The Short Version
Finding the best private health insurance in NSW is never going to be a simple task. As the state is home to the largest population in Australia, it also boasts some of the most advanced medical infrastructure in the country – especially in busy metro areas like Sydney, Newcastle and Wollongong. But that doesn’t make choosing the right private health insurance in NSW any easier.
Not-for-profit funds consistently perform well in our analysis, as they tend to deliver higher benefits back to members as a percentage of contributions. On the other hand, some of the biggest insurers by market share don’t always rank as highly when it comes to hospital cover, out-of-pocket costs or member retention.
If you want proper guidance that’s tailored to your needs, speaking to a Fair Health Care Alliance expert today can help you understand which policies suit you best across NSW health insurance.
What is the best private health insurance in NSW?
New South Wales is Australia’s largest state by population and, as such, has a dense network of both public and private hospitals. If you’re thinking about doing a health insurance Sydney comparison, know that most health funds have strong networks of contracted hospitals and specialists.
However, if you’re out in rural and regional areas like the Northern Rivers, Riverina and Western NSW, it’s important to realise that these parts of the state still face some challenges with access to providers, which could impact the performance of your preferred policy and your suitability for it.
As with our write-ups for the best health insurance funds in Victoria and in Queensland, we’re not here to attempt to crown a single ‘best’ health insurer. Instead, we use the latest data to examine key research metrics, so you can see exactly which funds offer the best value for money in NSW.
Here’s what you can expect our team to focus on when we compare private health insurance in NSW:
- Benefits returned as a percentage of contributions.
- Hospital-related charges covered.
- Percentage of no-gap or known-gap medical services.
- Retention and complaints data (which are indicators of member satisfaction and the reliability of each fund).
New South Wales health insurance market share
The figures below show the latest market share by health fund, including what percent of NSW they own, as well as what percent of their members are in NSW.
Note: the table below lists only the top 15 health funds.
| Health Fund | What percent of NSW do they own? | What percent of their members are in NSW? |
|---|---|---|
| BUPA | 25.20% | 31.60% |
| Medibank | 23.00% | 28.30% |
| HCF | 19.60% | 60.50% |
| NIB | 13.80% | 53.30% |
| Teachers Health | 4.90% | 68.60% |
| CBHS | 2.10% | 45.50% |
| Australian Unity | 1.60% | 18.10% |
| Westfund | 1.30% | 60.70% |
| GMHBA | 1.20% | 16.50% |
| Defence Health | 1.20% | 18.20% |
| HBF | 0.90% | 3.80% |
| GU Health Corporate | 0.70% | 51.30% |
| Peoplecare | 0.70% | 45.60% |
| Health.com.au | 0.60% | 35.50% |
| RT Health Fund | 0.60% | 49.50% |
Benefits as a percentage of contributions in NSW
This metric shows us how much each health fund pays back to its members in the form of benefits, relative to the premiums they receive. Generally, not-for-profit funds perform better here because they reinvest those profits back into member services – instead of distributing them out to shareholders.
Note: The industry average is 80.15%, so any fund performing above this is considered strong.
| Health Fund | Benefit as a % of Contributions |
|---|---|
| HBF | 87.90% |
| HCF | 87.70% |
| Police Health | 86.90% |
| Teachers Health | 86.00% |
| CBHS | 84.20% |
| St Lukes | 83.60% |
| Navy Health | 83.40% |
| Medibank | 83.40% |
| Westfund | 83.30% |
| Peoplecare | 83.30% |
| AIA | 83.20% |
| TUH | 82.60% |
| MDHF | 82.40% |
| Health Partners | 81.90% |
| BUPA | 80.90% |
Portability
Don’t re-serve waiting periods when you switch to a new health fund or policy
“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”
Hospital charges covered in NSW
These figures show how much of the total cost of in-hospital treatment is covered by a fund in NSW. That includes things like accommodation, surgery, prostheses and specialist fees – excluding the Medicare rebate.
Note: With the industry average in NSW being 88.7%, only a handful of private health insurers have shown they are exceeding that benchmark.
| Health Fund | % of Charges Covered |
|---|---|
| Peoplecare | 90.40% |
| HCF | 89.30% |
| AHM | 89.00% |
| Medibank | 89.00% |
| Queensland Country | 88.60% |
| Defence Health | 88.50% |
| BUPA | 88.30% |
| Latrobe | 87.40% |
| HBF | 87.30% |
| NIB | 86.90% |
| Health Partners | 86.20% |
| HIF | 85.70% |
| Australian Unity | 85.60% |
| GMHBA | 84.50% |
| AIA | 77.10% |
Percentage of services with no gap in NSW
This tells us how often patients avoid out-of-pocket costs entirely for medical services when treated in a private setting. This happens when a specialist agrees to a health fund’s no-gap scheme.
Note: The industry average for NSW is 89.3%, and most of the top insurers either meet or exceed this. Bear in mind, however, that some funds mentioned here – such as Defence Health – aren’t open to the public.
| Health Fund | % of no-gap services |
|---|---|
| NIB | 93.20% |
| Queensland Country | 91.80% |
| Australian Unity | 91.50% |
| Peoplecare | 91.00% |
| Health Partners | 90.70% |
| BUPA | 90.50% |
| Defence Health | 89.60% |
| HIF | 88.40% |
| HCF | 88.20% |
| HBF | 87.20% |
| AHM | 86.40% |
| Medibank | 86.40% |
| GMHBA | 84.20% |
| AIA | 82.00% |
| Latrobe | 78.50% |
Percentage of services with no gap or known gap in NSW
The below metrics include both no-gap and known-gap treatments (where out-of-pocket expenses are reduced and disclosed upfront).
Note: With the industry average in NSW being 96.4%, there are quite a number of private health funds that should be considered top performers.
| Health Fund | % no or known gap services |
|---|---|
| HBF | 99.20% |
| Latrobe | 98.60% |
| Peoplecare | 97.60% |
| Health Partners | 97.30% |
| Queensland Country | 97.20% |
| Defence Health | 96.90% |
| Australian Unity | 96.80% |
| HCF | 96.80% |
| AHM | 96.80% |
| Medibank | 96.80% |
| BUPA | 96.70% |
| HIF | 96.60% |
| NIB | 93.60% |
| GMHBA | 92.40% |
| AIA | 92.20% |
Bigger isn’t always better
It might be tempting to go with the biggest player in the market, but size doesn’t guarantee value. According to our research and what we hear from clients, some of the most dominant health funds in NSW by market share don’t necessarily return the biggest benefits or deliver the best outcomes for their members.
Smaller funds and not-for-profit health insurers like Peoplecare and HCF consistently punch above their weight, especially in terms of the benefits they deliver and their low-gap service metrics. This lines up with our own findings that not-for-profits generally outperform for-profit funds when it comes to delivering true value.
Finding the right health fund in NSW
NSW’s large and highly diverse population means that no single health insurer can suit everyone. The good news is that all the data is already at your fingertips, so by reviewing things like benefits returned, hospital cover and no-gap services, it becomes a little easier to narrow down your options.
Ultimately, the right policy will depend on your health needs and your budget. The good news? You don’t need to go it alone – and you don’t have to scour all the data yourself just to find a good deal.
You can speak with a Fair Health Care Alliance expert today by calling 1300 955 691 or compare health insurance NSW quotes online right now. We’ll make sure you never again have to overpay for cover you don’t actually need.
