Australians with private hospital insurance are actively claiming on their policies, averaging two claims annually, according to recent survey data released by Money.com.au.
Among those with hospital cover, 51% reported making between one and two claims each year, while 10% made three to five claims, and 7% claimed six or more times annually. In contrast, 31% of policyholders said they had never made a claim.
Chris Whitelaw, general manager of health insurance at Money.com.au, said the findings indicate most policyholders are making practical use of their insurance.
“Hospital insurance is a lifeline when health issues arise, and thankfully, the numbers show Australians are using that lifeline. The fact that the average policyholder claims twice a year proves it’s far from a wasted expense, especially considering some surgeries and hospital treatments cost thousands of dollars,” he said.
The data showed many policyholders rely on their insurance, particularly for procedures like elective surgery and overnight admissions.
Additionally, 21% of survey participants rated hospital insurance as their most important form of coverage. Of this group, 19% cited cost savings from claims as the primary reason.
Usage trends differed notably by age group. Baby Boomers were the most frequent claimants, with 68% lodging one or two claims per year. Gen X followed at 47%, while younger age groups – Millennials and Gen Z – were less likely to use their hospital cover, at 43% and 39%, respectively.
The rate of non-claimants also varied. Only 20% of Baby Boomers had never claimed, compared with 40% of Gen X, 36% of Millennials, and 30% of Gen Z.
Whitelaw noted that older consumers tend to use their coverage for health events, while younger individuals may hold policies for financial or compliance reasons without making claims.
However, a separate Money.com.au survey highlighted discrepancies in the use of extras cover, particularly among singles.
Forty per cent of single policyholders reported claiming only once or twice per year. In contrast, only 20% of couples and 31% of family policyholders reported similar low usage.
Whitelaw said the disparity likely reflects differences in how singles and multi-person households use services.
“It’s natural for couples and families to claim more frequently on their extras cover – more people on a policy means more people needing general or ancillary treatments, whether that’s dental visits, physio appointments, or optical check-ups. Someone on a single policy may naturally claim less, but if they’re only claiming once or twice a year, hypothetically for their bi-annual dental check-up, it means they’re still paying for dozens of benefits they’re not using,” he said.
On average, singles submitted three extras claims annually, typically for services such as dental, optometry, or physiotherapy.
Additional findings showed 26% of singles made three to five claims, 16% claimed between six and 10 times, and 9% claimed more than 10 times. Another 9% had made no extras claims.
Since the 2020 introduction of tiered hospital insurance categories – Basic, Bronze, Silver, and Gold – designed to standardise coverage comparisons, more than half of respondents (56%) indicated they only partially understood the system. Another 13% said it remained as complex as the prior model.
Whitelaw said that while the tiers were meant to clarify hospital cover options, policyholders continue to struggle with understanding inclusions and exclusions.
“We’re seeing more policyholders with specific health needs wanting to switch providers, but they’re still unsure whether another ‘Plus’ policy in the same tier includes all the benefits they were previously getting,” Whitelaw said.
