health.com.au was established in 2012 and is the first new private health insurer in Australia since 1976. They are an online-only health insurer and a subsidiary of GMHBA, a health fund with over 80 years’ experience in the private health industry.
health.com.au has acquired numerous awards such as the national Start Up Award, Partner of the Year and Best Health Insurance value of 2018.
health.com.au Key Facts
For-Profit or Not-For-Profit? For-Profit
Private Hospital Agreements Nationwide: 252
Day Hospital Agreements Nationwide: 219
Health Deal Represented? No
health.com.au Hospital Cover
health.com.au has 4 hospital policies to suit every age and medical need. These range from Entry Hospital Cover all the way up to High Hospital Cover. Here is a list of the hospital covers currently available from health.com.au:
- Entry Hospital
- Base Hospital
- Core Hospital
- High Hospital
health.com.au Extras Cover
Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy. Here is a list of all the current extras covers available:
- Active 60
- Pulse 50
- Pulse 60
- Extras 50
health.com.au Combined Cover
health.com.au has over 40 combined cover options to suit all needs and ages. Below are some of the current combined policies available:
- Simple Essentials 60
- Essentials Bundle 60
- Basics Plus Starter
- Classic Bronze Plus
health.com.au Waiting Periods
health.com.au recognise the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:
Hospital Waiting Periods
- 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 health.com.au?
health.com.au makes claiming extras quick and easy. Here are the 2 ways to claim:
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Online: You can visit the health.com.au website and lodge your claim by providing the details on your receipt.
health.com.au Gap Cover
health.com.au’s gap cover is called Access Gap Cover. 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. Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.
Gap Cover Ratings By State
To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover 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.
health.com.au medical services with No Gap: 74.1%
Industry Average: 79.1%
health.com.au medical services with No or Known Gap: 92.8%
Industry Average: 90.5%
health.com.au medical services with No Gap: 84.7%
Industry Average: 89.5%
health.com.au medical services with No or Known Gap: 95.3%
Industry Average: 95.7%
health.com.au medical services with No Gap: 86.7%
Industry Average: 86.7%
health.com.au medical services with No or Known Gap: 97.4%
Industry Average: 95.1%
health.com.au medical services with No Gap: 87.6%
Industry Average: 89.2%
health.com.au medical services with No or Known Gap: 96.3%
Industry Average: 94.5%
health.com.au medical services with No Gap: 83.1%
Industry Average: 89.5%
health.com.au medical services with No or Known Gap: 97.6%
Industry Average: 96.6%
health.com.au Medical Services with No Gap: 85.3%
Industry Average: 84.4%
health.com.au medical services with No or Known Gap: 96.1%
Industry Average: 96.2%
health.com.au medical services with No Gap: 90.8%
Industry Average: 90.2%
health.com.au medical services with No or Known Gap: 98.7%
Industry Average: 96.7%
health.com.au medical services with No Gap: 89.3%
Industry Average: 84.2%
health.com.au medical services with No or Known Gap: 96.6%
Industry Average: 93.8%