Telehealth and Private Health Insurance in Australia

Since the pandemic, telehealth has turned from being a temporary option to a permanent and integral part of the Australian health care system. Most telehealth services can now be claimed under both Medicare and private health insurance. Let’s take a closer look at how the combination of telehealth and private health insurance can help you access affordable, high-quality health care, from GP consults to allied health access to mental health counselling. Extras covered vary depending on your insurer, type of cover, and provider.

Since a change in the Australian Government’s Department of Health’s policy in 2022, extending Medicare cover to most telehealth services [1], private health insurers have largely followed suit. The devil is in the details, however, so your first step should be to check the health fund’s policy for the fine print. Often, a video consultation may be required, which not all telehealth providers offer for all services. If you hold an Extras policy with any of the below funds, you’ll either have access to a rebate or health fund-approved telehealth via a specific partner site. You’ll usually save about 7080 % of the provider’s fee. There may be annual caps for the number of visits or total cost of specific telehealth services the health fund reimburses. Here are some examples:

• Bupa and Medibank reimburse a percentage of telehealth service costs for members with the right extras cover. This means you can claim for GP, psychology, physiotherapy and other alliedhealth video appointments.
• HCF offers telehealth services through GP2U as well as mental health video sessions. This may reduce your out-of-pocket cost. Additional rebates for telehealth services not directly offered by HCF may depend on your extras tier.
• NIB provides allied health and GP video consults via Hub.health, similarly reducing out-of-pocket costs for members with the right extras cover.
• HBF also offers rebates for services provided by approved telehealth providers, if you have the right Extras policy.

You may wonder, if most telehealth services are covered by Medicare, why would I need to claim via my private health insurance? The answer is that similar to the way some GP clinics or specialists offer fully bulk-billed, partially covered, or fully privately paid consults, telehealth providers can largely set their own fees and decide whether to offer rebates or fully bulk-billed telehealth services. Currently, a fair number of providers offer some services for free but not all. This is where you can fall back on your private health fund to reduce your costs. You can use MediCompare’s reviews or tools to get a better idea of each provider.

• As already mentioned, health funds do often have caps on costs reimbursed as well as specific requirements. I’ve tried summing it up in simple terms, but again, the specifics depend on your insurance policy and individual health fund. Those that have partnered with a specific telehealth provider may not cover the same services via other providers or offer less favourable gap fees.
• In essence, GP video or phone consults are often covered without caps, while counselling sessions may have a yearly twenty-session limit. (Mirroring the annual ten-session cap on Medicare’s mental health treatment plans.)
• Physiotherapy, occupational therapy, and speech pathology normally require a synchronous video session, and the per-session rebate may be capped at roughly $50-70, often meaning a reduced out-of-pocket cost.
• Sessions with a dietitian or nutritionist fall under the Allied Health extras. If your policy covers this service and the provider is approved, you may benefit from a similarly reduced cost.
• To check if specialist video consults are included under your Extras cover, you need to ensure the specific service, e.g. dermatology, cardiology, is listed under your policy and book a consult with an approved provider.
• Prescriptions and medical certificates are considered part of the GP telehealth session. They are usually claimable, provided they do not exceed any caps.

1. Double-check your policy first for Extras cover including telehealth. This is a requirement for most funds still.
2. In the insurer’s portal, filter for telehealth to see approved clinicians and providers.
3. Verify the exact rebate and any annual caps in your policy.
4. Use a telehealth platform recommended by your provider or one hosting approved health care professionals.
5. When booking, double-check if the provider assists with your claim – some offer an “instant claim” function.
6. If necessary, keep your invoice and remember to claim.

Between bulk-billed telehealth services and your private health insurance cover, you should be able to reduce your out-of-pocket costs significantly. It is important to check both your private health fund’s policy/ Extras cover and the telehealth service provider you intend on using. Sometimes, the most affordable high-quality option may not be the most obvious.

This article is for informational purposes only and is not a substitute for professional medical advice. Please choose your provider with care. Always consult your doctor or a qualified health professional regarding any healthrelated questions or concerns.

[1] https://www.anao.gov.au/work/performance-audit/expansion-telehealth-services