7 Best Private Health Insurance with Pre-Existing Conditions in Australia

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In Australia, health insurance is an essential part of everyday life. There are numerous health insurance companies to choose from and determining which one is best for you can be difficult.


Each company provides different plans, so it is essential to compare your options before making a decision. You should think about the cost of the plan, the coverage available, and the company’s reputation. Read on.

Private Health Insurance with Pre-Existing Conditions
Credit: diabetes.co.uk

What are pre-existing conditions?

Pre-existing conditions are medical conditions that existed prior to the purchase of private health insurance.

If your health insurance policy expires and you develop a medical condition, you will be considered to have a pre-existing condition when you purchase your next policy.


The following criteria are used by the Department of Health to identify a pre-existing condition:

  • The symptoms or signs of the medical condition must have been “reasonably apparent” or “reasonably obvious” in the six months preceding enrollment in insurance OR
  • You have some symptom, sign, or impairment that would have been obvious to a reasonable GP conducting a routine external examination if you had sought a medical exam.

How will a pre-existing condition affect one’s health insurance policy?

The following are the most important things you should know about pre-existing conditions and your health insurance policy.

  • By law, all health insurance companies must cover people who have pre-existing conditions.
  • Pre-existing conditions do not increase the cost of private health insurance.
  • To be considered ‘pre-existing,’ a condition does not have to be previously diagnosed.
  • If you have a pre-existing condition/problem, you will typically have a prolonged waiting period before claiming hospital treatment on private health insurance than if the condition was not pre-existing.
  • After the waiting period, you can seek private treatment for your pre-existing condition and file a claim under your policy.

How does private health insurance work in Australia?

Private health insurance, as the name implies, is intended to pay for medical expenses that are not covered by the public healthcare system or Medicare.

It can also cover the cost of treatment in a private hospital or in a public hospital if the patient decides to be treated as a private patient. Policies must be purchased from licensed health insurers.


Private health coverage insurance comes in two main types:

  • Hospital cover: This covers the cost of treatment in either a public or private hospital.
  • Extras cover: This, also known as general treatment cover, pays for medical services that Medicare does not cover.

Ambulance coverage, which includes emergency transport and medical care, can also be bought in most states and territories, with the exception of Queensland and Tasmania, where the governments provide automatic coverage for permanent residents.

How much does private health insurance cost?

The premium price of a private health insurance policy is affected by several factors, including the type and tier of coverage, the number of people covered by the policy, and a person’s age, income, and residence.


Hospital coverage is available in four tiers: Gold, Silver, Bronze, and Basic, with each covering a specific list of treatments. Gold policies have the highest premiums because they cover all 38 types of treatments specified by the government. The cost of a gold policy for a single policy is around $160 per month. Basic, silver, and bronze policies are expected to have monthly premiums of $75, $80, and $115, respectively.

What benefits of taking out private health insurance?

According to the Department of Health, purchasing private health insurance has several advantages. There are four major benefits of obtaining this type of coverage. They are as follows:

#1. More health coverage and options

Policyholders with private health insurance can receive care in a private hospital with much shorter waiting periods for non-urgent procedures. They can select the physician of their choice to treat them as well.

#2. Avoid paying LHC loading

Australians who purchased private hospital insurance before turning 31 on July 1, 2000, also known as their “lifetime health cover base day,” and have kept it active since are exempt from paying a surcharge known as “lifetime health cover loading.” Those who didn’t might have to pay more for private hospital insurance over the following ten years. The extra cover is not subject to the loading amount.

#3. Tax Incentives

Policyholders can avoid having to pay the Medicare Levy Surcharge (MLS), which is a type of levy levied on Australians who do not have private hospital cover and earn a certain amount of money. MLS is intended to encourage people to obtain private insurance, thereby relieving pressure on the public health system.

#4. Premium Rebates

Most Australians who have purchased private health insurance receive a government rebate to help offset the cost of their premiums. This rebate is based on your income.

7 Best Private Health Insurance with Pre-existing Conditions in Australia

If you’re thinking about getting private health insurance or changing providers, it’s worth comparing the options on the Australian market to find the best provider and policy for your needs. Below is the Top private Health insurance in Australia: 

  • Australian Unity: 2.5% market share.
  • Bupa: 24.8% market share.
  • Nib: 9.3% market share.
  • HBF:7.3% market share.
  • Medibank: 27.3% market share.
  • GMHBA: 2.1% market share.
  • HCF: 11.9% market share.

#1. Australian Unity

Australian Unity was Australia’s first member-owned wellness company, founded in 1840. We have more flexibility to invest in products and services that allow our Members, customers, and community to thrive because we are the first member-owned well-being company.

Whatever your wellness requirements are, we are here to help. Anyone over the age of 18 who owns an eligible Australian Unity product or service is eligible to become an Australian Unity Member, granting you access to exclusive benefits that will help you measure and improve your personal well-being.

#2. HBF Private Health Insurance

Australians looking for health insurance that is customized to their specific needs should consider HBF Health Insurance. They can continue to give you new or improved benefits because they combine policies into a single plan and invest all premium profit.

Features and Benefits

  • Policies: 
  • This insurer offers six different hospital policies, with monthly premiums starting at $105.70.
  • Select from one of five Extras policies, with monthly premiums starting at $23.35.
  • There is no combined coverage offered by this insurer.
  • Waiting periods: Between seven days and twelve months.

#3. Bupa Private Health Insurance

Bupa is one of Australia’s largest private health insurers, with over 4 million customers. Customers can select from eight different Hospital plans, 22 different Extra cover options, and five Combined different policies. This insurer provides a variety of services that work collaboratively to improve the health of all Australians.

Features and Benefits


  • There are eight different hospital coverage options available, with monthly premiums starting at $102.35.
  • 22 Extras policies with monthly premiums starting at $26.70.
  • There are five combined policies to select from, with the lowest monthly premium estimated to be $130.55.
  • Waiting periods: range from 2 months to 3 years. This, however, is dependent on the condition and type of coverage you have in place.
  •  Distinctive features: Access to the Members’ First network of health care providers, with Bupa covering 60% to 100% of most dental, physio, chiro, and podiatry consultations.

#4. nib Private health insurer

Nib offers its members a variety of options with 7 Hospital policies and 19 Extras policies. In order to support even more successful behavior change initiatives, the rewards program is available to those who lead healthy lifestyles. It offers discounts at prestigious retailers as well as access to exclusive programs.

Features and Benefits

  • Policies: 
  • Select from 19 Extras options, with monthly premiums starting at $29.97
  • Seven different hospital policies, with prices ranging from $107.65 to $107.65.
  • This company offers a single combined policy that costs $116.51.
  • Waiting periods:  between one day and twelve months.
  • Distinctive features: Join the nib Rewards program when you reach your specific health objectives.

#5. Medibank Health Insurance

Medibank has been committed to its customers and the community since 1976. In addition to providing health coverage to over 3.9 million people, they also provide a range of healthcare services across Australia. Medibank, a non-profit health fund, is dedicated to the well-being of all its customers and provides easy access to high-quality care.

Features and Benefits

  • Policies:
  • Eleven hospital plans with monthly premiums starting at an estimated $101.80.
  • You can expect to pay premiums starting at $30.30 for 21 Extras policies.
  • 2 Combined policies, with premiums starting at $119.25 before rebates.
  • Waiting periods:  range from 2 to 36 months, depending on your needs.
  • Distinctive features: With the Medibank Members’ Choice benefit, this insurer provides members with access to a large network of healthproviders.


GMHBA is a non-profit health insurance and care provider based in Australia with over 85 years of experience. We provide affordable health insurance to help you take care of your health and well-being.

GMHBA is a not-for-profit health insurance and care provider based in Australia. Since 1934, we have served the community and grown to become one of Australia’s leading regionally based private health insurers.

We are dedicated to enhancing the health and well-being of our members, customers, and the communities in which we work. GMHBA Health Insurance has coverage to suit your needs whether you are a single, couple, single parent, or family

#7. HCF Health Insurance

HCF, based in Australia, is the country’s largest non-profit health fund. It was founded in 1932 to assist the community in paying for hospital care and has since grown to become the third-largest combined private health insurance and life insurance organization in the world. As a non-profit organization, HCF is able to provide more affordable health coverage than others.

Features and Benefits

  • Policies: 
  • Seven hospital policies with monthly premiums beginning at $104.30.
  • 5 Extras cover options are available, with monthly premiums starting at $16.95.
  • 5 Policies with monthly premiums starting at $129.40.
  • Waiting periods: range Between 2 to 12 months.
  • Distinctive features: With the HCF provider network, you can get up to 100% back on selected Extras from over 10,000 participating program providers.


The most common advantages of private health insurance are treatments in a private hospital and lower out-of-pocket costs when visiting specialists that Medicare does not cover, such as the dentist, optometrist, or physiotherapist. However, the benefits and level of returns vary depending on the health insurance provider and their policies.


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