Methodology
Our methodology
Which funds and policies we compare, where the data comes from, how we score them, and what we deliberately leave out.
A comparison is only worth reading if you can see how it was made. This page is the method every table, review and head-to-head on Plain Cover is built on. If a page departs from it, the page says so and explains why.
What we include
- Every private health insurer registered with APRA and listed on PrivateHealth.gov.au.
- Policies open to new members as at the date shown on the page. Closed and legacy products are excluded, and noted where readers are likely to hold one.
- Restricted-access funds are included and clearly marked, because eligibility is the first thing that decides whether a good policy is available to you.
Funds are included whether or not we have any commercial relationship with them. Where you cannot get a quote through us, the page says so.
Where the data comes from
- Premiums and policy inclusions — the government's PrivateHealth.gov.au dataset, cross-checked against each fund's current PDS.
- Tier inclusions — the Department of Health's clinical category definitions.
- Thresholds, rebate rates and loadings — the ATO.
- Complaints — the Private Health Insurance Ombudsman's published data.
- Waiting times — the AIHW's most recent elective surgery release.
Every table is stamped with the date the data was pulled. Premiums change on notice from the fund; the PDS is always the authoritative document.
How we compare policies
Like for like, or not at all. A policy is only compared against another at the same government tier, for the same coverage type (single, couple, family, single parent), at the same excess, and in the same state — because premiums are set state by state. Where a fair like-for-like match does not exist, we say so rather than forcing the comparison.
Quoted prices are the base premium before the rebate and before any Lifetime Health Cover loading, unless the page says otherwise, so that two policies can be compared without your income tier changing the answer.
How we score
Where we score policies, four things carry weight, and only these four:
Scoring weights
- Value — 40%. Premium measured against what the policy actually covers, not against the sticker price alone.
- Cover — 30%. Clinical categories included above the tier minimum, extras limits, and the waiting periods attached to them.
- Cost at claim time — 20%. Excess, co-payments, gap arrangements and the share of claims the fund settles with no gap.
- Member experience — 10%. Ombudsman complaints per thousand members, and how long the fund has held its price.
Scores are relative to the funds in the same comparison, not absolute. A policy that scores well in one table is not automatically the right policy for you, and we do not publish a single "best fund" score across the market, because no such thing exists once your own circumstances are involved.
What we deliberately leave out
- Star ratings from third parties. We do not republish awards we cannot audit, and we do not buy any.
- "Best" without a stated criterion. Every "best for" on this site names who it is best for and why.
- Member review scores. They are trivially gamed and we cannot verify the reviewers.
- Projected savings. We will show you what a policy costs today. We will not tell you what you will save over ten years.
The limits of any comparison
We compare published product terms. We cannot tell you how a fund will treat your particular claim, whether your surgeon participates in a gap scheme, or what your premium will be after your fund's next rise. Before you buy, read the PDS and check that your own doctors and hospitals are covered.
This is general information only — it does not take your circumstances into account and it is not financial or health advice. How pages are written and checked is on our editorial policy. Think the method is wrong? Email hello@plaincover.com.au — this page changes when someone shows us a better way to do it.