Anyone can join an open health insurance fund, but restricted funds cater to people working in a specific industry or group such as education, health, transport, police, defence, steel and others. Membership is usually restricted to people who work in that industry and their families, but can also include former employees.
Matthew Koce, CEO of Hirmaa, an organisation that represents restricted and other not-for-profit community-based health funds says, "Most people through family ties would be able to qualify for at least one restricted fund".
Even if your situation changes and you stop fulfilling the eligibility criteria for a restricted health insurance fund – you may change jobs or no longer qualify as a dependent – once you've joined a restricted health fund, you can usually retain your membership.
How do they compare?
In October 2014 we compared the policies of five restricted membership health insurance funds against our best buys for open health funds.
We looked at three of the largest restricted membership funds – Teachers Health, Defence Health and CBHS (for Commonwealth Bank of Australia group employees), and two of their direct competitors – Teachers Union Health (TUH) and Navy Health.
What we found:
- Restricted membership funds hold up well when compared with the best buys in our health insurance review.
- Restricted funds provide the same level of cover for a lot less money.
- The savings are even better with top cover policies.
What do health fund members say?
A survey we conducted in 2012 found that restricted health insurance funds have a solid track record of satisfied members.
- Teachers Health, Defence Health and CBHS all had significantly better member satisfaction for their hospital and extras cover than open funds.
- CBHS was the best-rated fund, with 88% member satisfaction in hospital cover and 87% in extras cover.
Hirmaa, the industry organisation, represents funds that provide health insurance to about one million Australians. These include some open funds that have featured prominently in CHOICE health insurance Best Buys in recent years, such as Peoplecare, Health Partners, St Lukes and Westfund, as well as restricted funds like Defence Health, Navy Health, Teachers Health Fund and TUH.
- 98% of their funds' members are satisfied according to a survey Hirmaa commissioned.
Restricted membership health funds
For more information check our best buys for five restricted funds or visit privatehealth.gov.au.