Why it's important to review your health insurance

Does your health insurance match your needs and lifestyle?

12 January 2024 6 minute read

Two men chatting as they emerge from the surf wearing wetsuits and carrying surfboards

Do you have pregnancy cover, even though your family is now complete? Have you given up rugby, but not the high level of Extras cover you selected when you were seeing your physio throughout the season?

As you approach every new stage of life, it’s important to make sure your health insurance matches your needs and lifestyle. At nib, we’re focused on helping you find a policy that’s right for you with a range of options when it comes to Hospital, Extras and combined covers, as well as the opportunity to increase your excess to help you save on your monthly premium.

Health funds categorise their hospital cover products into easy to understand Gold, Silver, Bronze and Basic tiers that reflect the level of cover they provide. Each tier has a minimum set of hospital services that must be included, but insurers can choose to include additional services on top of the minimum required to create ‘Plus’ products.

The way treatments are defined are the same across the board, so all health funds speak the same language when it comes to what you’re getting from your policy.

This means it’s easier than ever to review and compare your health insurance options, but it's important to remember it's not all about price – the cheapest policy may not be the right one for your circumstances.

To help you review your options, here are a few things you should consider.

1. What private health cover do I need?

This can be an overwhelming question. To help you answer it, consider the level of cover that will give you peace of mind, who in your life needs to be included in your private health cover and the specific services and medical procedures that are important to you. It help's to ask yourself some questions to kickstart the process:

What hospital services do I want to be covered for?

Before you start comparing any products, consider your personal circumstances and create a checklist of essential hospital services.

Here are a few questions to consider:

Are you looking to start or expand your family?
Do you have a family history of any illnesses?
What can you afford?

There’s a lot to consider, but once you’ve narrowed down the services that are important to you, you can start finding options that match. With Gold, Silver, Bronze and Basic Hospital cover tiers, this process is easier than ever.

For example, if everything on your checklist falls within a Silver product tier, you’re able to compare Silver policies across different health funds knowing that they’ll all meet the same minimum standard in terms of the benefits they provide.

Understanding waiting periods and pre-existing conditions

Please note, if you have an existing medical condition, you'll still be able to take out health cover, but you may need to wait longer to have any related treatment covered. Be sure to take note of waiting periods and become familiar with pre-existing conditions, so you don't end up disappointed with your cover selection later on.

What Extras cover do I need?

When you start to look at Extras options, shop around and consider the services you want to be covered for. Extras cover can include items such as dentist and optometrist visits, as well as things like physiotherapy or chiropractic treatments.

Once you have checked that the services you want are included in the cover you're looking at, confirm if any waiting periods apply and take note of the annual limits.

As you compare Extras covers, you'll probably notice the "percentage back" varies from cover to cover. This percentage back refers to the amount from the total cost of your service you'll get back from your health insurance.

Can I get Extras cover with Hospital cover?

Considering Extras-only cover? It’s worth factoring in that hospital cover is what you'll need to avoid the Medicare Levy Surcharge (if your taxable income is above certain thresholds) and Lifetime Health Cover loading (which means you will pay higher premiums if you don’t take out private health insurance before 1 July following your 31st birthday). There’s also our age-based discount for those of us who are under 30 – this discount could save you up to 10% off your private Hospital cover¹. Find out more by checking out our Discounts for people under 30.

2. What excess level is right for me?

Just like with your car or home insurance, excess (which is sometimes referred to as a front-end deductible) is an amount of money you agree to pay for a hospital stay before health insurance benefits are payable. Generally speaking, choosing a higher excess means you’ll pay less in health insurance premiums.

nib members are generally given the option to choose an excess limit of $250, $500 or $750 for singles, and $1,000 or $1,500 for couples or families. So, if you’re with nib, you’ll be able to opt for a higher level of excess in return for a lower premium. Find out more about your excess options.

3. Can I easily use private health cover?

When it comes to using your private health cover, you want to make sure you’re with a fund that makes claiming easy. With nib, you can easily claim by swiping your nib card at your provider (if they have this available) or through your phone (we have photo claiming on our nib app).

At nib, it’s easy to see the provider of your choice. We’ll pay benefits when you visit any nib recognised provider, as long as you are covered for the service, have served relevant waiting periods and have sufficient annual limits remaining. You can check your coverage and annual limits in the nib app or by logging into your member account online.

We also have a network of trusted health professionals to make it easier for you to get the best value out of your cover and help you lower your out-of-pocket expenses. You can search for a local provider online with our First Choice provider search tool.

4. How can I maximise the benefits of my private health insurance?

Excluding peace of mind and protecting yourself against the unexpected, it’s important to take into account some of the other benefits of your private health cover.

At nib, you can access a world of discounts, benefits, and offers from over 2,000 providers across Australia through nib Rewards. With 150+ retailers (think MYER, JB Hi-Fi, The Iconic and Kmart), 500 Good Food Guide and Gourmet Traveller restaurants and serious savings on everything from groceries to gym memberships, nib Rewards is our way of helping you live a fun, healthy and rewarding life. Find out how you can save today.

We've partnered with hub.health to help provide you with online, confidential, text-based consultations for prescriptions delivered straight to your door. Some of the common treatments include hair loss, premature ejaculation, contraceptive pill and herpes.

To keep you at your healthiest all year round, we also offer a range of Health Management Programs at no additional cost to eligible members² that aim to help get you in shape, keep you out of hospital, improve your physical and mental wellbeing and aid a quicker recovery post-hospitalisation.

We’re always here to help, but more importantly, we’re with you when you need us most – when you’re going to hospital. We provide the support you need to navigate the system whether it’s with a cover check, by providing you with the average cost of your procedure, giving you tips on keeping out-of-pockets low, helping you find a specialist or suggesting questions you should ask your specialist.

Why do I even need health insurance?

No one likes paying for things they feel like don’t need, so when reviewing your cover you may be tempted to get rid of your private health insurance altogether. But canning your cover could potentially cost you money in the long run, not to mention the peace of mind you get from cover and access to treatment.

Some of the benefits of private health insurance are:

Choice and control - choose where you wanted to be treated and by a specialist of your choosing.
Tax benefits - if your income exceeds the threshold for the Medicare levy surcharge, taking out appropriate health cover can help you avoid paying it in the future. Check out
www.ato.gov.au for more information.
Limit your Lifetime Health Cover loading - LHC is an additional charge applied to your hospital cover premiums if you haven't had private hospital cover from the year you turn 31. Essentially, for each year you're over 30, your premiums will increase by an additional 2%, up to a maximum of 70%.
Skip public hospital waiting lists - private health insurance can help you bypass those long public waiting lists for your covered services, meaning you can get the care you need without the wait.

How often should I review my health cover?

One of the benefits of reviewing your health cover is that it could save you money if you select a level of cover that suits your needs, rather than picking the cheapest option or the first one you see. Health insurance shouldn’t be set and forget, so keep comparing your options as your health needs change. For more information on when to review your cover, check out our article 7 signs it's time to review your cover.

So what are you waiting for? Get comparing today!

If you need help finding the right health insurance policy for you, contact our award-winning member service team on 13 16 42.

¹Aged-based discount is applied to eligible Hospital covers and is calculated at 2% per year you are under 30 from the time you take out your Hospital cover to a maximum of 10% for those aged between 18-25.

²Available to eligible nib members who’ve held Hospital Cover for 12 months and served their relevant waiting periods. Additional criteria vary according to each program.