7 Most Important Terms to Consider for Australia Health Insurance Plan

Important Terms to Consider for Australia Health Insurance

When it comes to the matter of health insurance in a foreign country like Australia, it is required to follow some important terms and conditions. Undoubtedly, Australia has one of the highest standards of living in the world, ranking seventh on the Human Development Index (HDI). It makes sense why expats adore it.


There are over 30 companies in Australia that provide a wide range of the top health insurance plans. Every plan has a distinct set of features that make it stand out from the competition. So, if you are searching for a health plan in such a situation, the options might overwhelm you.


The Australian healthcare system is categorized into two divisions; public and private health care systems. Each system has its own pros and cons, so choose one that suits your preferences and needs best. Public healthcare system offers services through a variety of channels, such as community-based services, public hospitals, and connected health organizations. Since 1984, the Australian Government has been offering healthcare services in Australia through a national health care program, Medicare.


Moreover, there are numerous health care providers that are operating recently in the country through pharmacies, specialty medical and allied health clinics, and private hospitals. Both public and commercial organizations provide funding for these services.


So to benefit from these plans, you must know about the important terms to consider for an Australia health insurance plan. It will save you from a lot of trouble. Get ready to explore 7 most important terms to consider for an Australia health insurance plan.

List of 7 Important Terms to Consider for Australia Health Insurance

Here I’ve shortlisted the most important things to consider before applying for an Australia health insurance;

  1. Coverage benefits
  2. Premium amount
  3. Deductibles
  4. Waiting periods
  5. Copayment or Coinsurance
  6. Sum Insured
  7. Exclusions

Let’s discuss them step by step to have a clear understanding.

1. Coverage Benefits

Are you one of those who just want to purchase a cheap international health insurance policy? If so, you need to reconsider it. The coverage features that each plan offers should be your first concern. Even though the majority of health insurance plans provide the essential coverage benefits, look for the plans with distinctive characteristics according to your needs and preferences. Consider these important terms before applying for an Australian health insurance plan.

  • The first and foremost thing to do is determine what coverage you actually need first, and then search for those types of health insurance plans that can provide it. For example, if you intend to have a child soon, search for plans that provide maternity coverage. Alternatively, don’t bother with such arrangements if your family is complete.
  • Secondly, search for any features that could expand the coverage area. Some things to note here include value-added advantages, yearly health check-ups, substantial no claim bonus, and sum insured restoration.
  • Ask your insurance provider about some of the incentives including pre- and post-hospitalization, network hospitals, daycare facilities, free health examinations, maternity benefits, the amount of money for claims, etc. 
  • Select a plan with the broadest range of coverage available. This would improve your financial stability and reduce the amount of money you have to pay out of pocket when filing claims.


2. Premium Amount

Determining the premium is one of the most important terms to consider for Australia health insurance plan. It is the amount you have to pay to maintain your health insurance coverage. Each insurer uses a different set of criteria and factors to calculate the premium amount, therefore you must understand how much you can afford to spend on your insurance. If you don’t pay the premium, your insurance will be canceled. 

Comparing the premium amount of different health insurance coverage plans of different companies is important for having a better understanding. Therefore, compare the premiums of several insurance companies that offer similar benefits. Examine whether the premium, considering the coverage, is reasonable or not. Then, select a company that offers a competitive premium amount for the same coverage advantages as offered by other insurance organizations with a higher amount.


3. Deductible

A deductible is a set amount that policyholders must pay annually toward medical costs before their insurance company begins to pay benefits. For instance, you get a health insurance policy with an annual $1000 deductible and spend $20k for a hospital stay. Indeed, you would only have to pay $1000; the health plan would then begin to cover the remaining $19,000 in premiums in accordance with the terms and conditions of the contract.

The main goal of a deductible is to lower the amount of small claims and maintain affordable premiums through cost-sharing. Plan deductibles can be either all-inclusive for all services or different for certain critical coverage, including prescription medicines. 

Plans with smaller deductibles typically have higher premium prices but provide more extensive health insurance coverage. On the other hand, plans with larger deductibles typically have less expensive premiums. Determining the appropriate deductible amount for your budget may involve considering your personal medical issues as well as your demands for individual or family coverage.


4. Waiting Periods

The waiting period is the time frame within which a health insurance policy prohibits certain coverage. Coverage is permitted after the waiting period has passed. There are several reasons why health insurance plans have waiting periods. Among them are the following: 

  • Waiting period before bariatric procedures, OPD costs, etc.
  • Maternity waiting periods can last anywhere from nine months to forty-eight months. 
  • Waiting period for certain diseases or medical procedures, such as joint replacement, tonsillectomy, hydrocele, fissures, hernias, cataracts, etc. Usually, this waiting time lasts for 24 months. However, in some schemes, the duration may change.
  • Pre-existing waiting periods can stay from 12 to 48 months. When purchasing a new policy, there is a waiting period for any illnesses or medical issues you may have. During this time, complications resulting from pre-existing conditions are not covered.

Waiting periods are unavoidable. On the other hand, you can discover a plan with a short waiting period. This is especially important if you want to get coverage for pre-existing conditions or if you are seeking maternity coverage.


5. Copayment or Coinsurance

Co-pay, also known as coinsurance, is the set sum that the policyholder and the insurance company must share in order to access certain medical services or medications. For instance, you buy insurance that has a $20 copay for primary care physicians and a $10 copay for generic medications. You are required to pay certain predetermined amounts for those facilities, regardless of the cost. Conventional co-payment agreements are relevant in the following situations: 

  • In case of certain ailments and/or therapies.
  • In the event that the policyholder is 61 years of age or older at the time of purchase.
  • If the coverage is purchased in a lower-tier city and treatments are received in a higher-tier city.

Seek out health insurance policies without a co-payment provision. If you can’t escape the clause, as with senior citizen plans, choose a plan with a reduced co-payment cost.


6. Sum Insured

The guaranteed sum that an insurance company promises to pay out in the event when a claim is made is known as the sum insured. Your age, income level, and any add-on coverage should be taken into account when selecting a “Sum Insured” because these factors also have an impact on the premium cost. To maximize the amount insured, it is always advisable to take care of medical inflation.


7. Exclusions

It is important to review the exclusions before acquiring the policy. Exclusions are illnesses, circumstances, or conditions that the insurance company does not cover; the patient is solely responsible for paying for those services. A person may be excluded for “first year” or “permanent” reasons. Exclusions for the first year are concealed from the second year, but permanent exclusions are never covered. 

Remember that 

Purchasing health insurance alone is not enough. Make sure the plan and the health insurer you have chosen are appropriate. Thus, choose the best health insurance plan by doing your study and keeping in mind the above given elements. 

Need customized help related to Australian health insurance plans according to your specific visa category and requirements?


Get Professional Help at The Migration

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The Migration is a registered organization that has MARA-certified agents in Australia to assist immigrants with visa related issues. Whether it’s about the basic consultation or you need assistance related to lodging visa application, contact The Migration. We, understand the importance of uniqueness of each case and visa category and provide solutions accordingly. So, why wait longer when the best services are just a click away. Book an appointment now and don’t miss out the opportunity to enjoy authentic consultation at affordable prices.

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What sort of medical coverage is required for my student visa?

You need to get Overseas Student Health Cover (OSHC) in order to be eligible for a student visa to Australia. However, candidates from certain countries won’t be able to get OSHC because of unique arrangements that their governments have made with Australia. Check here to see if you are a citizen of any of these nations or not. 

What kind of health insurance do I need in Australia?

If you want to acquire health benefits at lower cost, the Australian public sector, Medicare is your go to choice. Medicare is accessible to all Australian residents and foreigners if you meet the eligibility criteria. However, waiting periods in some cases in public healthcare can be longer than in the private system.

What kind of health insurance is required for a visiting visa?

In general, obtaining a visiting or business visitor visa for Australia does not require you to have health insurance. But due to Overseas Visitors Health Cover (OVHC), you can relax on your vacation knowing that your health insurance will cover the necessary medical care you’ll probably need in Australia.


Final Thoughts

With a better understanding of the most important terms to consider for an Australian health insurance plan, it wouldn’t be stressful to choose a customized plan. Selecting the right health insurance coverage gives you the freedom to manage your expenses and medical care, as compared to enrolling in a group insurance plan that is not suitable for you. Moreover, purchasing health insurance becomes even more convenient and hassle free if you seek professional help from immigrant lawyers. You can also contact us at The Migration in order to select the best plan according to your preferences and needs.


I, Samavia Shahid, am providing guidance to aspiring Australian migrants through my blogs. I share comprehensive information regarding complex visa pathways that will guide you towards the right course of action to acquire your immigration goals.