Ultrasound Examination In Doctors Office
Ultrasound Examination In Doctors Office

Australia’s stingiest health funds revealed


SECRET health fund benefit lists reveal some insurers are paying up to $730 more than their rivals for common surgeries proving not all health fund policies provide the same value.

The Australian Medical Association has compared the rebates major health funds provide for 21 common procedures including obstetrics, coronary surgery and hip replacements in their annual Private Health Insurance report card.

It shows health fund NIB has among the lowest rebates for most of the procedures paying just $3140 for coronary artery bypass - $731 less than the benefit paid by Australian Health Service Alliance ($3871).

Across the board, health funds HCF and HBF have among the highest benefit payouts.



The report also shows the amount your health fund pays in benefits also varies by state with BUPA paying 32 per cent more for chemotherapy treatment in Tasmania than in Victoria.

The percentage of medical services delivered with no gap fees to health fund members also varies with just two in three NIB members in the ACT facing no gap treatments while over nine in ten NIB members in South Australia pay no gap.

The benefits a health fund pays is a key driver of out of pocket expenses faced by patients and lower benefits can mean they face a gap payment not covered by health funds.

The report comes as the AMA and a range of health bodies warn the government it must act with increased subsidies and other measures to shore up health insurance which is in a death spiral of declining membership and rising premiums.


Nib Managing Director Mark Fitzgibbon’s health fund pays among the lowest benefits. Picture Hollie Adams
Nib Managing Director Mark Fitzgibbon’s health fund pays among the lowest benefits. Picture Hollie Adams


An IPSOS survey for by the Department of Health and Private Healthcare Australia found half of all Australians who used a private hospital paid gap fees averaging $1000, one in 50 people had gaps over $10,000.

"The report card reveals that the same doctor performing the same procedure can be paid significantly different rates by each fund," AMA president Dr Tony Bartone said.

"This is often the untold story behind patient out- of- pocket costs," he said.

The AMA is demanding a government website that will list doctors fees also show the benefits each health fund contributes so consumers can shop around for the best insurance deal.


HCF pays its members some of the highest benefits. Picture supplied.
HCF pays its members some of the highest benefits. Picture supplied.


NIB chief Mark Fitzgibbon told News Corp his fund had not increased the rebates it paid its members at all in the last year.

"We check what other insurers are paying and we think the schedule is fair and competitive," he said.

NIB and Medibank are piloting new programs to provide gap free hip and knee replacements to members. NIB has signed up 12 doctors in Newcastle, NSW, who provide the surgery at no cost to NIB member.

Health Minister Greg Hunt said his Department is reviewing private health insurance and working with stakeholder groups on potential further improvements for private health insurance.

"Potential areas for reform include regulatory changes that better facilitate care being provided in different settings where it benefits the consumer," a spokesman said.

Opposition health spokesman Chris Bowen is calling for a root and branch inquiry into health insurance.

"Greg Hunt arrogantly sits paralysed on taking action, while premiums for health insurance soar and consumers continue to walk away," he said.