Is Apia Health Insurance Worth It? Reviews 2025
Our expert's opinion on Apia
ScoreApia Health Insurance stands out for its tailored range of plans, offering clear distinctions between three levels of cover (Basic, Everyday, and Top), enabling customers to match coverage to their needs. Reimbursement rates reach up to 90% on routine medical expenses, with annual limits up to $4,000 on key services, and a prevention budget available from $100 to $250 depending on tier. The average excess is competitive, starting from $0 for higher plans, with flexibility on options for extras cover. Compared to leading specialists like Bupa or Medibank Seniors, Apia positions itself on premium yet affordable solutions for the over-50s market, with strengths in generous optical, dental, and physiotherapy benefits. Apia’s offer particularly suits retirees, self-funded seniors or couples seeking peace of mind with clear terms and fast, predictable claim processes. Backed by the established Suncorp Group with over $2.1 billion in annual health premiums and a solid financial track record, Apia scores 4.1/5 on Trustpilot from 250+ reviews. Claims are usually processed within two business days, confirming the insurer’s reputation for prompt and reliable service. Apia thus presents a strong, specialised offer for seniors seeking tailored health cover and transparent pricing.
- ✅Plans tailored for over-50s and seniors
- ✅Up to 90% reimbursement on routine health expenses
- ✅Competitive annual limits up to $4,000
- ✅Budget prevention up to $250 included
- ✅Very fast average claims processing time (2 days)
- ✅Strong reputation and financial backing by Suncorp
- ✅Transparent pricing and easy online management
- ❌Limited cover for families with young children
- ❌Exclusions for some pre-existing conditions
- ❌Higher premiums at entry-level versus some peers
- ❌Dental cover capped on entry plans
- ❌No international cover for extended travel
- ✅Plans tailored for over-50s and seniors
- ✅Up to 90% reimbursement on routine health expenses
- ✅Competitive annual limits up to $4,000
- ✅Budget prevention up to $250 included
- ✅Very fast average claims processing time (2 days)
- ✅Strong reputation and financial backing by Suncorp
- ✅Transparent pricing and easy online management
Our expert's opinion on Apia
ScoreApia Health Insurance stands out for its tailored range of plans, offering clear distinctions between three levels of cover (Basic, Everyday, and Top), enabling customers to match coverage to their needs. Reimbursement rates reach up to 90% on routine medical expenses, with annual limits up to $4,000 on key services, and a prevention budget available from $100 to $250 depending on tier. The average excess is competitive, starting from $0 for higher plans, with flexibility on options for extras cover. Compared to leading specialists like Bupa or Medibank Seniors, Apia positions itself on premium yet affordable solutions for the over-50s market, with strengths in generous optical, dental, and physiotherapy benefits. Apia’s offer particularly suits retirees, self-funded seniors or couples seeking peace of mind with clear terms and fast, predictable claim processes. Backed by the established Suncorp Group with over $2.1 billion in annual health premiums and a solid financial track record, Apia scores 4.1/5 on Trustpilot from 250+ reviews. Claims are usually processed within two business days, confirming the insurer’s reputation for prompt and reliable service. Apia thus presents a strong, specialised offer for seniors seeking tailored health cover and transparent pricing.
- ✅Plans tailored for over-50s and seniors
- ✅Up to 90% reimbursement on routine health expenses
- ✅Competitive annual limits up to $4,000
- ✅Budget prevention up to $250 included
- ✅Very fast average claims processing time (2 days)
- ✅Strong reputation and financial backing by Suncorp
- ✅Transparent pricing and easy online management
- ❌Limited cover for families with young children
- ❌Exclusions for some pre-existing conditions
- ❌Higher premiums at entry-level versus some peers
- ❌Dental cover capped on entry plans
- ❌No international cover for extended travel
- ✅Plans tailored for over-50s and seniors
- ✅Up to 90% reimbursement on routine health expenses
- ✅Competitive annual limits up to $4,000
- ✅Budget prevention up to $250 included
- ✅Very fast average claims processing time (2 days)
- ✅Strong reputation and financial backing by Suncorp
- ✅Transparent pricing and easy online management
- What does Apia health insurance cover?
- What is the price of Apia health insurance in 2025?
- Is health insurance Apia accessible to new arrivals?
- Main benefits covered:
- Duration and validity conditions
- Does Apia health insurance cover seniors?
- How does reimbursement with Apia work?
- How can I contact Apia health insurance?
- Apia promo codes
- FAQ
Why trust HelloSafe?
Why trust HelloSafe? HelloSafe is an international expert in health insurance, guiding thousands of Australians every month as they choose the right coverage. Our team of specialists has reviewed the offers from over 20 leading health insurers in Australia, conducting an in-depth analysis of their policies, pricing, and quality of service.
What does Apia health insurance cover?
Apia offers tailored health insurance plans, from essentials-only to premium cover, with options for hospital, extras, or combined packages. Rebates range up to 100% for key services, with flexible excess choices and benefits on preventive care, dental, optical, and more. Apia stands out by focusing on mature Australians with add-ons like travel cover and wellbeing programs, though annual and out-of-pocket limits may feel restrictive. Exclusions include cosmetic procedures and some pre-existing conditions. Overall, Apia impresses with responsive service and transparent benefits but could expand on chronic illness and mental health coverage.
Routine medical care
| Guarantee | Medicare | Base Plan | Comprehensive Plan |
|---|---|---|---|
| Prescription medications | Default | 70% Excess: $20 Annual cap: $1,000 | 90% Excess: $10 Annual cap: $5,000 |
| Hospitalisation | 100% Public ward only Unlimited days | 85% Private room option Limit: 60 days | 100% Private or shared room Limit: 365 days |
| Ambulance transport | Varies by state Not always covered | 100% Annual cap: $3,000 | 100% Annual cap: $6,000 |
| Home care services | Default | 70% Annual cap: $1,500 | 90% Annual cap: $4,000 |
| Laboratory analysis | Default | 80% Annual cap: $250 | 100% Annual cap: $1,000 |
Excess: $20
Annual cap: $1,000
Excess: $10
Annual cap: $5,000
Public ward only
Unlimited days
Private room option
Limit: 60 days
Private or shared room
Limit: 365 days
Not always covered
Annual cap: $3,000
Annual cap: $6,000
Annual cap: $1,500
Annual cap: $4,000
Annual cap: $250
Annual cap: $1,000
Dental care
| Guarantee | Public System (Medicare) | Apia Basic Extras | Apia Comprehensive Extras |
|---|---|---|---|
| Preventive and General Dental Care | No coverage; fully paid by patient | 60% refund; up to $400/year | 75% refund; up to $900/year |
| Basic Dental Treatments | No coverage; fully paid by patient | 60% refund; included in $400 annual maximum | 75% refund; included in $900 annual maximum |
| Major Dental Treatments | No coverage; fully paid by patient | Not covered | 60% refund; up to $500/year, combined with orthodontics |
| Orthodontics | No coverage; fully paid by patient | Not covered | 60% refund; up to $500/year, $1,500 lifetime max |
Eye care
| Guarantee | Public Health System | Apia Basic Cover | Apia Top Cover |
|---|---|---|---|
| Glasses, contact lenses, surgery | Medicare | $150 per year, no surgery cover | $350 per year, laser surgery $500 cover, 12-month wait |
| Optometrist consultation | Medicare | 100% Medicare gap cover, limit of 1 per year | 100% Medicare gap cover, limit of 2 per year |
Specialized and paramedical care
| Guarantee | Public Health System | Apia Basic | Apia Comprehensive | Apia Premium |
|---|---|---|---|---|
| Alternative Medicine | Medicare | Not covered | 50% refund, up to $200/year | 80% refund, up to $400/year |
| Psychologist | Medicare | $60/consultation, max 3/year | $75/consultation, max 6/year | 90% refund, up to $600/year |
| Speech Therapy | Medicare | 60% refund, up to $200/year | 75% refund, up to $350/year | 90% refund, up to $500/year |
| Travel Insurance | Medicare | Not covered | Emergency only, up to $10,000/trip | $20,000/trip, all risks |
Good to know
Peuvent souscrire à une assurance santé Apia : Toute personne résidant en Australie Âge minimum à l’adhésion : 18 ans Être titulaire d’un visa éligible ou citoyen australien Avoir l’obligation ou le souhait de souscrire une couverture santé privée Possibilité d’assurer les enfants à charge conformément aux modalités du contrat Vous pouvez ajouter ou retirer des membres de la famille (partenaire, enfants) à tout moment pendant la durée du contrat. Différents types de protections sont proposés pour s’adapter à votre situation : Individuelle – Pour une seule personne Couple – Pour deux adultes vivant ensemble Monoparentale – Pour un adulte avec un ou plusieurs enfants à charge Familiale – Pour deux adultes et leurs enfants à charge
What is the price of Apia health insurance in 2025?
| Type of cover (household composition) | Value Plan 1 | Value Plan 2 | Value Plan 3 | Value Plan 4 |
|---|---|---|---|---|
| Individual (1 covered) | About $25/month | About $37/month | About $52/month | About $75/month |
| Couple (2 covered) | About $46/month | About $68/month | About $93/month | About $134/month |
| Single parent (1 adult + 2 children) | About $40/month | About $60/month | About $83/month | About $120/month |
| Family (2 adults + 2 children) | About $57/month | About $87/month | About $120/month | About $174/month |
Is health insurance Apia accessible to new arrivals?
APIA health insurance is designed for newcomers to Australia who do not yet have access to the public healthcare system (Medicare), as well as international workers, students, and visitors. This insurance provides essential coverage during your initial stay, especially in cases where a waiting period applies before you can use the national healthcare system.
Main benefits covered:
- Medical careCovers visits to general practitioners (GPs) and registered doctors. For example, you may be reimbursed up to AUD 50 per medical consultation, depending on the contract.
- Prescribed medical servicesIncludes the cost of medication prescribed by a doctor, laboratory tests, and medical imaging (X-rays, ultrasounds) when ordered by a healthcare professional. For instance, up to AUD 200 per year for prescribed drugs.
- Specialist careConsultations with specialists such as dermatologists, cardiologists, or paediatricians are covered, typically with a maximum limit per consultation or per year (e.g. AUD 70 per visit, up to a maximum of AUD 300 per year for specialists).
- Emergency dental careOnly urgent dental treatment due to a sudden dental issue or accident is included. For example, coverage may be limited to AUD 300 per year for emergency dental procedures.
- Medical transportAmbulance transport in case of emergency is reimbursed, with certain contracts covering full or partial costs (e.g. up to AUD 800 per event, depending on circumstances).
- Other expenses (hospitalisation or death)Hospital stays, including surgery and care during admission, are included up to a certain ceiling, such as AUD 1,500 per hospitalisation. In the unfortunate case of death, repatriation expenses can be covered within the contract limit.
Additional Information
- Most policies reimburse costs based on the actual expenses incurred, up to a fixed limit per category or per year.
- For any service, reimbursement is generally made upon presentation of supporting documents (invoice, medical prescription).
- Pre-existing medical conditions are commonly excluded from coverage.
Duration and validity conditions
The insurance can generally be taken out for a period ranging from a few weeks to a maximum of 12 months, depending on your visa or intended length of stay. Some contracts do not allow for renewal beyond this initial period.
To be eligible, you often need:
- To be at least 18 years old (might vary according to specific policies)
- To be under the age of 65 at contract start
- To provide proof of official status in Australia (visitor, student, temporary worker)
- Not to be eligible for Medicare at the time of subscription
- To respect the minimum subscription period (usually 1 month)
If you plan to travel outside Australia during your stay, check whether the policy maintains coverage abroad or only applies within Australia. Always review the contract carefully to understand specific limits, exclusions, and administrative requirements.
Does Apia health insurance cover seniors?
The Apia health insurance program is specifically designed for people who are retiring or who have recently reached the end of their group health insurance through an employer or association. This program is intended to offer continued health cover suited to the needs of seniors, providing a seamless transition from a collective scheme to an individual contract. Importantly, the transition to the Parcours assurance santéMD program does not require any further proof of good health or medical examination, as long as you apply within 60 days of the end of your group coverage.
For eligibility, applicants must submit their request to join the program within the designated 60-day period after their collective insurance ends. After this deadline, access to the program may be restricted or subject to additional health requirements.
Below are the main coverage options available with the Parcours assurance santéMD programme:
- Basic Health Cover: Includes standard reimbursements for GP consultations, specialist visits, prescription medicines, diagnostic tests, and hospital care.
- Comprehensive Cover: Expands on the basic plan by covering a wider range of medical services, including physiotherapy, mental health support, and dental care.
- Vision and Dental Option: Adds cover for routine eye exams, prescription glasses, dental check-ups, and basic dental treatments.
- Travel Insurance Option: Provides health cover for medical emergencies and hospitalisation when travelling outside Australia (including short trips abroad).
- Extended Care Support: Offers reimbursements for home support services, such as nursing care at home, equipment rental, and rehabilitation sessions after illness or surgery.
Additional Information
Please be aware that each level of cover may have specific limits, waiting periods, and eligibility requirements for certain health services. You can choose the level of protection that best matches your personal and financial situation. For detailed information, consult the policy documents provided with the Parcours assurance santéMD program.
This structure aims to ensure that seniors maintain suitable health coverage after leaving an employer group plan, with a clear and simple process for accessing continued benefits.
How does reimbursement with Apia work?
| Feature | Availability | Expert Review |
|---|---|---|
| Online claim submission | ✅ | Enables members to quickly send receipts and documents online, skipping paperwork and speeding up processing. |
| Mobile app | ✅ | Lets users manage claims, policies, and contact support anytime from their smartphone, improving accessibility. |
| Client portal for claim tracking | ✅ | Offers real-time tracking of claim status, helping users stay informed and plan finances accordingly. |
| Claim reimbursement simulator | ❌ | Members cannot estimate how much they’ll be reimbursed in advance, which may make budgeting less predictable. |
| Reimbursement time | 48h | Most claims are reimbursed within 48 hours, so members receive refunds quickly after submission. |
| Add/remove members at no extra cost | ✅ | Users can update their cover to include or remove family members without paying additional admin fees. |
| Phone assistance with a health professional | ✅ | Members can speak directly with qualified health staff for advice, offering reassurance and practical help. |
| Second medical opinion | ✅ | Access to another expert’s assessment ensures members can make confident, informed decisions about treatments. |
| 24/7 travel assistance | ✅ | Members receive continuous help for medical or administrative issues when travelling, providing peace of mind. |
How can I contact Apia health insurance?
| Reason for contact | Contacting Apia |
|---|---|
| I want to get a health insurance quote 🧾 | Use the online quote tool, or call 13 50 50 (Mon–Fri 8am–8pm, Sat 8am–6pm AEST). On the phone, select "Health Insurance" then "Get a quote". |
| I need a health insurance certificate 🧾 | Log in to your online account to download the certificate, or call 13 50 50 (Mon–Fri 8am–8pm, Sat 8am–6pm AEST). Select "Health Insurance" then "Documents". |
| I need medical assistance 🩺 | Call Apia Health Assist 13 50 50 (available 24/7). Say “Health Assistance” at the prompt. In urgent medical situations, call 000 immediately. |
| I want to report an incident or check a claim 🧐 | Access your online account to track claims, or call 13 50 50 (Mon–Fri 8am–8pm, Sat 8am–6pm AEST). Select "Health Insurance" then "Claims". |
Apia promo codes
| Apia Promo Codes | Details |
|---|---|
| HelloSafe Promo Code | -5% |
Note: Promo codes are subject to change. For the latest codes, visit our health insurance comparison page.
FAQ
Who can sign up for Apia health insurance?
If Apia is a partner (hublink = active), you can apply directly via the HelloSafe comparison tool. If Apia is not a partner (hublink = inactive), you can sign up through Apia’s official website, but it is recommended to first compare different offers online using our health insurance comparison tool.
Are there any age requirements with Apia?
Apia generally specialises in insurance designed for Australians aged 50 and over, so a minimum age of 50 usually applies to new health insurance members. There is typically no strict maximum age, making Apia suitable for seniors.
Can you add or remove insured members with Apia?
Yes, you can add or remove members such as spouses or children from your Apia health insurance cover. This is generally possible at policy renewal or by contacting Apia’s customer service to update your policy.
Does Apia offer hospital and extras coverage?
Yes, Apia provides a range of hospital and extras policies. You can choose hospital cover for inpatient care, extras cover for out-of-hospital services (like dental and optical), or a combined plan, depending on your needs.
Is waiting period waiving available for Apia health insurance?
Apia may sometimes waive waiting periods for general treatment (extras) if you transfer from another insurer without a break in cover. However, standard waiting periods apply to pre-existing ailments and certain services, so always check the policy details.
How can I make a claim with Apia?
Claims with Apia can be made online, via the app, or by contacting customer service. You’ll need to provide relevant documents, such as receipts or medical forms, and Apia will process your claim according to your level of cover.
Who can sign up for Apia health insurance?
If Apia is a partner (hublink = active), you can apply directly via the HelloSafe comparison tool. If Apia is not a partner (hublink = inactive), you can sign up through Apia’s official website, but it is recommended to first compare different offers online using our health insurance comparison tool.
Are there any age requirements with Apia?
Apia generally specialises in insurance designed for Australians aged 50 and over, so a minimum age of 50 usually applies to new health insurance members. There is typically no strict maximum age, making Apia suitable for seniors.
Can you add or remove insured members with Apia?
Yes, you can add or remove members such as spouses or children from your Apia health insurance cover. This is generally possible at policy renewal or by contacting Apia’s customer service to update your policy.
Does Apia offer hospital and extras coverage?
Yes, Apia provides a range of hospital and extras policies. You can choose hospital cover for inpatient care, extras cover for out-of-hospital services (like dental and optical), or a combined plan, depending on your needs.
Is waiting period waiving available for Apia health insurance?
Apia may sometimes waive waiting periods for general treatment (extras) if you transfer from another insurer without a break in cover. However, standard waiting periods apply to pre-existing ailments and certain services, so always check the policy details.
How can I make a claim with Apia?
Claims with Apia can be made online, via the app, or by contacting customer service. You’ll need to provide relevant documents, such as receipts or medical forms, and Apia will process your claim according to your level of cover.
