Not-For-Profit Health Insurance

Learn about not-for-profit health insurance providers and how they work here with Savvy.  

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, updated on July 10th, 2023       

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Health Insurance Banner - Elderly man in a wheelchair being helped by a young nurse

If you’re considering a new health insurance policy in Australia or looking to switch providers, you have a choice between insurers who are private companies and make profits for their shareholders or not-for-profit health insurers. This may be an important point of difference for you when deciding which insurer is best for you and your family’s needs.

You can find out all about not-for-profit health insurers here with Savvy. Read our guide to learn about which private health funds are not-for-profit in Australia and how these providers work before you purchase your health insurance policy.

What is a not-for-profit health insurance fund?

A not-for-profit health insurance fund provides health insurance to its members but doesn’t seek to make a profit by providing this insurance. Instead, they can plough any surplus they make back into their business or the community by offering free programs and reduced premiums.

Out of the 34 health funds in Australia, more than 25 of these funds are either not-for-profit health insurers or are owned by a not-for-profit organisation. These insurers have grouped and formed the Members Health Fund Alliance. They now represent more than five million Australians and comprise private health insurance funds which are either not-for-profit or are part of a member-owned group, region or community.

Some of these not-for-profit insurers are restricted funds, which means you have to be part of a particular group, company, organisation or union to become a member. For example, to buy a policy with the Teachers Health Fund, you have to be employed in the education sector or be a close family member of someone in that sector. However, other not-for-profit or mutual funds are open to anyone who wishes to join the fund and buy a health insurance policy.

Who are the not-for-profit health insurance funds in Australia?

The list of not-for-profit health insurers operating in Australia today is as follows: 

Funds open to everyone:

  • HBF 
  • Lukes Health 
  • Queensland Country Health 
  • Australian Unity 
  • Mildura Health Fund 
  • Westfund 
  • Phoenix Health Fund 
  • HIF 
  • HCF 
  • HCI 
  • CBHS 
  • RT Health 
  • Latrobe Health Services 
  • Hunter Health Insurance 
  • Health Insurance Fund 
  • Territory Health Fund 
  • Peoplecare Health 
  • Health Partners

Restricted funds:

  • Teachers Health 
  • Navy Health 
  • TUH 
  • Emergency Services Health
  • Nurses and Midwives Health 
  • Police Health 
  • Defence Health 
  • Reserve Bank Health Society Ltd 
  • Uni Health 
  • ACA Health 
  • Doctors’ Health 
  • CBHS Health Fund

What is the difference between a not-for-profit and a for-profit health fund?

Not-for-profit health insurers return any surplus they make back to their members. This may be in the form of providing free health services, additional benefits or lower premiums. Some not-for-profit organisations also offer generous grants to community organisations and charities.

For-profit private health insurers are private companies which offer health insurance with the aim of returning a profit to their shareholders, like other private companies. They include Australia’s two largest funds, Medibank Private and BUPA, which between them issue more than 50% of the private health insurance policies held in our country. Medibank was previously the Australian Government’s not-for-profit health insurer, but it was privatised by the government in 2014 and is now listed on the Australian Stock Exchange.

How do I compare not-for-profit health insurers?

Not-for-profit insurers offer the same or similar levels of health cover as the for-profit funds do, but they can also sometimes offer additional benefits and services on top of basic health cover. When comparing not-for-profit health insurers to find the best deal for your health insurance needs, cost is not the only factor to take into consideration. The cheapest health insurance policy may not always be the one which offers you the cover you need, which is why it’s so important to compare different offers. When comparing funds, you should also consider the following:

  • The types of health insurance on offer – (such as hospital cover, extras cover, ambulance cover, combined policies, family policies and more)
  • The different levels of cover available – (for hospital cover, the tiers on offer will be basic, bronze, silver or gold)
  • The inclusions and exclusions which may apply to the health insurance cover on offer, for both hospital and extras cover
  • The benefit limits for extras cover – per annum, per clinical category or based on a limit for the life of the policy
  • The percentage of fees paid out by an extras policy – this can range from 50% for a cheaper extras policy to 75% or more for top-level cover
  • The waiting periods which apply – if any. This will depend on whether you’ve held private health insurance before, and if you’ve already served waiting periods or not
  • Excess limitshow much excess you may be required to pay if you’re admitted to hospital and make a claim on your hospital cover. The higher the excess payment you agree to, the lower your monthly premiums may be
  • Co-payments – these are another out-of-pocket expense you may have to pay if you need to be admitted to hospital. For example, a co-payment may be $100 a day for each day you’re in hospital, capped at $700.

In addition to the above comparison factors, it’s also important to consider:

Whether you qualify for membership of any restricted funds

There are numerous health insurance funds which exist for particular categories of people. These restricted health funds have membership rules and are only open to members who fit within their membership profile. Examples are:

  • Police officers (such as Police Health)
  • Members of the Defence Forces (such as Defence Health and Navy Health)
  • Members of the Emergency Services (such as Emergency Services Health)
  • Nurses or midwives (such as Nurses and Midwives Health)
  • Doctors (such as Doctors’ Health Fund)
  • Teachers (such as Teachers Health, or TUH for the Queensland Teachers Union)
  • Employees of a particular bank (such as Commonwealth Bank Health Fund CBHS)
  • Members of a particular church (such as ACA Health Benefits fund for members of the Seventh-Day Adventist Church)

Special offers

From time to time, some not-for-profit health funds advertise special offers designed to attract new customers. These can represent a great deal for those looking for health insurance for the first time or who have an existing health insurance policy and are looking to switch funds. Special offers can include:

  • A waiver on waiting periods before you’re able to make a claim (for example, a waiver on all two-month extras waiting periods)
  • Several weeks of free insurance (usually after buying a policy and paying premiums for a set period). For example, six weeks of free insurance after your first three months’ worth of premiums have been paid 

Additional member benefits

This is a strong comparison point between not-for-profit health insurers. There is a wide variety of additional benefits available besides just health insurance (although for-profit funds also offer additional members benefits too). Typically, health funds pay back between 70% and 90% of the premiums they receive in the form of payouts and benefits to members.

Not-for-profit funds take out their necessary running costs (what is required to run the fund, such as staff wages, rent, management costs and other overheads) and can reinvest their surplus by providing a selection of these additional member benefits. They can include:

  • Free eye checks and no-gap glasses (from selected private optometrists who are members of a particular provider network)
  • Free dental check-ups (from selected private dental clinics who are part of a provider network)
  • Free or reduced-cost visits – such as to chiropractors and physiotherapists
  • Rewards programs – offering cheap movie tickets and shopping discounts
  • Free health phone hotlines – so you can speak to a qualified nurse to get online health advice
  • Free health programs – for example, a holistic 18-week program to assist those living with diabetes to make healthy lifestyle choices
  • Free weight-loss programs – or subsidies to approved weight-reduction eating programs, such as Weight Watchers
  • Free skincare check-ups – to check for early signs of skin cancer
  • Free quit-smoking programs
  • Free mental health care programs 

By comparing all the different member benefits on offer, as well as the health cover provided, you can compare with confidence and choose a health fund that feels right for your health needs.

Frequently asked questions about not-for-profit health insurers

Are not-for-profit health funds cheaper than other funds?

Not necessarily, but this will depend on the specific health insurance policy you choose to buy. In general terms, not-for-profit health funds may offer value if you live near specialists who are members of that fund’s provider network or can take advantage of all the additional health care benefits they offer members.

Are all restricted health funds run on a not-for-profit basis?

No – it isn’t a legal requirement for a restricted health fund to be run on a not-for-profit basis, although many are run as such. For example, Doctors’ Health Fund is a for-profit fund owned by the Avant Mutual Group (which is a group that operates on a not-for-profit basis).

Is it possible to get free dental treatment if I’m a member of a not-for-profit health fund?

Many health funds have their own provider networks including private dentists who can offer free basic treatment to particular fund members. Therefore, it may be possible to get free basic check-ups and teeth cleaning and polishing as part of your extras cover policy. For this reason, it’s important to compare insurers and find out what private providers are offering in your particular area.

Do not-for-profit health funds offer the best range of coverage for health insurance?

Not all not-for-profit health funds offer the full range of health insurance policies available in Australia. For example, as of March 2023, Mildura Health Fund only offers gold or basic hospital cover policies but doesn’t offer silver or bronze-tier policies.

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