Know Your Coverage: How Much Will Your Health Insurance Pay?
Published September 11, 2026
Whatever the level of expenditure on health insurance that you have, you will obviously want to ensure that you get good value for your money. Regardless of how much you pay for your health insurance, one way or another, you want to be assured that you get value for your money. When checking the cash value you receive when making claims, you should be aware of the following:
As with all insurance plans, the purpose of health insurance is to financially assist you when you require medical care. However, unlike all other insurances, health insurance is distinguished by the number of incidents covered under it. Unlike home insurance, for instance, which involves incidents such as fire, flooding, or damages, health insurance will include a wide variety of incidents.
In the case of health insurance, the claim made on it depends on what type of coverage you have: Hospital Extras and/or Ambulance. The reasons for claiming are multiple: they may vary from ambulance service through cataract surgery and fertility treatment up to rehabilitation, weight-loss programs and hearing aid and much more. In no case can you claim on your health insurance plan more than you have paid in premiums.
How much refund can you expect from health insurance?
Based on the data provided by Private Healthcare Australia the peak body representing health insurance industry-for every dollar that Australians spend on health insurance they receive back about 84 cents in return. Of course, it is just an average figure-sometimes you may receive even more, sometimes it may happen that you receive nothing at all from one year to another, depending on your level of coverage and health needs. The older you become, the more often you tend to make claims. However, unless you undergo expensive surgery, the money spent on health insurance during your lifetime will always exceed those received in claims.
How much money do you get back through Hospital Cover?
Hospital Cover is a policy that applies to hospital treatments when you are admitted as a private patient in a private or public hospital. Since most people who are healthy will not claim on their Hospital Cover regularly, instead of thinking of how much money you are getting back, consider how important it will be to have private hospital treatment in case you need elective surgery like knee replacement or tonsillectomy. If you can afford to spend a lot of time waiting in the public hospital, then this Hospital Cover will not provide you with a lot of value.
The Health Economist, Professor Luke Connelly from University of Queensland, suggests that Hospital Cover offers the highest value on average when you are in your mid-50s and above, and hence have a greater likelihood of claiming; but there is nothing certain here.
How to switch health insurance policies
If you have worked out that your health insurance isn’t providing good return relative to your premiums and claims, it’s time to look for a better policy. At Utility Market, we have made this quick & easy. Our calculator makes it a point to search every insurer in Australia in a matter of seconds, giving you all of your options, so you can make the right choice. Look for a new health insurance policy or compare your current policy to others available. So find a policy that gives you the best value for your budget, lifestyle and health care needs.
Compare with Utility Market and switch to a better future Today!
