Your personal circumstances won’t directly affect your private health insurance premiums

As consumers we’re all very familiar with purchasing car insurance and the common factors that go into determining your car insurance premium, such as type of vehicle, age, driving history, which suburb the car is parked, gender and the frequency at which you use your car.

You may also have noticed that what you pay for your car insurance is lower than what your children pay, assuming they’re old enough to drive and own a car. This is because statistics show that younger drivers are more likely to make a claim.

That’s how risk-rated insurance works. But is not how health insurance works in Australia.

If you call nib to get covered for health insurance, an 80-year-old smoker, will pay the same premium and receive the same benefits as a 25-year-old non-smoking athlete who is covered under the same policy. No matter how many times you make a claim, this won’t change.

This is known as ‘Community Rating’ and applies to all health funds in Australia. 

It is illegal for health insurers to refuse cover or vary the premium charged to a person based on their level or risk of requiring future treatment, age, gender, race, sexual orientation, health, religious beliefs, family size and any other reason.

If you do join a health insurer with a pre-existing condition, such as a dodgy hip or knee you will need to wait 12 months before claiming for this condition. However, the benefit you receive, and the cost of your premium will remain the same as any other member on the same product tier, e.g. Gold, Silver, Bronze or Basic, provided they’re with the same health fund.

It’s so important that Australians understand our community rating system and that the myth - that health insurers charge members more based on their personal circumstances - is busted.

Far too many times have we heard “horror” stories of members not wanting to make a claim for an ambulance because they’re afraid their premium will rise, or they’re just too afraid to join in the first place fearing their premium will be financially crippling as a result of their condition.

We’re here for your better health, irrespective of your condition.