Understanding PHI

When choosing your private health insurance, it is important to make sure it suits your particular health needs, as well as your budget.

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While our policies can help you avoid high-cost bills there are many other benefits in being a member with Hunter Health Insurance. These include:

Having greater control over your health care

With private health insurance, you can choose your own doctor and hospital.

If you have a serious medical condition, you can have greater confidence in getting the very best care in a great facility and have a higher chance of being able to have a private room in the hospital where available 

Avoid having to wait for treatment 

Depending on your needs you may have to wait for long periods to be served in the public system – particularly for elective surgery.  While the public system provides great services in emergency situations, if your condition is not life threatening you may have to wait for months or even over a year to receive your medical procedures. Private cover allows you to avoid those waits.

Benefits you can pro-actively claim on 

Unlike insurances for items like a car or house, an Extras policy can be proactively claimed on to help maintain your health. Depending on your policy, you could get money back every time you visit the dentist, physio, chiropractor, and more. 

Avoid additional taxes and higher premiums in the future 

If you earn over $93,000 per annum (single) you will likely be liable to pay the Medicare Levy Surcharge. However, the MLS is waived for those who hold an eligible private health insurance hospital cover.  For some people, taking out basic hospital cover with Hunter Health Insurance could cost less than paying the surcharge. 

Peace of mind 

The peace of mind factor cannot be underestimated. We never know what the future holds for us or our families. It’s a concept that we accept when we take out car insurance and hope we never have to use it. But if the time comes, knowing that you have the option to go private, avoid the queues and significantly reducing the potential high costs depending on your chosen level of cover puts you in the drivers seat to get the best outcomes.   

We are local

Hunter Health Insurance is here when you need us – maintaining  a local presence in the Hunter where you can pop in and discuss any of your needs face to face.  We were born in the Hunter 70 years ago and that’s where our focus remains.

With private health insurance, you can choose your own doctor and hospital.

Depending on your needs you may have to wait for long periods to be served in the public system – particularly for elective surgery.  While the public system provides great services in emergency situations, if your condition is not life threatening you may have to wait for months or even over a year to receive your medical procedures. Private cover allows you to avoid those waits.

You can’t claim your private health insurance as a tax deduction. However, you can:

  • Reduce the cost of your policy with the private Health Insurance Rebate – which is the amount the Australian Government contributes towards your premium.
  • Avoiding paying additional taxes via the Medicare Levy Surcharge – depending upon your income.

The best way to make sure that you are only paying for the Benefits you need is to talk to you Fund.  Contact us and we can walk you through the options available to make sure that your policy is working best for you and your health needs.

Adding an excess to your policy is another way to reduce the cost of your premium – talk to us if this is something you would like to consider.  Co-payments can also reduce the cost of your premium – however there are no co-payments on Hunter Health Insurance Policies.


This is an amount of money you pay towards the cost of hospital treatment, regardless of the number of days of hospitalisation.

For example – Mary, Tom and their children, Mark and Samantha have a family membership with an excess of $500. This means that they are charged a lower premium (the monthly/ annual cost) for their hospital insurance because they have agreed to pay the first $500 of hospital charges if they require hospital care.

The number of excesses you are required to pay in each financial year may be subject to a cap depending on the type of cover you have (e.g. whether you have a single or family policy).  In some cases, no excess will apply for dependant children covered by the policy.

When choosing a health insurance product make sure you understand how these excess payments apply.

If you are transferring from another Fund or changing your Hunter Health Insurance policy to alter the excess amount payable, there may be a period of time where the prior excess will continue to apply.

If you are switching to a higher excess, no waiting periods will need to be served.

If you are switching to a lower excess or removing your excess, the waiting period applicable to in-hospital services will apply to your new excess –  e.g. if the waiting period applicable to those services is twelve months, then the waiting period for the new excess will also be twelve months, even though you may not need to serve any waiting period on the Benefit or service itself due to having held that level of Benefit cover with your prior Fund or product.


A co-payment is an amount that you are required to pay towards the cost of hospital accommodation.  Hunter Health Insurance policies do not have co-payments.


The Federal Government rebate can also reduce the cost of your premiums – if you aren’t sure whether the rebate applies to your policy, contact us so that we can make sure this has been applied  correctly for your circumstances.

Federal Government rebate

The Federal Government rebate was introduced 1 January 1999 and was revised 1 April 2005 to include the Seniors Rebate scheme now giving three possible levels of rebate:

  • Federal Government rebate off your premium for members aged 64 or under
  • and additional percentage rebate off your premium for members aged 65 – 69
  • and a further additional percentage above 65 – 69 rebate off your premium for members aged 70 or over.

The Federal Government rebate on private health insurance also applies to ambulance cover.


Ways to claim

There are different ways to claim the Federal Government rebate

As a premium discount reducing your upfront cost by completing the ‘Application to receive Federal Government Rebate Form’; or
Claiming the rebate in your tax return.

When you take out health insurance you are purchasing a product (a health insurance policy) from a private health insurance organisation (a fund).

The extent of insurance cover you obtain depends upon the health insurance product you choose. The money you pay to purchase this insurance cover is called a health insurance premium. The money the fund pays for treatment you receive is called ‘benefits’.

There are two types of private health insurance cover available

  • Hospital cover

    This covers hospital related treatments as a private patient including doctor’s charges and hospital accommodation. The level of benefits you receive depends upon the product you choose.

    Explore hospital cover 

  • Supplementary (or Extras) cover

    This helps with the cost of services such as physiotherapy, dental and optical treatment that are not covered by Medicare, nor associated with a hospital admission. There are a range of options available.

    Explore Extras options

Whether you’re taking out a policy for just yourself or for your family, choosing the right policy for your loved ones and/or yourself is important.

Get a quick quote to see the various policies, benefits and pricing that may be suitable for you – or if you prefer, give us a call and we can walk you through the options.

Restricted cover is where certain services are specified as being restricted services under a hospital product and where minimum benefits are applicable.

  • In a private hospital: These benefits would not cover all hospital costs and are likely to result in large out-of-pocket expenses.
  • In a public hospital: If the minimum benefits are less than what your chosen public hospital charges, you may have out-of-pocket expenses to pay.

When you join a health fund or upgrade your existing level of hospital cover, you may have to wait some time before you can claim benefits for some services.

This is called a waiting period. Waiting periods that apply to hospital cover include:

Waiting periods on Hospital cover

12 months for treatment related to a pre-existing condition.

A pre-existing condition means an illness or condition with signs or symptoms that existed 6 months before the day on you joined or upgraded to a higher level of hospital cover.

Whether an ailment is ’pre-existing’ is determined by a medical practitioner appointed by the health fund. It is not necessary for you or your doctor to have diagnosed the condition. In making this judgement, however, the fund’s appointed practitioner may also consider the opinion of your own medical practitioner.

What does this mean?

If you have less than 12 months membership and you need hospital treatment, you should confirm with your fund whether or not the pre-existing condition waiting period applies to you. It is important you confirm your eligibility for benefits before you are admitted to hospital. Otherwise, if you proceed with your admission and your condition is subsequently determined to be pre-existing you will be required to pay all outstanding hospital and medical charges.

Funds will require you to obtain facts about your illness from your treating practitioners. So, if you have less than 12 months membership on your current hospital policy, contact your fund as soon as you know you have to go to hospital.

12 months for obstetrics (pregnancy) services

2 months for all other hospital treatments except accidents

Waiting periods on Extras Cover

Waiting periods for extras services may vary between products and between health funds. There are usually different waiting periods for different extras services.

What does this mean?

You should check the waiting periods on services carefully when choosing your health insurance fund product and you should also check the limits that apply to each person on the membership.

A pre-existing ailment or condition is an ailment, illness or condition where the signs or symptoms existed during the 12 months before you joined Hunter Health Insurance or upgraded to a higher level of cover, even though you may not have been diagnosed.

If there’s any doubt as to whether an ailment or condition is pre-existing, we will appoint a medical practitioner to examine information provided by your doctor, together with other relevant claim details.

If you need treatment for any procedures listed as an exclusion on your hospital cover, you will not receive any benefits from us and may have significant out-of-pocket expenses.

Ensure you have reviewed the exclusions list before buying your cover.

An excess is the amount you choose to pay if you are admitted to hospital for planned treatment. Depending on your level of hospital cover, you can reduce your premium by opting for a higher excess or pay a bit more to get a lower excess.  

You will not pay a hospital excess for dependent children. 

You pay only one hospital excess amount per financial year on a Single Memberships or two on a Family Memberships, if an excess is applicable to your selected cover.

A gap payment is the difference between the fee charged and the benefit paid by your health fund.

Hospital gap payments

Hunter Health Insurance has gap cover available on all its open hospital component products. This is aimed at eliminating any out-of-pocket expenses to our members. However, this is not always the case, and it is important that members obtain a quote from their practitioners, including anaesthetists or assisting surgeons, to determine if there will be an out-of-pocket expense.

Gap payments for hospital treatment can occur for 3 reasons

  1. Product choice – Gap payments will arise if you have chosen a hospital product with an excess, a co-payment, or an exclusion or restricted benefits for certain procedures.
  2. Gap payments – hospital accommodation – Some hospitals have an agreement with individual health funds to charge an agreed amount for treatment so that you will have either no out-of-pocket expenses for hospital or medical related services or you will know before-hand what costs you will bear. Gap payments for hospital accommodation can also arise if you choose to be treated in a hospital that does not have an agreement with your health fund. Wherever possible, you should always contact your fund before hospitalisation to confirm the level of benefits that will be paid.
  3. Gap payments – doctor’s fees for in-hospital services Gap payments may also arise for medical services received in hospital. When you receive medical treatment in hospital as a private patient, Medicare pays 75 per cent of the Commonwealth Medicare Benefits Schedule (MBS) fee for the doctor’s service and your health fund pays the remaining 25 per cent of the MBS fee. If your doctor charges above the MBS fee, you may have to pay the difference between the MBS schedule fee and the doctor’s fee.

Extras gap payments

Gap payments can also occur if the fee charged by your service provider such as dentist, physiotherapist or optician, is greater than the benefit paid by your fund for that service. The level of benefit health funds pay for extras services is at the discretion of health funds and is not regulated by the Government.

Some health funds impose annual limits on the benefits payable for some ancillary services. Some health funds also have agreements with extras service providers to reduce or eliminate out of pocket expenses.

These agreements with hospitals, doctors and extras service providers may change over time. Hunter Health Insurance members can check their benefits or limits associated with their level of cover by referring to the product information.

You might need to make a claim after going to hospital, being transported in an Ambulance or using a service from your Extras cover. There are a few different ways you can claim, depending on the service and your chosen health provider.

On the spot: If you have your membership card with you, many of our Extras providers can process your claim immediately at your appointment so you’ll only need to pay the difference of what’s owing. 

Online: You can go to our online Claim Form complete the details and upload your Extras or Ambulance receipt in a few easy steps

In a branch: You can always visit us in person with your Membership Card and your original receipts and we’ll take care of the rest.

Email: Send your original receipts to [email protected]

By post: Send your original claim form and original receipts to Hunter Health Insurance, P.O. Box 183, Cessnock NSW 2325

Before making a claim you’ll need to make sure that you:

  • have provided us with your bank details so we can pay your claims.
  • are covered for that treatment or service and have served any relevant waiting periods
  • have already had the treatment or service and are submitting the claim within 2 years of the service date.

If you are having treatment in hospital, there’ll likely be different parts involved in claiming. Usually, the hospital where you’ve had your treatment will take care of claiming for the costs for things like accommodation, theatre-room hire and prostheses.

You will be given a claim form to complete and sign, and the hospital will then send the bill to us. If there’s an excess, or any other out-of-pocket expenses, you’ll usually pay the hospital directly.

There are also medical costs, like surgeons and anaesthetists, not handled by the hospital. Your doctor and anaesthetist will create their own invoice and you’ll need to first claim through Medicare who’ll give you a Medicare Benefit Statement.

We require this Medicare Benefit Statement so we can process our portion of the claim. Sometimes your doctor and anaesthetist will lodge your claim to Medicare and Hunter Health Insurance on your behalf, so ask your practitioner about their billing so you know what to do next.

Claiming on your ambulance cover 

If you need to make an Ambulance claim, you can do it through:

  • Online 
  • In a branch; or
  • By post

Ambulance cover will vary from state to state:

NSW & ACT members

If you live in New South Wales or Australian Capital Territory, a levy is included in the hospital component of your private health cover. This entitles you to free ambulance transport under the State Government Ambulance Transport Schemes.

If you are sent an invoice for ambulance transport, send it to us and we will settle it. If you have pension or social security entitlements in NSW or the ACT complete that section on the back of the invoice and return it to the ambulance service.

If you fall outside the State-based arrangement for ambulance services and are not otherwise covered, you can claim under your Hunter Health Insurance cover for State Government-provided emergency ambulance services.

Claims that are not paid on the spot will normally take up to 7 business days to be processed and paid into your chosen bank account.

There are a number of reasons a claim may be rejected, including:

  • The service is not included on your cover.
  • Information is missing from the receipt/s provided.
  • The photo of your receipt was blurry.
  • The claim is for a service you had over two years ago.
  • The service is covered by Medicare, which means you must submit to Medicare first, and then if applicable complete your claim with us.

If you are unsure why your claim has been rejected, please contact us.

Types of membership

You become a member of a health insurance fund when you purchase a health insurance product. There are three possible categories of health insurance membership.

  • Single membership – provides cover only for the one person named on the membership application.
  • Couples Membership – provides cover for the member and the member’s nominated partner.
  • Family Membership – provides cover for the member, the member’s nominated partner and/or dependants.

There are several ways you can join:

  • Online: Choose the right product for you by getting a Quote, then complete the online application form.
  • Call: 02 4990 1385

Visit our branch: Come and have a chat to us in person and we’ll help you choose the product that is right for you.

Yes you can and we will recognise any waiting periods that you have already served with your previous fund for like to like benefits so long as you join within 30 days of leaving your previous fund.  If you are switching and upgrading your benefits you will need to serve the necessary waiting periods for your higher entitlements.  

Switching to Hunter Health Insurance is easy. First choose the right cover that best fits your needs and then complete your application and transfer. We can also assist you at our retail branch or over the phone on 02 4990 1385.

Once we have the details of your previous fund we’ll ask them to send us a clearance certificate. If they send it to you, please forward it to:  Hunter Health Insurance, [email protected] or alternatively to P.O. Box 183, Cessnock NSW 2325.

Funds may not provide exactly the same hospital benefit entitlements, so if you are not sure contact us so that we can check the details for you.

Australian Private Health Insurance only applies to treatment within Australia.

Membership suspension

You can apply for ‘Suspension of Membership’ if you are travelling overseas and will be out of Australia for a continuous period of not less than 2 months to a maximum of 24 months. This will allow you to freeze cover and not have to pay contributions for that period outside of Australia provided all persons listed on that membership will also be travelling for the same period.

Your membership will be resumed to the same level of cover prior to your date of travel except for any condition or ailments that arise during the period of suspension which will be treated as pre-existing conditions and the appropriate waiting period apply. Please understand that No Benefit will be considered if the service was incurred during the suspended period.

Submitting your request

With your request to suspend membership for travel purposes, you must submit supporting documentation for all persons covered on your membership prior to your departure. Documentation includes itineraries and e-tickets. If no evidence of your travel for the period of suspension requested is received, no suspension will be applied to your membership.

On returning to Australia, you must reinstate your membership within 1 month and pay commencing from the date of return, and supply evidence of the date you returned to Australia. If no evidence is received your suspension will be cancelled and may have Lifetime Health Cover implications.

Suspended cover may affect your Medicare Levy Surcharge, please contact the Australian Taxation Office for details.

Hear what our members have to say

As the Hunter’s first not-for-profit health insurer, we started by serving those in the community most in need — miners and their families.


“My family has been with HHI since the beginning & we’ve never had any issues or problems. We like that they’re a not for profit, and community minded. In comparison to other funds, I believe Hunter Health Insurance to be the best value in both member contributions and benefit claims.”


“My husband and I are in our 30’s and shopped around for the best health cover. And given we have a newborn baby, health cover was more important than ever. We are delighted with HHI. Their contribution rates are very reasonable, and their service and benefits are reliable.”


“My husband was hospitalised and we never saw a bill!
Hunter Health Insurance looked after paying for everything, promptly and efficiently. We were previously with another health fund and now we enjoy the same cover for 20% less contributions!
Doesn’t get much better than that!”


“I believe Hunter Health Insurance is a marvellous fund. I was in hospital recently for a hip replacement and it didn’t cost me a penny – Hunter Health Insurance paid every bill very quickly.”


“My husband and I have recommended Hunter Health Insurance to family and friends for years. We have Silver Plus cover and when my husband spent some time in hospital, the bill was immediately paid by Hunter Health Insurance without fuss.”


“We are very happy with Hunter Health Insurance and wouldn’t dream of going to another health fund. They’re friendly and their contribution rates are very competitive.”