What are the Best Health Insurance Funds in Victoria?

Not all health insurance funds in Victoria (VIC) are created equal. Let's take a look at the best health insurance funds in VIC state.
Melbourne Downtown River

The Short Version

Your search for the ideal health insurance policy in Victoria (VIC) will be far from straightforward. With a high concentration of private hospitals in metropolitan areas such as Melbourne and Geelong, picking the right health insurance poses a peculiar challenge, especially for those residing in more remote locations.

Our investigation indicates that not-for-profit funds generally offer superior value, primarily providing higher benefits as a percentage of contributions due to their member-oriented philosophy. It might also seem most reasonable to go with the largest funds; however, the funds with the largest market share might not always provide the best coverage and out-of-pocket expenses.

Enlisting the expertise of a Fair Health Care Alliance expert is advisable for a customised selection that meets your specific requirements. We can navigate the intricacies of Victoria’s health insurance landscape and assist in making a well-informed choice.

Responsive Button

Conclusion

Victoria’s distinct landscape, blending bustling urban centres with serene rural spaces, profoundly impacts healthcare accessibility and the suitability of health insurance options. Notably, private hospitals are largely concentrated in urban locales like Melbourne, prompting a significant consideration for appropriate health insurance coverage throughout the state. Our comprehensive analysis evaluates the performance metrics of various health insurers in Victoria, mainly focusing on hospital charge coverage and the ratio of benefits to contributions.

Recognizing that a larger market share does not necessarily imply better service delivery is paramount. Not-for-profit insurers typically lead in value, thanks to their commitment to reinvesting profits into enhancing member benefits. However, choosing the right fund goes beyond mere statistics; it requires a deep understanding of individual needs and local nuances.

Conclusively, navigating the complexities of Victoria’s health insurance market demands careful consideration of several factors, including the extent of hospital charge coverage, effective management of gap payments, and the overall value of benefits relative to contributions. While larger insurers seem like the obvious choice, not-for-profit organizations often provide better value by prioritizing member benefits over profits.

Obtaining tailored advice is essential, considering the complexities and personal variables involved in selecting a health insurance policy. 

We encourage Victorians to consult with a Fair Health Care Alliance advisor to ensure a well-informed decision that best suits their specific healthcare requirements. Our team of experts is ready to help you navigate the options and choose the ideal health insurance plan that fits your needs.

Test Page - Button 7

Which is the best insurance in VIC?

Victoria, often celebrated for its rich cultural heritage and dynamic community, stretches far and wide, encompassing bustling urban hubs and serene rural landscapes. Here, private healthcare facilities primarily cluster around major city centres like Melbourne, leaving slimmer pickings as one travels into the vast expanse of Regional Victoria.

In Victoria, the complexity of the health insurance sector mirrors its geography, displaying a vast array of products and policies that healthcare providers across the state might not universally recognise. This article identifies health insurers that offer services better tailored to Victorians. It’s impractical to pinpoint a single “best” health insurance fund; however, a detailed analysis focusing on crucial success metrics could shed light on which funds excel in Victoria.

This evaluation will scrutinize areas such as coverage of hospital charges, doctor’s gap payments, the ratio of benefits to member contributions, and the local presence of the funds within Victoria. The investigation leverages the most recent data from the Commonwealth Ombudsman’s State of the Health Funds Report, refreshed annually on April 1st with insights from the past year. Notwithstanding minor data fluctuations and future updates, our goal is to spotlight the standout performers, bearing in mind the broad spectrum of health insurance options in Victoria. For customized insights into navigating Victoria’s health insurance offerings, it’s recommended to seek advice from the Fair Health Care Alliance.

Test Page - Button 4

Victoria Health Insurance Market Share

This section delves into the performance indicators of various health funds in Victoria, especially regarding their management of contributions, hospital charges, and out-of-pocket costs for their members. The insights are derived from the latest information provided by the Private Health Insurance Ombudsman.

Health Fund What percent of VIC do they own? What percent of their members are in VIC?
Medibank 32.80% 28.90%
BUPA 23.70% 21.30%
NIB 7.70% 21.30%
Australian Unity 7.40% 60.90%
HCF 6.70% 14.80%
GMHBA 6.30% 63.30%
Defence Health 2.60% 29.90%
Latrobe 2.40% 88.20%
CBHS 1.50% 24.40%
Teachers Health 1.50% 15.10%
HBF 1.20% 3.70%
MDHF 0.90% 84.40%
Health.com.au 0.80% 33.70%
Peoplecare 0.70% 32.80%
HIF 0.60% 15.60%
CUA Health 0.40% 17.00%
GU Health Corporate 0.40% 22.30%
Doctors' Health 0.40% 29.30%
Navy Health 0.40% 27.50%
Transport Health 0.30% 68.90%
All Others Funds Combined 1.13% N/A

Is Bigger Always Better?

An important insight from our analysis shows that having the largest market share in Victoria does not guarantee the best performance in all metrics. This echoes findings from our previous article, The top 5 best health insurance funds in Australia, illustrating that a fund’s size does not necessarily dictate its efficacy.

Benefits as a % of Contributions in Victoria

We’ve arranged the subsequent table according to benefits as a % of contributions from members. This measure essentially indicates how much value members receive in benefits and payouts relative to their premiums, covering in-patient and out-patient medical costs, doctor’s gap fees, extras payouts, or any other health benefits.

The dominance of not-for-profit health funds at the top of this list underscores their commitment to reinvest profits back into services and benefits for their members, aligning with their overarching goal of member satisfaction.

Health Fund Benefit as a % of Contributions
Nurses and Midwives 98.50%
HBF 88.10%
CBHS 87.80%
CBHS Corporate 87.20%
Police Health 96.90%
Defence Health 86.80%
HCF 86.70%
Health Partners 86.70%
Teachers Health 86.40%
Navy Health 86.10%
Peoplecare 84.70%
Transport Health 84.60%
GMHBA 84.50%
St Lukes 84.00%
Medibank 83.70%
MDHF 83.60%
QCH 83.50%
TUH 83.50%
Industry Average** 82.90%
AIA Health 82.80%
RT Health Fund 82.80%
Phoenix 82.50%
Doctors' Health 82.30%
BUPA 81.60%
HIF 80.80%
Latrobe 79.70%
Westfund 79.70%
ACA 78.70%
CUA Health 78.50%
Australian Unity 76.90%
CDH 76.70%
Reserve Bank 76.30%
Onemedifund 75.70%
HCI 75.40%
NIB 73.50%

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”

Test Page - Button 5

Hospital Charges Covered in Victoria

Health Fund % of Charges Covered
AHM 91.50%
Medibank 91.50%
Peoplecare 91.30%
Defence Health 91.30%
BUPA 91.10%
GMHBA 90.60%
Industry Average** 90.50%
Latrobe 90.10%
Australian Unity 90.00%
HBF 89.80%
HCF 89.80%
Health Partners 89.50%
Queensland Country 89.40%
HIF 87.40%
NIB 84.60%
AIA 81.20%

In Victoria, the data reflects the average proportion of the total cost that each health insurer reimbursed for in-patient treatments, with 100% representing the full cost of the medical treatment. The Commonwealth Ombudsman defines this as covering expenses like hospital accommodation, theater fees, prosthetic devices, and specialist charges (excluding the Medicare contribution) as well as related benefits (after deducting any excesses and co-payments).

It’s critical to point out that the industry norm for hospital-related expenses covered in Victoria is 90.50%, which is slightly higher than the nationwide average of 89.90%. Locating a health insurer that offers coverage for hospital-related expenses exceeding the average is a significant challenge. However, we at Fair Health Care Alliance are here to assist in navigating through this task.

Test Page - Button 6

What health funds do 'No Gap' procedures?

Health Fund % No Gap Procedures
Australian Unity 91.40%
Peoplecare 91.10%
BUPA 90.80%
Defence Health 89.80%
NIB 89.70%
Health Partners 87.90%
GMHBA 87.70%
HIF 87.40%
Industry Average** 87.30%
Queensland Country 87.30%
HBF 86.10%
HCF 86.00%
AIA 85.10%
AHM 84.40%
Medibank 84.40%
Latrobe 75.00%

What % of services in Victoria do health insurers provide with 'No Gap' or 'Known Gap?'

Health Fund % No Gap or Known Gap Procedures
Latrobe 99.70%
HBF 99.60%
BUPA 99.00%
Peoplecare 98.70%
Defence Health 98.50%
HCF 98.50%
Health Partners 98.30%
Australian Unity 98.20%
HIF 98.10%
Industry Average** 97.80%
AHM 97.40%
Medibank 97.40%
Queensland Country 97.40%
GMHBA 96.80%
AIA 96.60%
NIB 90.90%

In Victoria, the percentage of in-patient health services where no gap was charged illustrates when patients did not incur any out-of-pocket expenses besides their individual excess. This happens when physicians are part of a gap-cover scheme facilitated by the patient’s health insurance.

A “No Gap” procedure in this context implies that the doctor has entirely forfeited the gap fee. On the other hand, a “Known Gap” procedure points to a situation where costs are lessened, though not entirely removed. These statistics highlight the portion of private procedures in Victoria carried out either without a gap or with a mitigated gap.

The landscape of health insurance in Victoria is complex, given the varying access levels to private hospitals and medical services. Individuals in rural Victoria may encounter challenges akin to those in Western Australia, with a predominant concentration of private hospitals in metropolitan areas such as Melbourne. Certain health funds offer superior travel and accommodation benefits to support individuals who must traverse great lengths for medical treatment. Conversely, other funds present more financially accessible options for those opting for public hospital care as private patients.

Considering these aspects, pinpointing the best health fund in Victoria poses a challenge. Different funds address distinct requirements, so it’s vital to seek tailored advice for your specific circumstances. Don’t hesitate to reach out to us for personalized health insurance guidance and to review your options based on performance metrics.

What are the Best Health Insurance Funds in Victoria?

Health Insurance Advisor at Fair Healthcare Alliance

Alexander Valentino is a dedicated health insurance advisor with years of industry experience and consulting across key Australian sectors. He has helped over 1,000 Australians save more than $100,000 annually by finding tailored health insurance solutions. With a focus on product knowledge and customer education, Alexander guides clients through the complexities of health insurance, offering expert advice based on evolving industry trends. His mission, inspired by his nonna’s poor experience with health insurance, is to ensure Australians avoid overpaying for health coverage, providing advice as if he were helping his own family.

Table of Contents

Related health Insurance Articles