Tell us your experience with Health Care Insurance (HCI) health fund

Do you have something to say about Health Care Insurance (HCI)? Tell us your good experiences, bad experiences or otherwise and help inform the CHOICE Community.

Read our HCI health insurance review

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I switched to HCI (Premier Hospital & Extras) 4 months ago. I contacted them by email and phone for various bits of information in the first month and was completely satisfied in all metrics (time, accuracy, professionalism, friendliness, etc) each time. They presented with the feel of a small business providing personal service.

All the claims to date have been extras, HiCAPS paid. I just renewed my Vic Ambulance membership that was reimbursable. There is no online claiming but the phone app is breathtakingly easy. You take a photo of the bill via the app, 4 routine acknowledgements, and off it goes. You receive a confirmation of the claim by email, and in my case it was processed only a few hours later.

So far I am extremely happy with my decision to go with them.


About a year ago we followed Choice’s high recommendation of HCI for health cover for our family. I thought I had read the comparisons carefully enough, but on every point over the past year we have been worse off or not covered at all compared to our old funds that didn’t score as well on the Choice reviews. Previously, it was a pleasure to stand at a reception somewhere and have our old health funds cards swiped and for the person to be surprised at how generous our old funds were. These days we are used to the opposite - the receptionist pulling a face at how poorly HCI pays or telling us that we’re not covered at all (even though we have top hospital and top extras). The HCI customer service is like dealing with a dodgy impersonal ATM that doesn’t want to give you your money. I was recently hospitalised for emergency orthopaedic surgery on a badly broken leg. The hospital had a time of it getting the claim out of HCI. Belonging to HCI is an embarrassment. Choice may have been impressed with them but the people who deal with health funds every day find HCI a poor performer. For us it is a difficult situation because to swap funds again will affect waiting periods, but I still think we’ll look at risking that because you can’t put a price on confidence and peace of mind, which HCI doesn’t provide and doesn’t care that it doesn’t provide.


You aren’t alone. We have found the same problem with comparing health insurance…it is really hard to compare like for like. After spending some time researching to find a better deal we ended up thinking it be better the devil you know rather than try to work out the one that you don’t. It was confusing and very hard to ascertain what the real differences polices really meant to us.


I switched to HCI last financial year and have found their customer service to be personal in a ‘small company way’. eg they don’t seem to have lots of staff manning the phones but when they respond it has been very personal. All my claims to date have been HICAPS paid and I got exactly what was expected. Compared to my old fund they pay a bit less for the routine but lots more for the more serious things we used and will use in future.

The bottom line is that to date they have been as expected and they have paid claims exactly to their pro forma.

I suspect one’s impression will be different if one’s previous fund had a top dollar premium for a top dollar payment, but we are value oriented. With the myriad funds and plans it is obviously important to assess what and how they cover, not just a ‘star rating’.


Hi @Gamekeeper, sorry to hear our past review didn’t help you out. We have a new system now to help people cut through the confusion and compare health insurance, so we hope that makes things a little easier. It seems like you have a good understanding of health insurance, but if there are any questions we can assist with please let me know.

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If you change Health Funds waiting periods are waived if you buy the same sort of cover. It is only when you upgrade that th3 waiting periods apply. I have changed several times over the years and no waiting fees have ever been applied.

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Just got my notice of the annual increase. Nearly fell off the chair as it is 13.4% out of pocket increase and 12.5% when the higher government rebate (!!!) is counted.!

The headlined average of 3.95% for 2018 suggests someone is diddling somewhere. A shopping I will go but since they started on the low side it remains to be seen if anyone will offer even comparative cover, let alone a better one at the price point.


After comparing Private Health Insurances through your comparison tool. The comparisons results showed us that we have more advantages and it is cost effective to move from our current Healthcare provider (Bapa - we are with them for more than 12 years) to Health Care Insurance (HCI). I sent an email on the 15th March 2018 to HCI requesting additional information to compare with our current provider. After contacting over the phone and resending the email, I contacted them once again recently but the response was that they can’t find the email. Has some one else had similar experience with HCI or this is just an unfortunate incident? Don’t want to move to a new Health Care Provider with poor customer service.

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My emails and calls have always been responded to timely and well. No online claims via their web site but there is an app, and my single experience with it to date had my claim paid in only a few hours. Prior to moving make sure you have the 1 April price increases in hand! They are not on the comparison tools until they are in effect. If you join prior to 1 April the current prices will hold but you can only prepay 6 months with them and then get to ‘enjoy’ the higher price.


Like others here I have switched to HCI and been very impressed with the level of service. Always friendly and helpful. You call them and are greeted with a polite “hello” rather than pressing buttons.

However, like a few have mentioned, premiums have just risen significantly. Mine have increased a whopping 14.5%. For me, this could be a warning sign that perhaps they haven’t been managing their fund well, or something else might be going on I’ve missed?

Before joining I did have a very quick flick through the Annual Report for 2016 and their Annual Report for 2017 doesn’t indicate that anything like this was on the way:

Everything appeared to be pretty good.

  • $650k profit, slightly down on 2016
  • $14.2m equity up from $13.5m
  • No other red flags, once off items or future issues raised by the director’s report or auditors

I wonder what is going on for such a large increase.


Replying to myself…

I called HCI to confirm that everything was correct with my cover/details/premiums and that nothing had changed, like the government rebate. HCI confirmed that nothing had changed on my policy except the pricing. Aside from the usual increases they have now introduced state based pricing to reflect the different costs for claims from different states.

I can understand this, things like ambulance cover are included in all NSW & ACT hospital policies, whereas it is not included elsewhere. This is maybe $10 p/m. I assume the rest of the increase is due to other costs which are higher in some states, I was told that VIC & NSW residents have seen the largest premium increases.

Still, reviewing the Choice article on the latest price rises had HCI at 8.9%.

Assuming this is calculated correctly (@dangraham where’s the data from?) HCI’s overall increase seems way out of line with their financial statements.


Agreed, but in my case (Vic) they started very low and finished middle of the pack.

Re ambo service, HCI pay for a membership as a benefit (Vic) but it has to be claimed.


The data is from the Department of Health. Because these are weighted averages funds can really pump up the price on policies with few members and not have it affect their headline figure. I suspect that’s what happening here - most of their members are in Tasmania, and they’re probably seeing lower increases. I’ve seen one extras policy (not HCI) with a 50% increase. HCI’s a pretty small fund with (previously) a pretty competitively priced product - it wouldn’t surprise me if they’re trying to put the breaks on growing too quickly outside of Tassie.

Now that we’ve got the new policy-level price data we’re going to have a look which products had the biggest increases on April 1. Keep an eye out, HCI might well be on the list.


Thanks for the clarification. I’d guess the net effect might be similar? no idea.

I think so, perhaps their demographic has shifted so rapidly as to substantially distort their cost base in a very short amount of time? I do think state based pricing is probably fairer over all. Otherwise, members in states with cheaper facilities are effectively subsidising those in states with greater costs which they can’t really access. However, where do you stop? No doubt there are large differences between regional areas and city areas.

Initial hunts for other policies still have HCI ontop for me but I’m eagerly awaiting the next iteration of the insurance finder tool.


We’re a couple of days at the most away from publishing the update.

Risk pools for hospital insurance are drawn along state lines, which would stop health funds from having more granular pricing. The administrative headache would probably outweigh the cost benefits. We’ve also come across funds that have different extras benefits in different states - eg claim more for a physio session in Victorian than NSW - which makes me think some actuaries have too much time on their hands.


One of the reasons most providers are substantially cheaper in the NT - no private hospitals (well there’s almost one, in Darwin) and very few specialists that aren’t FIFO from the big smoke plus government assisted travel to the southern states for treatment of conditions not well handled in the NT - as they say, “when in pain, take the plane” …


HCI has ‘blessed’ me with an 8.73% increase for 2019. Considering the government claims the average increase is only 3.25%, this is the second year running HCI has exceeded 8%, and most every report for any fund is also ‘up there’, I am curious which funds have less than 3.25% increases?

Could it be the statistics and average computation might be as honest as any self serving pollie?

While HCI has been very good in my few years with them, time to shop around again :frowning:

edit: HCI claims the average of all funds with comparable products to HCI have an average 5.53% increase for 2019 across those products. 3.25%? 5.53% I am sure each version can be substantiated by the respective statisticians. :roll_eyes:

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Although months into the pandemic HCI just sent me, unsolicited, a mask for each of us insured. RRP maybe $12-15 the pair but it is the thought that counts, even if a bit late in the game. It beats the many emails about being COVID-safe.

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Their announcement today (4/11/2021)

Maximum Age of Dependants Increased

I am pleased to advise that we’ve implemented changes that will now allow eligible dependent children to remain on HCI family policies longer.

From 1 November 2021, HCI has raised the maximum age for eligible dependants from age 24 to age 31.

We’re delighted to be one of the first private health insurers in the country to introduce these changes. As a not-for-profit health insurer, we recognise that many HCI members, and their children, will benefit from these changes.

For further information, please visit: Dependant Extension Update - Health Care Insurance

Yours sincerely,
Michelle Wade
Chief Executive Officer