Do you need to update your private health cover?

Updated February 2023 | 5 min read
Words by Bonnie Bayley

Get the most out of your cover by making sure your private health insurance is right for you and your life stage. 

Whether it’s a long-term relationship, a growing family, a health condition or the kids leaving home, a change in your lifestyle or life stage can change what you need from your private health cover.

Even if your circumstances haven’t changed for a couple of years, your health needs might have.  

“It’s wise to review your cover every two years as individual circumstances can change,” recommends Belinda Williams, head of contact centre operations at HCF.

Here are some key times in life when your private health insurance might need a review.

You’re now in a long-term relationship

If you’re both on separate policies, you may want to consider taking out couples cover (or family cover if one or both of you already have kids). The benefits are less paperwork and access to each other’s information (handy if one of you goes into hospital). Plus, if either of you has lifetime health cover loading, it gets averaged between you both.

But if you have different healthcare needs (for example, one of you enjoys using extras and the other doesn’t), sticking to two singles policies can be a better option so you can tailor your policy to your individual needs.

“We’d suggest you call us or come into a branch, so we can discuss your needs, and recommend the cover that best suits you,” says Belinda.

You’re planning a family

There’s generally a 12-month waiting period for pregnancy and birth-related services on hospital cover and this is usually included in higher tier hospital policies.

All private health insurance hospital cover is ranked by tiers: gold, silver, bronze and basic, where gold is the top level of cover.

So, if you’re thinking about having a baby, and want to go to a private hospital, you’ll already need to be on, or upgrade to, a policy that covers pregnancy before falling pregnant. This means you’ll need to have pregnancy cover for 12 months before you go into labour, which can happen earlier than your estimated due date.

“The medical cover itself kicks in only at the point you’re admitted to hospital to deliver the baby; private health insurance can’t cover outpatient services like doctors’ visits, ultrasounds or anything that happens outside the delivery,” says Belinda.

If you want your baby covered from birth, you can add them to your cover within two months of them being born.

As your kids grow

As your children move into primary school and become teenagers, their health needs can change too.

“You might find initially that you want to use your cover for things like swimming lessons for a younger child with asthma; then, when they move to secondary school, they might need orthodontics,” says Belinda.

Health services that may be included, like dental, speech therapy, podiatry, physio and prescription glasses, are all things to consider, depending on your kids’ needs.

You're no longer in a relationship

There’s a lot to think about when a long-term relationship ends, and while your health cover may not be the first item on your list, you will need to separate your cover from your ex-partner, and possibly take out singles or single parent cover instead.

Single parent families may get a discount (around 20% of the family rate) on hospital and extras cover on certain levels of HCF cover. Our team can talk you through your options to make sure you find the right cover for your new family circumstances.

From kids to adult dependants

When your children turn 22, they need to be single (not married and not in a de-facto relationship) and studying full-time to stay on your HCF family policy for no extra cost. If they meet those requirements, they can stay on your policy until the day before they turn 31. If they’re not studying full-time, they can stay on your policy for an additional loading to your family’s current premium.

You’re getting older

Getting older or retiring are milestones that may merit a health cover review. It’s a good time to think about your changing health needs and priorities, and what you may need down the track.

“When you’re older, you may need things like hip replacement coverage, cataract removal or coverage specific to kidney issues,” says Belinda.

So, it may be worth considering a higher level of hospital cover.

You have a health condition

If you’re diagnosed with a health condition, your private health cover could help cover the costs, give you more choice of hospitals and doctors and get you treated sooner. Depending on your current hospital cover and new care needs, you might want to upgrade your policy, which could mean serving a 12-month waiting period.

But, if you’ve just been diagnosed with a health condition, it's worth calling your health fund to discuss your needs and if you're eligible for immediate cover.

“Even if we can’t cover any initial procedures, we may be able to help with subsequent procedures, and it may be that you need ongoing medical care,” says Belinda.

Your income goes up

If you’ve reached a new income level lately, it’s important to know that as your salary increases you may need to pay an extra Medicare levy (on top of the 2% you already pay) if you don’t have an appropriate level of private hospital cover.

It may even be cheaper for you to pay for hospital cover than to pay the extra tax, and you may also qualify for a government rebate on your premiums to help you pay for it – plus you’ll have private hospital cover there for you if you need it.

The income amounts can depend on several factors, but you can calculate yours on the ATO website, or call us on 13 13 34 to talk about whether the levy might affect you.

Your income goes down or cost of living stress kicks in

Life can take unexpected turns at any time. You may have lost your job or are struggling with the rising cost of living and looking for a way to stick to a new budget. We understand that it happens – and we’re here to help. Get in touch with our team who can work with you to help you get the best value out of your health insurance.

Waiting periods

Waiting periods must be served before you can claim for a service – and there’s waiting periods for both hospital and extras services.

They apply if you’re a new member or if you rejoin after a break in cover. They may also apply if you’re an existing member and you upgrade your cover. If you’ve upgraded your cover, you’ll only need to serve waiting periods for services you weren’t previously covered for.

If you switch to HCF cover from another fund within 30 days, you won’t have to re-serve any waiting periods (except for hearing aids) for benefits you were previously covered for.

If you have a pre-existing condition, you may have a 12-month waiting period before you’re eligible for any benefits for hospital treatment. But for psychiatric care, rehabilitation and palliative care, you only need to wait two months.

To check your cover is right for you, call us on 13 13 34 or visit a branch.