Having private health insurance isn’t just about covering medical bills when you’re sick – at least not for everyone. Some people look for policies that also promote preventative health measures, especially if they have rebates for gym memberships, wellness programs and other lifestyle benefits. Insurers use these perks as a way to keep members with the company. Not only that, but healthier policyholders can reduce the likelihood of having to pay out medical claims in future.
If you’re wondering what type of benefits you might be able to claim through your health insurance – whether that’s gym memberships, wellness programs or something in between – read on for everything you need to know.
Why do health insurers cover gym memberships and wellness programs?
The logic is simple: healthier members are less likely to make expensive claims. Encouraging policyholders to keep up their fitness and wellness levels means health insurers benefit from fewer payouts while their members enjoy better health. It’s a win-win.
Programs that support physical fitness and overall wellbeing are seen as investments in your long-term health, especially if they can reduce the risk of chronic conditions like obesity, heart disease, diabetes and more.
Moreover, these benefits align with the growing notion of preventative healthcare in Australia. As the adage goes, prevention is better than cure, and insurers are bundling together more perks to support this philosophy.
What types of wellness benefits are available?
Here’s a breakdown of some of the most common wellness benefits you might be able to find through various extras policies:
1. Gym memberships
Depending on your policy, some health insurers will let you claim a portion of your gym membership fees. However, to actually use this benefit you’ll typically need a referral from your GP or other relevant health professional – they will confirm that gym attendance is necessary for managing a specific health condition you have, such as diabetes or cardiovascular issues.
- Eligibility criteria: You may need to complete a health management form signed by your doctor.
- Limits: Policies will have annual caps on gym membership claims. For example, you might be eligible to claim up to $300 annually, depending on your policy.
2. Fitness classes
Alongside gym memberships, some policies include group fitness classes like yoga, Pilates, swimming and aquarobics. These can be great for people who are managing specific health conditions requiring low-impact or therapeutic exercise.
3. Personal training
If you prefer one-on-one sessions, some health funds may cover a portion of your personal training costs. Similar to gym memberships, a referral from a health professional will be required, and your trainer must be registered with your health fund.
4. Weight-management programs
Programs like Weight Watchers, CSIRO Total Wellbeing Diet and other structured weight-management initiatives can also be claimable under certain extras policies – aimed at helping people manage their obesity-related health issues.
5. Health screenings
Many health insurance policies will cover screenings like skin-cancer checks, bone-density tests, mammograms and more. While not directly related to fitness, they can play a factor in your overall wellness by catching serious health problems early.
6. Disease management
Some policies also have financial support for disease-management subscriptions with organisations that run programs for diabetes, cardiac, mental health and orthopaedic-related issues.
7. Stress management and mental wellness
Beyond the physical health benefits, some policies will include rebates for stress management programs, hypnotherapy or counselling services, which are particularly valuable for managing your mental health.
How much can I claim for gym memberships and wellness programs?
As you might expect, the total amount you can claim will depend on your health fund and the level of cover you choose. Insurers generally apply three types of limits:
- Annual limits: The maximum amount you can claim per year for all services within a specific category, such as lifestyle benefits.
- Sub-limits: The maximum amount you can claim for a specific service, such as gym memberships.
- Lifetime limits: The maximum amount you can claim over the course of your life. Once it’s maxed out, you won’t be able to claim any further benefits, even if you switch health funds.
For example, your health fund might allow for a $500 annual limit on lifestyle benefits, with a $150 sub-limit for gym memberships. Check your policy’s PDS to better understand the exact limits that apply to you.
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”
What should I look for in a policy with wellness benefits?
1. Eligibility requirements
Not all gym memberships or wellness programs are automatically eligible for rebates. Insurers might require that you provide:
- A referral from a GP or health professional.
- Proof that the service is part of a health management plan for a diagnosed condition you have.
- Membership at a gym or facility recognised by the insurer (i.e. within their network).
2. Waiting periods
Extras policies will have waiting periods for certain services, which you will need to see out before you can claim any benefits. You might be on the hook, for example, for a six-month waiting period that applies to gym memberships or weight-management programs.
3. Provider recognition
Health funds typically require that gyms, personal trainers or wellness program providers be registered with them. If your preferred provider isn’t recognised, you might need to find an alternative or look at comparing and switching funds.
4. Policy inclusions
Look for policies that include other extras you’re likely to use (e.g. good dental or optical benefits in an extras policy). That way you can get the most bang for your buck.
How to claim gym memberships and wellness benefits
- Get a referral: If required, get a health-management form from your insurer and have it completed by your GP or other health professional.
- Check your fund’s network: Make sure that your preferred gym, trainer or program is recognised by your health fund.
- Keep receipts: Always have valid receipts for any claimable expenses, as you’ll need to submit these with your claim.
- Submit your claim: Most insurers will let you make a claim through their app or online portal. Otherwise, you can send everything to them via post. Just remember to include all the required paperwork.
Are there any exclusions?
Yes, not all wellness-related expenses will be covered, even in the most comprehensive policy. Some common exclusions you can expect include:
- Casual gym visits or trial memberships.
- Joining fees or bundled gym passes.
- Exercise equipment or home-gym purchases.
- Recreational classes like martial arts or dance (unless specifically prescribed by a health professional).
Always check the fine print so you aren’t surprised when it’s time to make a claim.
Why gym memberships and wellness benefits are worth considering
Let’s say you have an annual gym membership at $1,000. If your private health insurance partially covers it by up to $300 (annual limit), then your out-of-pocket costs are reduced to $700. You might also be able to claim benefits on other fitness classes or personal training sessions too, which could help you hit your health goals faster – and without breaking the bank.
Beyond the financial savings, these benefits will also encourage you to live a more active, healthier lifestyle, which could reduce your need for expensive medical treatments in the years ahead.
Conclusion
Depending on what you want from your private health insurance policy, gym memberships and a range of wellness programs could more than make up for the cost of your premiums.
While not all policies include these perks, finding one that matches your lifestyle and health goals can be a huge contributor to your overall wellbeing. You can start comparing health insurance with Fair Health Care Alliance today.
