Who is the best health insurance funds in Australia?
With so many health insurance companies and brands available in Australia, choosing the right one can be daunting. Selecting a health fund that offers reputable hospital coverage, fair extras rebates, flexible policy options, and excellent customer service is essential.
In this article, we’ll explore the top five health funds in Australia for 2025 based on key performance data extracted from the most recent annual State of the Health Funds Report conducted by the Commonwealth Ombudsman for private health insurance.
The Short Version
Different health funds perform well in different areas, so it’s not as simple as naming the top 5 health funds. It’s interesting to note that we rarely see the big for-profit health insurers topping the charts. Not-for-profit health insurance in Australia is proven to perform to a higher standard in our below-listed areas, however, many not-for-profit funds are restricted and can’t be joined by everyday Australians.
Despite the great funds we recognize in this article, it is general statistics only. Any fund can have any number of poor-performing policies and great-value policies alike. The best health insurance in Australia is a policy that is accurately matched to your needs and/or your family’s health needs – an exercise that requires helpful advice from a Fair Health Care Alliance adviser.
Get a 100% free quote now and get this off your to-do list.
Despite the great funds we recognize in this article, it is general statistics only. Any fund can have any number of poor-performing policies and great-value policies alike. The best health insurance in Australia is a policy that is accurately matched to your needs and/or your family’s health needs – an exercise that requires helpful advice from a Fair Health Care Alliance adviser.
Get a 100% free quote now and get this off your to-do list.
What Makes the Best Health Insurance in Australia?
We’ll start with an important caveat: the following assessment of what constitutes the “best” health insurance in Australia are general performance statistics only. In other words, just because a health fund looks good on paper doesn’t mean it is the best health fund for you, nor may they have a policy that matches your unique needs.
This is why it’s fundamentally important to get trustworthy health insurance advice and a transparent and informative health insurance comparison with Fair Health Care Alliance.
There are several redeeming indicators when measuring the efficacy of a private health insurance company. These include:
- Gap-Cover performance in private hospitals,
- Hospital-related charges covered,
- Extras benefits covered,
- Total benefits returned to the member vs premiums paid,
- Member retention (how happy customers are)
- Share of total complaints vs market share
We will walk you through these performance indicators and help you understand what they actually mean when comparing a health insurance company or brand.
Best Health Insurance for Member Retention
Member Retention means the percentage of members who join the health fund that remain as a member and do not leave. A high customer retention number means the fund members are happy and are less likely to cancel or switch to another insurer – a fair indicator that the fund is doing something right. Other factors may include a very convincing retention team that contact members when they leave to intice them to stay.
Top 5 Health Insurance Companies for Member Retention (Open vs Restricted)
| Open Funds | Retention% | Restricted Funds | Retention% |
|---|---|---|---|
| HCF | 98.6% | CBHS | 93.0% |
| Onemedifund | 93.6% | Police Health | 92.2% |
| Teachers Health | 92.4% | Mildura Health Fund | 91.8% |
| HBF | 92.3% | ACA | 91.9% |
| Health Partners | 90.90% | Reserve Bank | 91.4% |
Who is the best health insurance for Benefits vs Premiums paid
The benefits as a % of contributions score is an indiciation of how much a private health insurer returns back to members when compared to how the member pays them for the policy. This figure could be looked at as cents returned in the dollar. For example, if a health fund has a 90% Benefits score, then they are returning 0.90 cents back to the member for every dollar recieved. The term ‘Benefits’ encompasses any kind of payout across private hospital and extras cover. This figure is an overall indicator only, meaning any fund can have a set of very generous policies and a set of very poor policies – this performance indicator shouldn’t be the be-all-and-end-all when deciding on a new health insurer to join.
Top 5 Health Insurance Companies for Benefits % (Open vs Restricted)
| Open Funds | Benefits Paid% | Restricted Funds | Benefits Paid% |
|---|---|---|---|
| HBF | 88.1% | CBHS | 87.8% |
| HCF | 86.7% | Police Health | 86.9% |
| Health Partners | 86.7% | Defence Health | 86.8% |
| Peoplecare | 84.7% | Teachers Health | 86.4% |
| GMHBA | 84.5% | Navy Health | 86.1% |
Percentage of Total Complaints Vs Market Share
We created this metric by comparing the health fund’s share of total industry complaints versus their market share. For example, if a health insurer has a 20% Market share but only 10% of all complaints, we can surmise that fund has a 0.5 Quality Score (the lower, the better) and significantly fewer complaints than they should have. In other words, they’re looking after their members and minimizing areas where customers may need to complain.
Top 5 Health Funds for Quality Score (Complaints vs Market Share)
| Health Fund | Quality Score | Type |
|---|---|---|
| Peoplecare | 0.20 | Not for Profit |
| CUA Health | 0.40 | Not for Profit |
| Police Health | 0.40 | Not for Profit |
| Medibank | 0.70 | For Profit |
| Queensland Country | 0.75 | Not for Profit |
Who is the best health insurance in Australia for hospital related charges covered?
When an insured member goes to a private hospital for an in-patient service, there are many hospital-related charges that the health insurance company can cover, including accommodation, theatre-room fees and associated doctor’s fees. Below are the best health funds covering the most hospital-related charges. This is a broad average across Australia, so it’s critical to note that each health fund performs better or worse in particular Australian States.
Best health funds covering the most hospital-related charges (Australia wide)
| Open Funds | Hospital Related Charges Covered | Restricted Funds | Hospital Related Charges Covered |
|---|---|---|---|
| HBF | 94.4% | ACA | 94.4% |
| Hunter Health | 93.6% | RT Health | 93.2% |
| Health Partners | 93.2% | Reserve Bank | 93.0% |
| Onemedifund | 93.2% | Police Health | 92.8% |
| HCI | 92.8% | Doctors Health | 91.9% |
Which health insurance companies performed best for No Gap Cover in Hospital?
The hospital “Gap” is the difference between what your private health pays back for a particular surgery and how much the private doctor or anesthetists charge in total. Health insurance covers you up to 100% of the Medicare Benefit Schedule fee for a procedure, but a doctor can charge whatever they like above this fee. This gap is payable by the member. If the doctor is willing to participate in “gap cover” with the health insurance company, this means that the fund will pay more if the doctor agrees to charge a lower fee, resulting in no gap at all or a reduced gap (known gap) for the patient. Here are the top 5 health funds for best no-gap cover last year.
Overall best health insurance for Gap-Cover in Private Hospital (Australia-wide)
| Open Funds | % No-Gap | Restricted Funds | % No-Gap |
|---|---|---|---|
| HBF | 92.8% | RT Health | 93.5% |
| CUA Health | 92.5% | ACA | 92.8% |
| Phoenix | 92.2% | Doctors Health | 92.4% |
| HCI | 91.8% | TUH | 91.9% |
| NIB | 91.8% | Reserve Bank | 91.6% |
Which health funds pay the most back in total on Extras claims?
Extras claims are lifestyle benefits that health insurance can cover outside of private hospital, like dental, optical, physiotherapy etc. The following tables demonstrate last year’s best health funds regarding the average amount covered across all extras claims. Once again, this is a national average, and each health insurer performs differently in each State.
Which health funds paid the most back on Extras last year?
| Open Funds | % Extras Benefits Paid | Restricted Funds | % Extras Benefits Paid |
|---|---|---|---|
| St Lukes | 57.3% | Reserve Bank | 71.2% |
| NIB | 57.2% | Police Health | 67.2% |
| Health Partners | 56.9% | ACA | 56.2% |
| HBF | 56.3% | Doctors Health | 53.7% |
| Phoenix | 54.1% | TUH | 52.8% |
Conclusion
We’ve learned today that different health insurance companies excel in different areas. The best health insurance in Australia is not dictated by the great numbers we’ve shared above, however, comes to down knowing how to match a great policy with excellent benefits to the unqiue health needs of the person applying.
The health requirements of the applicant, the frequency of visit on extras, the state or region they reside, and the health practices they choose to attend for treatment all have a significant bearing on which health insurance might be best at any one time.
This is why getting clear and trustworthy health insurance advice is of paramount importance. Contact us for a 100% free health insurance comparison and we’ll take the time to help you find an excellently matched policy.
