This study aims to deeply understand customer experiences, motivations, and preferences regarding private health insurance. The research will focus on how customers select providers, their service satisfaction, reasons for switching, and what fosters long-term loyalty. Combining moderated and AI-supported methodologies, we seek to uncover actionable insights to improve customer experiences and engagement in the private health insurance sector.
4
human moderated
From all time
100
AI moderated
From all time
Loyalty programs
167
Travel planning
103
Cost savings
80
Price comparison
78
Booking process
76
User experience
48
Most users began their journey on comparison websites, which were praised for providing side-by-side comparisons of price, benefits, and coverage. Some noted these tools were detailed and well-structured, while others found them confusing or limited in options.
After identifying a shortlist on comparison platforms, users visited individual provider websites to explore specific plans, benefits, and exclusions in more depth.
Some users relied on government-endorsed comparison websites for unbiased information, considering them objective and trustworthy.
Customer reviews were additional factors users considered when evaluating providers.
Users prioritized monthly premiums over annual costs, focusing on affordability and the flexibility to switch plans if needed. Many expressed a willingness to pay slightly more for additional perks and benefits.
Hospital cover and extras like dental and optical were significant decision factors. Users wanted clear, transparent information about limits and inclusions.
When users couldn’t find answers online, they called customer service centres for clarification, valuing responsive and knowledgeable support.
Many users found it challenging to compare policies across providers due to inconsistent presentation and unclear terms, which made the process overwhelming.
Some comparison websites failed to show well-known providers or offered only one unfamiliar option, reducing their effectiveness.
Frustration with the comparison process led some users to stick with their current provider, even if they felt the coverage wasn’t ideal.
Users wanted providers to publish detailed fact sheets outlining coverage limits for services like dental, physiotherapy, and hospital care in a standardized, easy-to-understand format.
Being tied to long-term contracts with limited flexibility to switch providers was a pain point for some users, making them hesitant to commit.
Users reflected on whether they were getting the best coverage for the price and emphasized the importance of re-evaluating their policies regularly to ensure alignment with their needs.
Users are frustrated with the rigid allocation of individual limits for extras, such as $1,000 for dental or physiotherapy. These fixed limits often do not align with their specific needs, leaving unused benefits in some areas while falling short in others. Many users prefer a "pooled benefits" system, allowing them to allocate a combined limit (e.g., $2,000) across the extras they value most, maximizing utility and minimizing waste.
Users are dissatisfied with being forced to pay high premiums for coverage they rarely or never use, such as weight loss or skin surgery. The inability to exclude low-relevance items from their policies or customize coverage based on personal needs creates a sense of wasted expense and poor value for money. Greater flexibility to tailor plans would address this concern and better meet users' unique requirements.
"I’m paying a high premium for coverage like weight loss surgery, which I’ll probably never need. Why can’t I just remove these extras and reduce my premium? It feels like the plans are made to suit the insurer, not the customer. I’d rather customize my policy to focus on the things I actually use regularly, like physio and dental."
Users frequently switch when their current provider fails to offer adequate benefits, particularly for extras like dental, optical, or other specific needs such as pregnancy or family policies. Caps on coverage (e.g., $400-600 limits on dental) that don’t meet their family’s requirements prompt users to explore better options. Unmet needs for specific treatments (e.g., dental implants) drive users to seek providers offering more tailored coverage.
Rising premiums and a lack of perceived value for money are the primary reasons for switching. Users are drawn to providers offering lower costs or better benefits for a similar price, especially for essential services and extras. The search for budget-friendly options often leads users to evaluate alternative providers.
Providers that don’t allow users to upscale, downscale, or adjust their plans quickly lose customers to more flexible competitors. Long-term lock-in contracts without options to modify coverage based on life changes (e.g., transitioning from single to family plans) frustrate users and encourage them to switch.
Significant life events, such as starting a family, transitioning to adulthood, or new health concerns, often necessitate a change in coverage. Users seek policies that better align with their evolving needs, such as combining individual plans into a family plan or upgrading for new medical requirements.
Users are persuaded to switch by compelling offers from competitors, such as additional perks, better coverage, or improved claim limits. Positive experiences or recommendations from friends, family, or trusted sources influence decisions to explore alternative providers.
Users highlighted the importance of a fast and efficient claims process. Claims submitted via mobile apps or online platforms were praised for their ease of use and quick approvals, often within 24-48 hours. Features such as uploading receipts, selecting claim types, and receiving clear communication (e.g., approval emails and refund timelines) contributed to a seamless process. Transparency about coverage, expected refunds, and clear limits on extras (e.g., dental) enhanced trust in the provider and influenced user loyalty.
Lengthy claim processing times, such as waiting over a week for approval or additional requests for information, created frustration. Users expressed dissatisfaction when they had to follow up through calls or emails multiple times, significantly when responses were delayed by 3-5 business days. Repeated or prolonged issues discouraged users and made them consider switching providers.
Mobile apps and digital tools made a significant positive difference in the claims experience. Users appreciated features such as scanning health insurance cards at healthcare providers for immediate coverage or pre-calculating out-of-pocket expenses during appointments. Technology-driven claims processes reduced manual effort and increased satisfaction by simplifying reimbursements.
Apps that provide real-time updates on claims, remaining benefits, and gaps in coverage significantly enhance user experience. Users value being able to check this information at a glance, which builds trust and satisfaction. Transparency about how much is reimbursed and how much coverage is left for the year is highly appreciated, as it makes users feel in control of their insurance policies.
A well-designed app or website that prioritizes ease of navigation improves user satisfaction. Features like displaying critical information (e.g., benefits, coverage, and claims) prominently on the home screen make a positive impact. Poorly structured platforms or features buried under layers of menus frustrate users and can make them feel undervalued by the provider.
Users desire features beyond the basics, such as recommendations for healthcare providers or services based on location. For example, a map or list of top-rated providers (e.g., dentists or physiotherapists) in unfamiliar areas would add significant value. Recommendations and proactive communication tailored to users’ needs can make the app feel more like a helpful tool than a transactional platform.
Apps and websites should emphasize user-centric design, offering flexibility to adjust policies, track coverage, and review costs easily. Customers feel dissatisfied when they perceive platforms to serve the provider's interests more than their own. Features such as regular policy check-ins or reminders to evaluate coverage can help ensure the platform meets changing user needs over time.
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