More claims, more often - Southern Cross releases results
Southern Cross paid out a record 3.8 million claims in the 2025 financial year - up by 16% on FY24 - according to results released today.
Tuesday, September 30th 2025, 7:16AM 
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Southern Cross Health Society Group paid out a total of $1.706 billion in claims during the 12-month period ending 30 June 2025, up 14% from FY24.
A total of $6.85 million was paid out every business day, and the insurer returned 94% of premiums collected directly to members via claims.
Southern Cross Health Society Group reported a deficit of $51.8 million for the year. It comprises a $56.9 million deficit from health insurance operations, partially offset by a $13.9 million surplus from subsidiary investments and an $8.8 million group accounting consolidation adjustment.
However, the health insurance deficit is a $42.2 million improvement compared to FY24's $99.1 million loss.
Chief executive Nick Astwick said that more members are making claims, and more often.
“There is clear evidence our public health system remains under pressure, we’re seeing members of all ages using their policies more than ever to access the private healthcare treatment they need, when they need it,” Astwick said.
Claims breakdown, cost management initiatives
The record claims included 340,224 surgical procedures (up 7%), 651,443 specialist consultations (up 7%), 853,674 GP visits (up 5%), and 538,950 prescriptions (up 153%). The prescription claims surge followed the reintroduction of $5 government prescription charges in July 2024.
Top procedures by total payment included knee replacements ($80.7 million), colonoscopies ($80.4 million), hip replacements ($72.2 million), hysterectomies ($52.1 million), and skin excisions ($52 million).
To help members manage premium affordability, 17,772 members added or increased policy excess levels during the year to retain coverage. Southern Cross also expanded its Affiliated Provider network to 2,500 contracted healthcare providers nationwide, adding 143 providers during the year, and achieved national pricing for imaging procedures including x-rays, CT scans, and MRIs.
Operating costs decreased 3% year-over-year, with health insurance overhead expenses dropping from 13.1% to 11.3% of premiums.
Financial outlook
Southern Cross Medical Care Society Group maintains total reserves of $418.9 million and holds an A+ financial strength rating from Standard & Poor's. Investment holdings of $617.9 million returned $43.4 million in income during the year.
Chair Chris Black noted that the Group used reserves strategically over two years to absorb increased claims costs rather than passing the full impact to members through higher premiums - an approach it has employed eight times over the past 25 years.
Black also stated that an active programme is underway to return to surplus in FY26 while managing claims costs and keeping premiums affordable.
He said this would include broadening the scope of contracting arrangements for specific medical procedures, using technology where possible, and looking for efficiencies in core operations.
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Around 2005, the premiums for the entire medical insurance industry were approximately $650 million, and individuals were spending $1.7 billion out of pocket on private medical care directly.
Insurance claims in 2005 totalled between $550 million and $624 million in paid claims.
Now we're looking at one company that's nearly hitting the whole 2005 private health spend and nearly three times the industry premiums alone with $1.815 bil premium (94% paid as claims).
It's a bit nuts!