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Data reveals Aussies in a world of confusion as 30 June looms large

4 min read
16 Jun 2015

Benefits, Gap Fees and costs top the list of worries as health

cover deadline approaches


Three-quarters of Australians are not aware of the benefits they’re entitled to in their private health policies, research has found. On top of this, a quarter (26 per cent) don’t know the Private Health Insurance rebate exists and 45 per cent do not understand how it works[1]. As 30 June approaches, one thing is clear: confusion abounds around health insurance, making it vital that Australians get the facts.

Consumer advocate regularly surveys Australians with and without health insurance and in the last 12 months the company’s data shows many Aussies simply do not understand their health policies. The top five areas of confusion are:


  1. 3 in 4 Australians with health insurance are clueless as to what to claim
    Three-quarters (77 per cent) of Australians with private health insurance are not aware of the benefits they are entitled to.[2] Abigail Koch, spokesperson at says, “We often speak with customers who are paying $3500 a year in health insurance costs, and yet they don’t know they’re paying for joint replacement or gastric banding, for example. To reduce premiums, we recommend consumers eliminate coverage for treatments they don’t need.”
  2. 1 in 5 Australians with health insurance are confused by information overload
    When asked how much information they received from health insurance providers prior to buying a policy, nearly a quarter of respondents (23 per cent) said they received too much information that was difficult to understand. “If you’re confused about your policy then give your health fund a quick call. You’re the customer and they’re obliged to talk everything through with you to ensure you’re comfortable with the service you’re paying for,” says Abigail.
  3. We’re unnecessarily paying tens of millions in gap fees
    In the first quarter of 2015, Australians forked out $152 million in medical gap fees[3], despite having private health insurance. However, gap fees can largely be avoided or reduced by using doctors that have gap cover agreements with your health fund. Abigail says, “The first step is to seek the list of healthcare providers with gap cover agreements from your health fund. If you go with one of these providers your fund will pay all of their charges.”
  4. 1 in 2 Australians with health insurance don’t research before buying
    Nearly 1 in 2 people (48 per cent of respondents) don’t research their policies before purchasing them. Of these, 27 per cent said they allowed someone else to choose policies on their behalf, while another 21 per cent just called a well-known insurance brand and let them choose their policy for them. Abigail says, “Private health insurance isn’t cheap so make sure you’re getting real value from your policy. Request your annual claims statement to find out what you claimed over the last 12 months. If your claimable benefits were much lower than the premium you paid, then it’s time to think about switching to a policy that’s more relevant to your needs.”
  5. Half of Australians with health insurance may have unsuitable policies
    In a recent survey, nearly half of respondents with private health insurance (49 per cent) said they hold a form of basic cover but were unable to say their policy is the best for their circumstances. Abigail says: “With premiums increasing by an average 5.72 per cent over the last five years, many consider policies unaffordable. However, the reality is, avoiding cover now could lead to a hefty bill if you need medical treatment in the future.”


All research figures can be supplied in full and the results come from separate surveys completed by Australians with and without health cover and were carried out for in the last 12 months.

[1] An independent survey carried out by Pure Profile on behalf of The 622 respondents were individuals living in Australia with private health insurance. Questions answered online by approximately 40% males / 60% females from all Australian states (80% in NSW, Vic and Qld). Respondents were an equal split of singles without kids, young couples preparing for a family, families with young kids, families with older kids and empty nesters.

[2] An independent survey carried out by Pure Profile on behalf of The 1011 respondents were individuals living in Australia with private health insurance. Respondents were an equal ratio of male to female, aged over 18 years old.  Respondents were representative of the Australian population NSW (33%), VIC (26%), QLD (17%), WA (11%), SA (8%), TAS (2%), ACT (2%) and NT (1%).

[3] Australian Government Quarterly Gap Payment and Medical Benefits Statistics March 2015

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