: 1 Day
  • New Conditions: 2 Months
  • Pregnancy and birth-related services: 12 months
  • Pre-existing conditions: 12 months
  • Rehabilitation & Palliative care: 2 months
  • Weight Loss Surgery: 12 months

How Do You Claim Extras With Apia Health Insurance?

You will need to raise a claim once you have received healthcare treatment or bought an item covered by your policy. You can lodge a health insurance claim with Apia Health Insurance in the following ways:     

On the spot: You can swipe your membership card at almost 20,000 health care providers that support the HICAPS electronic claims system. This allows you to have your claim processed immediately.     

Online: You can log into your online account through the apia.com.au website and make your claim by providing the details included on your receipt.

By phone: Members can call 1800 274 213 to walk through their claim process with a customer service representative.

By post: You can fill out a claim form and submit it along with your receipt from the provider to: GPO Box 756, Melbourne VIC 3001.

Apia Health Insurance Gap Cover

Apia Health’s medical gap cover is called MediGap.

If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. MediGap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.

You would be able to gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap.

Gap cover Ratings By State

You can gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap. While it is more likely that a medical service covered under your fund can be utilised at no personal cost to the customer, it is entirely the choice of the physician whether or not to participate in the gap scheme. 

Medical Services with No Gaps: The percentage of claims that were fully refunded.

Medical Services with No or Known Gaps: The percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed. 

The information below outlines the percentages of services covered under no-gap and known-gap.

Apia Health Insurance Medical Services with No Gap: 66.2%

Industry Average 79.1%

Apia Health Insurance Medical Services with No or Known Gap: 66.2%

Industry Average: 90.5%

Apia Health Insurance Medical Services with No Gap: 92.6%

Industry Average: 89.5%

Apia Health Insurance Medical Services with No or Known Gaps: 92.6%

Industry Average: 95.7% 

Apia Health Insurance medical services with No Gap: 91.4%

Industry Average: 86.7%

Apia Health Insurance medical services with No or Known Gap: 91.4%

Industry Average: 95.1%

Apia Health Insurance medical services with No Gap: 85.9%

Industry Average: 89.2%

Apia Health Insurance medical services with No or No or Known Gap: 85.9%

Industry Average: 94.5%

Apia Health Insurance medical services with No Gap: 93.6%

Industry Average: 89.5%

Apia Health Insurance medical services with No or Known Gap: 93.6%

Industry Average: 96.6%

Apia Health Insurance medical services with No Gap: 81.8%

Industry Average: 84.4%

Apia Health Insurance medical services with No or Known Gap: 81.8%

Industry Average: 96.2%

Apia Health Insurance Medical Services with No Gap: 85.3%

Industry Average: 90.2%

Apia Health Insurance Medical services with No or Known Gap: 85.3%

Industry Average: 96.7%

Apia Health Insurance Medical Services with No Gap: 77.2%

Industry Average: 84.2%

Apia Health Insurance Medical Services with No or Known gap: 77.2%

Industry Average: 93.8%

Apia Health Insurance Ambulance Cover

All of Apia Health’s Hospital policies offer ambulance coverage as a standard benefit for the following services:

  • Emergency Transport
  • Paramedic Attendance (on the spot treatment)

Apia Health will also cover members for emergency transfers in the event that the hospital they are admitted in does not offer the specialist treatment required.

Medicare does not provide Ambulance cover, and while some states provide a subsidy for emergency transportation, others may require ambulance usage to be an out-of-pocket expense, usually around $900.

Do you need an ambulance cover?

All states and territories in Australia: All Department of Veterans Affairs Health Card holders qualify for free state ambulance.

You may not need to take out an Ambulance Cover depending on where you live:

ACT qualifies Concession, Pensioner, and Health Care Card holders for free emergency ambulance services. Residents of the Australian Capital Territory who are not entitled to concession can purchase ambulance cover with a private health fund.

New South Wales qualifies Health Care, Pensioner Concession and Commonwealth Seniors Health Care Card holders for free emergency ambulance services. Residents who are not entitled to concession can purchase ambulance cover with a private health fund.

Victorian residents who hold Victorian Pensioner Concession or Health Care cards are eligible for free emergency transport services. Residents who do not qualify for concession can purchase ambulance coverage straight from the state ambulance services or purchase ambulance cover with a private health insurer.

Queensland residents are covered for emergency ambulance services by their state government.

South Australia residents can purchase ambulance coverage straight from the state ambulance services or take out ambulance cover with a private health fund.

Western Australia qualifies residents who are over 65 and entitled to the Australian Government pension for free emergency transport services. Residents who do not qualify for concession can purchase a subscription straight from the state ambulance services or purchase cover from a private health fund.

Tasmanian residents are covered for emergency ambulance services by their state government. 

Residents of the Northern Territory who hold Centrelink Pensioner Concession or Health Care cards are eligible for free emergency ambulance. Residents who do not qualify for concession can purchase ambulance coverage straight from the territory ambulance service or take out ambulance cover with a private health fund. 

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