COVID-19 Health Insurance FAQs

Answers about COVID-19 (coronavirus) and health insurance

How does the current pandemic situation affect private health insurance? We’ve compiled answers to some of the questions we’re receiving from customers. The situation is evolving, so we’ll keep this page up to date with new information as it is released.

COVID-19 Health Insurance FAQs

What should I do if I don’t have health insurance?

If you don’t have health insurance, it’s important you thoroughly weigh up your individual healthcare and financial circumstances to see if it could be a good option for you – particularly during these uncertain times.

The majority of private health insurers are now covering COVID-19 in all levels of hospital cover (i.e. Basic to Gold), provided you have served the required waiting periods. Depending on the insurer, it’s common for new health insurance customers to sit up to a two-month waiting period before they claim on any services in their hospital cover. It’s standard practice across all insurers that you need to sit a 12-month waiting period before you can claim treatment for pre-existing conditions.

Health insurance may also help alleviate the strain on the public system, now that the Australian Government’s suspension on some elective surgeries is set to be lifted on the 28th of April 2020. With an appropriate level of cover, you may be able to access some elective surgeries sooner compared to if you didn’t have cover, along with your choice of doctor (if they’re available) by going private.

If you’d like to talk through your options, call our team of friendly health insurance professionals on 1800 931 635. Alternatively, see what options are available on our panel by visiting our comparison service.

Last updated 21/04/2020

Which clinical category does COVID-19 come under?

COVID-19 does not fall under any clinical category. Instead, the majority of insurers, including all on our panel, are covering any COVID-19-related treatment no matter your level of hospital cover.

Last updated 31/03/2020

Do I need to contact my fund if I get diagnosed with COVID-19?

If you’re unsure if your insurer covers treatment for COVID-19, then we recommend you call them to find out your coverage before you’re treated as a private patient.

If you had just taken out a health insurance policy before you were diagnosed with COVID-19, you might like to ask your insurer if you’re still within your waiting period. You typically need to serve a waiting period before you can claim on your policy. However, your insurer might have altered this requirement, so it’s best to ask the question.

Last updated 31/03/2020

Is the Australian Government Private Health Insurance Rebate still changing on 1 April 2020?

No, changes to the Private Health Insurance Rebate have been delayed until April 2021.

Last updated 31/03/2020

Do I need to re-sit my waiting periods if I suspend my policy on one of the financial hardship programs?

Depending on your insurer, you may need to re-sit waiting periods if you suspend your cover via your insurer’s financial hardship program. What these waiting periods could look like will again depend on your insurer.

We recommend you contact your insurer directly to discuss your options if you are struggling with financial difficulty.

Please note that you won’t be able to claim on any of the services or treatment on your policy during the suspension period.

Last updated 31/03/2020

How do I find out which health insurers aren’t increasing premiums on 1 April 2020?

Call and speak to our health insurance professionals on 1800 931 635. All health insurers on our panel are delaying the annual health insurance rate rise by at least six months – and a further extension will be considered closer to that time.

Last updated 31/03/2020

Is my hospital excess waived if I’m admitted to a private hospital for COVID-19?

Many insurers require you to pay an excess when you claim on your policy for treatment. At the time of writing, many insurers will likely require you to pay the agreed-upon excess amount, as outlined in your policy brochure.

Also keep in mind that some insurers require you to pay a co-payment, as outlined in the policy Product Disclosure Statement. Co-payments may be payable for each day you’re admitted as a private patient.

Last updated 31/03/2020

Which services can I still access under my extras policy during COVID-19?

As is always the case, the out-of-hospital services and treatment you can access under your extras policy will depend on:

  1. your level of extras cover; and
  2. if you’ve served any applicable waiting periods on your policy.

As a consequence of the COVID-19 restrictions, you may also need to ask whether or not your healthcare provider can treat your condition at this time.

For example, you may be able to access subsidised treatment from your physio if this service is listed on your extras policy and you’ve served any waiting periods. However, depending on COVID-19 restrictions that apply in your local area, your appointment may be held over the phone or via videoconferencing (if clinically appropriate). This is called a telehealth appointment.

To help ease financial pressure on Aussies, insurers are covering such telehealth appointments for allied health services like physiotherapy, psychology and chiropractic.

When it comes to dental care, restrictions are dialling back from Level 3 (for more urgent dental care) to Level 2, which permits a greater range of services, like examinations, non-invasive fillings and hand scaling.[i] This change takes effect from 27 April,[ii] and you’ll be able to claim on these services, up to the limits of your extras policy.

For optical care, some optometrists are still holding in-store consultations for more crucial needs, as well as online tests.

Depending on your extras policy, you can also continue to access rebates on medication that isn’t listed on the Pharmaceutical Benefits Scheme (PBS) – a government scheme that subsidises certain medication.

If you’re unsure if your extras policy is providing value for your money during these times, chat to our health insurance professionals on 1800 931 635, or compare extras policies on our free online service.

[i] Australian Dental Association. ‘ADA DENTAL SERVICE RESTRICTIONS IN COVID-19’. Last updated 25 March. Date accessed 23 April 2020.
[ii] Australian Dental Association. ‘The Prime Minister has announced a move back to Level 2 restrictions Level 2 restrictions [sic], effective 27 April’. 21 April 2020. Date accessed 23 April 2020.

Last updated 23/04/2020

What happens if I’ve prepaid my policy?

If you’ve prepaid your health insurance policy, we recommend you contact your insurer directly to understand which options may be available to you.

Last updated 31/03/2020

What is the value in having private health insurance during the pandemic?

In these ever-changing circumstances, some Aussies are wondering how their health insurance could still help them during the COVID-19 pandemic.

To help cut through the noise, we’ve broken down how health insurance could still offer value.

Hospital cover for COVID-19

While COVID-19-related emergency treatment is being managed through the public system, Aussies with COVID-19 can still select to be treated as a private patient if they need a choice of doctor, according to Private Healthcare Australia’s Dr Rachel David*.

In fact, all of the health insurers on our panel now cover COVID-19, no matter your level of hospital cover (i.e. Basic to Gold), provided you have served any applicable waiting periods (as explained under Will I need to serve waiting periods for COVID-19?).

Access elective surgery sooner

All non-urgent elective surgeries in both public and private hospitals were previously suspended, to allow hospital staff to allocate and preserve vital resources to deal with the pandemic. In good news, these restrictions have been eased and you will be able to access some elective surgery options after Tuesday April 28, 2020, in both public and private hospitals.

This will include the following procedures:

  • All IVF
  • All screening programs where they have ceased
  • Post cancer reconstructions, including breast reconstruction, dental procedures like fitting dentures, braces, non-high-speed drilling, and basic fillings
  • All procedures for children under the age of 18
  • All joint replacements including knees, hips, and shoulders
  • All cataract and eye procedures
  • Endoscopy and colonoscopy

Dr David explained that the public system would likely face a ‘bottleneck of non-emergency surgery’ once this crisis has passed*. If you hold private hospital cover, you could help not only alleviate this strain on the over-burdened public health system, but you could also access treatment sooner through the private system as you get to avoid lengthy public hospital waiting lists.

Prior to the impacts of COVID-19, private hospitals were catering for 60% of the elective surgeries in Australia, so we know that insurance will play a pivotal role in catering for those in need of elective surgeries now that they’re becoming available again.

Please note: If you cancelled or downgraded your hospital or extras cover while all non-urgent elective surgery was restricted, you may need to re-sit any applicable waiting periods for you to claim on any treatment and services you had lost.

You can still access emergency surgery

You’re still covered for emergency surgery in a private hospital. Dr David said this includes ‘private admissions for essential surgery, medical and mental health care’*.

Dr David also reiterated that crucial treatment for health conditions like ‘heart attacks and acute appendicitis does not stop because of the current situation’.

Emergency dental treatment and funding for telehealth services

When it comes to the value of extras policies (i.e. insurance that covers some out-of-hospital services), insurers are:

  • continuing to provide access to and reimburse critical dental care up to the limits of your cover;
  • covering telehealth services from psychologists, as well as several other telehealth services, like physiotherapy, where clinically appropriate*; and
  • continuing to cover some medication that isn’t listed on the Pharmaceutical Benefits Scheme (PBS) – a government scheme that subsidises certain medication.

What is being done to make private health insurance more affordable?

As private health insurance is critical in relieving pressure on Australia’s public healthcare system, health funds and the government are doing all they can to assist Aussies during this difficult time.

Affordability measures being taken include:

  • delaying the annual 1 April premium increase for at least six months;
  • delaying changes to the Australian Government Private Health Insurance Rebate to April 2021 (this could have reduced your rebate, and in turn, increased your premiums);
  • offering hardship programs so you can still maintain cover during this difficult time.

Last updated 21/04/2020

  • *Private Healthcare Australia. ‘Health funds welcome Government’s private hospital guarantee’. 31 March 2020. Date accessed 31 March 2020.
  • *Private Healthcare Australia. ‘Health funds back private hospital capacity guarantee’ 29 March 2020. Date accessed 31 March 2020.
  • *Private Healthcare Australia. ‘Health funds welcome Government’s private hospital guarantee’. 31 March 2020. Date accessed 31 March 2020.
  • *Ibid.

If I can get cover for COVID-19 on any hospital policy, why should I hold a higher level of cover (i.e. Silver or Gold)?

While all of the health insurers on our panel are now covering COVID-19 no matter your level of hospital cover, it’s important you still consider your other healthcare needs when reviewing your policy.

For instance, you might be on a waiting list for a knee replacement – cover that’s found in Silver Plus and Gold policies. Now that the Australian Government’s suspension on some elective surgeries (including all joint replacements) is set to be lifted on the 28th of April 2020, you could be treated sooner if you hold the right level of cover. Why? Because private cover allows you to avoid public waiting lists, which are typically longer than private ones.

As such, you can avoid what Private Healthcare Australia’s Dr Rachel David refers to as ‘the bottleneck of non-emergency surgery [in the public system] that will undoubtedly follow this crisis’.*

If you were to drop or downgrade your level of cover, be aware that you’d need to upgrade your cover again and re-serve applicable waiting periods of up to 12 months for pre-existing conditions. If you want to be privately covered for the services you remove, you’d need to re-serve these waiting periods before you can make a claim.

If you're considering health insurance, compare your options with us or speak with one of our health insurance professionals on 1800 931 635.

Last updated 21/04/2020

*Private Healthcare Australia. ‘Health funds back private hospital capacity guarantee’. 29 March 2020. Date accessed 30 March 2020.

Why is the private health insurance rate rise being delayed?

Many health insurers, including most on our panel, are delaying the 1 April premium rate rise for at least six months.

Private Healthcare Australia Chief executive Dr Rachel David said this move aims to help relieve pressure on customers during COVID-19.*

‘This is a continuing process and health funds will be regularly reviewing their financial position in coming months to provide as much support as possible to members,’ said Dr David.

Health insurers are also offering hardship programs to help Aussies who are struggling financially due to COVID-19.

Last updated 30/03/2020

*Private healthcare Australia. ‘Health funds Postpone 1 April Premiums Increase’. 29 March 2020. Date accessed 30 March 2020.

Why are funds increasing their policy prices in the current environment?

Health insurers do apply an annual rate rise to cover the increasing costs of hospital, medical and other healthcare-related costs, such as staff wages, complex medical procedures, equipment and technology. This rate rise typically applies to policies on 1 April each year.

However, to help protect their members’ welfare during these times of economic uncertainty, many insurers, including most on our panel, are postponing the rate rise for at least six months. Insurers may delay the rate rise even further, depending on conditions closer to that time.

Many insurers are also providing support packages and financial hardship programs*, designed to provide relief to customers from paying their premiums during these tough times.

If you’re concerned about how you could manage your health insurance premiums because of COVID-19, you should contact your insurer immediately to discuss your options.

If you're considering health insurance, compare your options with us or speak with one of our health insurance professionals on 1800 931 635.

Last updated 30/03/2020

  • *NIB - nib offers members COVID-19 support package (2020)
  • *CUA - CUA unveils Financial Assistance Package to support members affected by COVID-19 (2020)
  • *Westfund – Coronavirus relief for members (2020)
  • *Frank - COVID-19 information for Frank members (2020)

If I’ve been diagnosed with COVID-19, does my insurer consider this a pre-existing health condition?

If you’ve been diagnosed with COVID-19 before taking out a hospital policy, your immediate treatment will be provided via the public system. Most private hospital health insurance providers apply a 12-month waiting period for pre-existing conditions – which includes treatment for any condition having shown signs or symptoms within six months of taking out the policy.

The insurer determines what they deem a pre-existing condition with the help of an independent medical expert.

Last updated: 30/03/2020

Does health insurance cover COVID-19?

All the private health insurers on our panel now cover COVID-19 in their hospital policies, no matter which tier you’re on (i.e. Basic, Bronze, Silver or Gold).

Private health insurance may also help you avoid public waiting lists for elective surgeries in a time where the hospital system is expected to be placed under significant pressure. Having private cover for these treatments may mean you can be admitted for such surgeries sooner, once some elective surgeries re-commence after April 28th, 2020.

If you have any other questions, our health insurance professionals are available to assist. Simply call 1800 931 635. If you're considering health insurance, compare your options with us.

Last updated: 21/04/2020

If I buy health insurance now, when will I be covered for COVID-19 as a private patient?

You will be covered for COVID-19 hospital treatment once you have served any relevant waiting periods.

If you are already infected, your immediate treatment will be given via the public system, as most private hospital insurance providers apply a 12-month waiting period for pre-existing conditions.

Call and talk to our private health insurance professionals and they can review your options on 1800 931 635.

If you're considering health insurance, compare your options with us.

Last updated: 30/03/2020

Can my insurer cancel or refuse to renew my insurance policy if I am diagnosed with COVID-19?

No. If you have served any relevant waiting periods, and you have the appropriate level of private hospital insurance, your insurer will honour your policy and help pay for the cost of your treatment as a private patient. Health insurance is community rated, which means it doesn't discriminate based on your age or health status when it comes to (a) how much it costs, and (b) which treatments and services you wish to claim on.

If you're considering health insurance, compare your options with us or speak with one of our experts on 1800 931 635.

Last updated: 30/03/2020

Does my hospital insurance policy cover COVID-19?

The good news is the majority of health funds, including all of the brands on our panel, now cover COVID-19, regardless of whether you’re on a Basic, Bronze, Silver or Gold policy.

If you're considering health insurance, compare your options with us.

Last updated: 02/04/2020

Will my health insurance policy cover GP visits and tests for COVID-19?

Health insurance will not pay a benefit towards GP visits and tests outside of the hospital setting.

Medicare will assist with the cost of GP visits and COVID-19 tests. Get in touch with Medicare directly to learn more, or call the Australian Government's National Coronavirus Helpline (1800 020 080).

Last updated: 30/03/2020

Will I need to serve any waiting periods for private health insurance before I can be treated for COVID-19?

You may need to serve waiting periods before you’re admitted as a private patient if you’re taking out a hospital policy for the first time or, potentially, if you’d had a gap in your cover.

If you’re new to health insurance, you’ll typically need to wait two months for non-pre-existing conditions before you can claim on any services and treatment. Also, keep in mind that you may need to wait up to 12 months to claim on pre-existing medical conditions.

Many health insurers, including all of those on our panel, are now covering COVID-19, whether you have a Basic, Bronze, Silver or Gold policy. If you’ve already served any applicable waiting periods, you’ll be able to claim on your COVID-19 hospital treatment if you’re admitted as a private patient.

If you have any other questions, our health insurance professionals are available to assist. Simply call 1800 931 635. If you're considering health insurance, compare your options with us.

Last updated: 02/04/2020

What level of health insurance do I need to cover COVID-19?

All of the insurers on our panel are now covering COVID-19 no matter your level of hospital cover.

When choosing which level of hospital cover is right for you, you need to also consider your other healthcare needs.

Our comparison service can help you differentiate between the recently-created ‘tiers’ of coverage (Basic, Bronze, Silver, Gold) when getting a health insurance quote, or you can find more information about these reforms here.

If you have any other questions, our health insurance experts are available to assist. Simply call 1800 931 635. If you're considering health insurance, compare your options with us.

Last updated: 02/04/2020

If I need to be quarantined, will my health insurance cover me?

Currently, those patients being quarantined are being managed via the public health system, with health professionals determining if they will be sent to a hospital facility, ordered to quarantine at home, or in another facility.

If you are admitted into hospital as a private patient, you may be covered for COVID-19-related treatment. In fact, all of the health insurers on our panel are now covering COVID-19, no matter your level of hospital cover, provided you have served any applicable waiting periods.

It is standard across funds that if you’re new to health insurance and have taken out a hospital policy, you may have to wait a period before you can claim on any health costs. This also applies to any COVID-19 claims.

Waiting periods do vary; however, your health fund may ask you to wait at least two months for non-pre-existing conditions before you can claim on any COVID-19 hospital treatments as a private patient.

If you're considering health insurance, compare your options with us or speak with one of our experts on 1800 931 635.

Last updated: 02/04/2020

Is there anything else that I should be thinking about?

For many of us, it's likely that our budgets will be tight for a while. In times of economic uncertainty, reviewing your household bills can provide confidence that you’re not overpaying.

Reviewing your options for products like car insurance, energy, home insurance and even petrol prices through Compare the Market is free and only takes a few minutes for each.

Visit our homepage to get started.

Last updated 30/03/2020

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