485 Insurance

Essential for your 485 visa

Firstly, it is important to know that you do have choice in who you get your 485 insurance from while you are in Australia. 485Insurance is likely to get you the best deal without affecting your visa.

485 insurance often referred to as Overseas Visitor Health Cover (OVHC) is a product designed to assist foreigners meet the costs of medical treatment they may need while living in Australia. A number of insurance providers have products available that will meet the minimum level of coverage. You are able to choose a product which is right for you, as long as it meets the Department of Immigration’s requirements.

The Australian medical landscape has two streams, public and private. Public healthcare is generally provided free of charge to Australians although more and more medical practitioners are pricing their services above the MBS, meaning a "gap" fee will need to be paid. In the private system, doctors essentially charge what the market will pay. As you would expect, generally service is better in the private health system. Having said that, for the most part, the private health system uses the same facilities as the public health system - in Australia going private is usually a choice related to access to medical personnel, rather than gaining access to medical facilities.

Separate health insurance, over and above 485 insurance, can be entered into in order to cover the cost of using the private health system. It should be noted that more and more, private health fund rebates do not cover the private medical practitioners' fees, so there will likely be out of pocket expenses, even with private health insurance on top of 485 insurance cover.

According to 485 visa requirements, at a minimum, 485 insurance policies must cover the following:

  • Public hospital
    • overnight and day only hospital accommodation (all costs including: all theatre, intensive care, labour wards, ward drugs);
    • emergency department fees that lead to an admission;
    • admitted patient care and post operative services that are a continuation of care associated with an early discharge from hospital.
  • Surgically implanted prostheses
  • Pharmacy - all PBS listed drugs that are prescribed according to the PBS approved indications, that are administered during and form part of an admitted episode of care - a benefit equal to the PBS listed price in excess of the patient contribution
  • 100 per cent of the MBS fee for in-patient medical services (for example, surgery), or less if the patient is charged less.
  • Ambulance services
  • Minimum benefit of $1 million per person per annum.

485 insurance policies may only exclude the following:

  • Assisted reproductive treatments (e.g., IVF);
  • Elective cosmetic treatments;
  • Bone marrow and organ transplants;
  • Treatment while travelling to or from Australia;
  • Treatment arranged before coming to Australia; and
  • Treatments covered by compensation and damages provisions of any kind.

To comply with the minimum level of health insurance, the only waiting periods that maybe imposed are:

  • 12 months for pregnancy related conditions;
  • 12 months for pre-existing conditions; and
  • 2 months for psychiatric, rehabilitation and palliative care, regardless of whether or not the condition is a pre-existing.