Making the Most of Your Health Insurance: What You Can Claim
Published September 11, 2026
No matter how much you spend on health insurance, you want to make sure that you are receiving value for money spent. If you think about the amount of money that you can claim back and wonder whether it is enough to cover your costs, this is the information that you need to understand.
Health Insurance, just like any other kind of insurance, is there to be there for you financially when you need to receive healthcare services. What makes health insurance unique is the number of occasions that can serve as the reason for claiming money from insurance company. You usually claim from your home insurance only about those events that occur rarely, yet cost a lot of money to fix, like fire damage, flooding, or damages. It all depends on the kind of health insurance that you have purchased, for example, Hospital & Ambulance Insurance. There are many situations where people would be eligible to make claims-from emergency ambulance service to cataract surgery, fertility treatments, rehabilitation, weight loss programs, hearing aids, and so forth. You cannot realistically hope to get more out of health insurance than you put in.
How Much Do You Get Back From Your Health Insurance?
According to the information released by Private Healthcare Australia, which is the peak body for the health insurance industry, Australians receive approximately 84 cents on every dollar that they spend on health insurance premiums. The figures mentioned are just averages – sometimes they may get more and sometimes they may not receive any refunds whatsoever, depending on the type of cover and health needs of individuals. Moreover, the more aged an individual becomes, the higher the chances that they will claim. However, regardless of this, the overall cost incurred on health insurance throughout one’s life will normally exceed the amount claimed. So, how can we determine whether or not the money is being put back into our pockets?
What should you expect from Hospital Cover?
Hospital cover is designed to help with your hospital procedures where you will be admitted as a private patient. Most healthy individuals will not make many claims through Hospital cover, hence focusing on the financial return of your Hospital cover is wrong. Instead, consider the value that Hospital cover will add to you if you need an elective surgery such as knee replacement. In case you have no problem waiting in the queue in the public system, then Hospital cover may not add much value for you. As per an esteemed Professor of Health Economics, Luke Connelly of the University of Queensland, Hospital Cover adds the most value when you are in your mid-50s and above, and you are likely to claim.
How much should you get back from Extras Cover?
Extras Cover is for health treatments outside hospital, by dentists and allied health professionals-think physiotherapists, chiropractors, and optometrists. Extras Cover is the form of health insurance where you need to claim back more than you spend on premiums to make it worthwhile. So, take a look at how much you claimed back in the last year and compare it to your annual premiums.
Switching Your Health Insurance Policies
If you are of the opinion that your health insurance is not offering 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 searches every policy from every insurer in Australia in minute, giving you all of your options so you can make the perfect choice. Seek for a new health insurance policy or compare your current policy with others.
In a nutshell, it is imperative to find out a brand-new policy that provides the best value for your budget, lifestyle and healthcare needs.
