Health insurance for sterilisation

Health insurance policies for sterilisation

Below you'll find a selection of Finder partners that cover sterilisation, and the minimum policy tier that covers the treatment. All have a two-month waiting period. All prices are based on a single individual with less than $97,000 income and living in Sydney.

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Finder Score - Hospital cover health insurance

Each month we analyse our hospital insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare hospital cover a bit faster.

Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. Each policy is given a price score and feature score. These are then combined to determine each policies's Finder Score.

Read the full Finder Score methodology

What are the main types of sterilisation available?

In general, if someone never wants to have children then sterilisation can be an effective option. The two most widely-used methods of voluntary sterilisation are:

In Australia, it is illegal to undertake either of these procedures on persons under the age of 18 unless it is a clear medical necessity. Needless to say, no health insurance will cover illegal procedures.

How does health insurance handle contraceptive surgery?

Private health funds will cover vasectomies, tubal ligation and hysterectomies in varying ways, depending on the level of cover you have purchased and the conditions of the policy. Things to consider are:

• Your level of cover. Because sterilisation is an elective procedure, vasectomies and tubal ligation are typically covered under higher-tier hospital policies. Check your health insurance policy's Product Disclosure Statement (PDS) or contact your fund to find out if your policy covers it.
• Your hospital cover. Vasectomies do not usually require hospitalisation, but tubal ligation does and hysterectomies in particular require spending several days in hospital. Hospital stays will incur additional costs. To find out how a private health fund covers these and the limits which may apply, look at the hospital cover section of the policy. It is possible that your health fund will cover the surgery itself, but won't cover the hospital stay and related costs.
• What sterilisation covers. Sterilisation typically refers to tubal ligation and vasectomies. Sterilisation is the term to look for if you want a private health fund to cover your contraceptive surgery, and it is a good idea to familiarise yourself with the terms and conditions surrounding it.
• What gynaecological services covers. In both the hospital and general cover sections you may find that a policy includes gynaecological services. Typically this refers only to medically necessary services, like emergency hysterectomy, and not elective ones like tubal ligation.
• What fertility and infertility services mean. Fertility and infertility services, although related to sterilisation, are not connected to the contraceptive surgeries on offer and do not cover vasectomies or tubal ligation (which are sterilisation) or hysterectomies (which is a gynaecological service). However they do refer to vasectomy or tubal ligation reversal surgery, which is a procedure to undo sterilisation.

Can't I just get these types of medical service under Medicare?

You can. Because vasectomies and tubal ligation are not emergencies and Medicare offers relatively good benefits for them.

So, it's not usually worth choosing a fund on the basis of whether or not they cover these. However, going private may still be worth considering if:

• You only want to see a particular practitioner for your vasectomy or tubal ligation.
• You don't want to wait for a bulk-biller to fit you in.
• You are considering an elective hysterectomy for reasons such as a family history of cervical cancer.

How do I claim sterilisation services on health insurance?

To claim a vasectomy or tubal ligation with a private health fund:

• Make sure your chosen doctor is approved by the health fund.
• Book an appointment and confirm that they work with your fund.
• Pay them in a way approved by the insurance plan. This may be by simply swiping a health fund membership card, giving them your details, or paying up-front and then claiming it back later.

Claiming a hysterectomy can be more complicated as it depends on your reason for having the procedure and the methods used by the surgeon.

Bottom line

Having a vasectomy or tubal ligation procedure is easy and relatively inexpensive, but it should also be considered very carefully first. Covering sterilisation with public or private health insurance is simple, but undoing it can be much more complex and expensive.

Frequently asked questions

• What types of sterilisations are available in Australia?

  The two most widely-used methods of voluntary sterilisation are tubal ligation and vasectomy. A hysterectomy, which removes a woman's uterus, is also a common operation.

• Are there any sterilisation-specific exclusions I should be aware of?

  Exclusions are conditions where your policy will not pay a benefit. Before getting waist-deep in the world of contraceptive surgery, study your health insurance policy and look for these details in particular:

  • No payout for procedures done outside of Australia.
  • No cover for additional costs like hospital meals or administrative fees.

  • No cover if the treatment isn't curing a specific problem. Hysterectomies, for example, might not be covered if undertaken to reduce the future odds of cervical cancer because that is not an immediate problem. On the other hand, tubal ligation might still be covered even though it's non-essential because it is "curing" the "problem" of fertility.

• What about policy limits, how do these work?

  A limit is the maximum amount that your insurance policy will pay out. There are typically a variety of different maximums active simultaneously:

  • A maximum amount that the insurance fund will ever pay for any procedure
  • A maximum dollar amount or number of treatments that can be claimed in a year
  • A maximum number of procedures or dollar limit of treatments per person
  • A maximum number of benefits that can ever be claimed over the course of the entire policy

• How do excess payments work?

  You must pay the total flat sum of all applicable excesses when making a claim. Typically, there will be more than one:

  • A standard excess that applies to all claims made by any customers of that fund
  • An extras excess for claiming ancillary cover features
  • Hospital excess to cover the fund's additional expenses associated with your hospital visit
  • A special excess which applies depending on special circumstances, pre-existing conditions etc.

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