Medical insurance

[Yvonne]

What private medical insurance company are you with and why? Thanks

[Dedrei]

We are with Medibank Private.

We did a lot of online quotes and found them to be quite reasonable and value for money, I think.

[Guest Larry]

I was with Medibank Private when I first arrived. - They are the biggest.

But then Australian Unity offered a good deal to members of the Institution of Engineers Australia, so I moved about three years ago.

[Ajay]

We're with IMAN, which includes specialist repatriation cover (a requirement under a 457 visa). I pay $297 per month for the family, and the cover is pretty good. I've only had to claim once so far, and it was incredibly quick.

Hope this helps!

Cheers

Ajay

[Danie]

I'm with Medibank Private and reasonable happy!

Being an ex-Discovery Health member I'm not use to paying for stuff and claim it back! Small price to pay...

Overall I can't complain much and the cover is reasonable good!

A friend of mine is with one of the others... have for got the name... and they (the fund) don't pay anything for any medicine only hospital cost... he received a shock last week when he claimed and they said sorry we don't cover prescriptions.. eina...

Check around and chat to friends for reference!

Danie

[sonnetjie]

We have been with Medibank Private http://www.medibank.com.au/ since we have been in the Oz. When we arrived we asked around and compared a few medical insurance companies and found that Medibank Private met our needs and that the price was really reasonable . You can structure your cover to meet your needs you can start with a really basic cover and build it up from there.

[Riekie]

Sorry, this is quite a lengthy explanation about health insurance in Australia - hope you find this helpful. The information was supplied by Choice.

Broadly speaking, you can choose hospital cover and extras (ancillary) cover. These are available separately or combined.

Hospital cover pays some of the doctors’ fees, a benefit for accommodation and some treatment costs in hospitals the fund has an agreement with. But it may not include cover for ‘extras’ such as phone calls or television sets.

There are three types of private hospital insurance cover:

• private patient in a public hospital
  
• private patient in a shared ward in a private hospital
  
• private patient a private room in a private hospital (if there’s one available)
  What you may not get:
  • 100% cover in all hospitals.
    
  • The gap
    
  • The cost of any pharmaceuticals not covered by the PBS.
    
  • A guarantee of a private room.
    

Extras cover contributes to the cost of non-hospital treatments that aren’t covered by Medicare. This usually includes dental or physiotherapy treatment and products like glasses and contact lenses, plus less common treatments such as acupuncture or podiatry. The range of benefits paid varies between funds, and the payout is unlikely to cover the whole cost of the treatment.

A key factor in choosing hospital insurance is the private hospitals you can go to with a particular fund. It’s becoming common for funds to have an ‘agreement’ with certain hospitals: if you have full cover and stay in these hospitals, 100% of your accommodation costs will be paid (apart from any excess or co-payment). The cover you get in a non-agreement hospital depends on the fund: some only pay a basic rate set by the government, while others pay a bit more. Either way you’re likely to have extra costs after a stay in a non-agreement hospital.

If you’re looking for hospital cover, make sure you get a list of the hospitals the fund has an agreement with. If your preferred hospital or the hospital your specialist has an agreement with isn’t listed you should probably choose a different fund, but bear in mind that agreement hospitals can change over time. Check periodically that the one you want is still covered.

If you're in a rural area it’s especially important to check how far you’d have to travel to the nearest agreement hospital.

It's also important to check any other restrictions that apply to the hospital cover you're considering. For example a number of policies also place limits on some treatments (which means that the fund will only meet part of the costs) and may exclude coverage for some treatments altogether.

Commonly limited and excluded treatments include:

• Assisted reproduction
  
• Bone marrow transplants
  
• Coronary bypass and major heart surgery
  
• Cataract eye surgery
  
• Dialysis
  
• Hip, knee and other joint replacements
  
• Obstetrics and birth related care
  
• Plastic surgery and cosmetic surgery
  
• Psychiatric care
  
• Rehabilitation
  

So remember, if you specifically want coverage for any of these things, make sure you check and double check with your health fund to make sure they aren’t excluded or limited in any way.

Extras cover

Ancillary (extras) health insurance covers non-hospital treatments that aren’t covered by Medicare — for example, dental treatment or physiotherapy, glasses and contact lenses, plus less common treatments such as acupuncture or podiatry. Some ancillary policies give you a benefit for a gym membership or complementary treatments like massage.

There are no complex government policies affecting ancillary health insurance — you can take it out later in life without getting penalised. So it’s worth calculating how much money you got back from your claims in the past year and comparing it with the price of the policy. Are you getting value for money?

Some funds restrict the overall amount by combining the maximum limits — for example, saying you can have $400 worth of physiotherapy and chiropractic in a year instead of $400 for each. This restriction can mean very large differences in how much you’ll get. It’s also worth noting the difference between family limits and single limits. Some products limit the number of times a family can claim for some services.

For ancillary cover, especially if you're in a rural area, check whether the healthcare provider of your choice (such as an acupuncturist) is covered by the fund.

Different rates for different people?

Health insurance used to be available as either family or single cover — with single cover being half the cost of family. These days there can be four categories: family, single, single-parent and couple. Despite this change we found that single insurance usually still costs half the family rate, with couple and single-parent rates for the most part being the same as family. If there’s no difference in cost, single-parent families and couples may be better off choosing a family policy. That way you don’t have to alter your cover if your circumstances change.

The 'bells and whistles'

Many of the funds also have other features, ranging from their own dental or optical clinics that entitle you to a higher benefit, to ambulance cover included with ancillary cover, to cover for chinese herbalism or massage therapy. Wanting some particular extra features may help you decide which fund to choose. However, read the brochures carefully and check if the fund is more expensive than those without the extras.

Before signing up with any fund, read its brochure and key features guide thoroughly. If there’s anything you don’t completely understand about your entitlements, write to the insurer and get written answers to your questions before you join. It may seem like a hassle, but not in comparison to the problems you’ll encounter if your cover doesn’t match your expectations.

Fine-print checklist

Here are a few of the questions to ask the fund — when you take out insurance, when you’re reviewing it and before you go into hospital:

Hospital

• How does your excess or co-payment work?
  
• What’s not covered?
  
• Are there any limits to treatment, even with so-called 100% cover? For example, you may only be entitled to a certain number of overnight stays overall or there may be day limits for specific treatments like for psychiatric or intensive care.
  
• If you have partial cover, what are the limitations or exclusions?
  
• If there are benefit limitation periods, how long are they and how much does the fund cover during this limitation period?
  
• Is the hospital you want to go to an agreement hospital with the fund?
  
• Does the fund have an agreement with any doctors to cover the ‘gap’ between the actual charge and the Medicare Schedule fee?
  

Extras

• If ancillary (extras) benefits are listed as a percentage, is it a percentage of any fee charged or of a ‘reasonable fee’ set by the fund?
  
• What are the annual limits for ancillary benefits and do these apply per person or per membership?
  
• Do the providers of ancillary services need to be registered with the fund? Some funds require practitioners to be registered with the appropriate state board. Others require them to be specifically registered with the fund, which can limit the practitioners you can go to.
  
• If there is a specific register, make sure you contact the fund to find out if a practitioner is on it before you get treatment, otherwise you won’t get a benefit.
  

Hospital & extras

• Who counts as a member? Family cover generally includes your partner and children under a certain age — the age varies from fund to fund, it could be 16, 21 or even up to 23. Some policies may include full-time students under 25 or other dependants. If this extended cover is offered, does it cost any extra?
  
• Are there any advantages to longer membership? These may include higher benefits or benefit limits, or lower excesses the longer you’re a member.
  

In their promotional material health funds often say its easy to switch but it can become stressful if things go wrong.

If your new fund doesn' t get the necessary paperwork in time, extra costs may apply. Or worse, there may be a gap in membership leaving you without any private cover and liable to pay a part of the Medicare Levy Surcharge. Use our tips to avoid switching traps.

Questions to ask a new fund before switching:

• What waiting periods will apply?
  
• Are any treatments excluded?
  
• Are any treatments restricted to public hospitals?
  
• Are any treatments initially limited to care as a private patient in a public hospital?
  
• What excess/co-payment applies, is there an annual maximum per membership?
  
• If you want to go to a specific private hospital or be covered for treatment by a specific health practitioner will there be out-of-pocket expenses?
  

Get a detailed quote in writing, showing applicable government rebate, discounts and Lifetime Cover loading.

Steps to complete when switching funds:

• Apply for cover with the new fund. Ask the new fund to commence its cover only when the old cover is cancelled.
  
• Arrange the cancellation of your old cover yourself. Request a clearance certificate (shows membership level and Lifetime Cover status) and an itemised claims statement from your old fund. The new fund may give you a request form to send to your old fund. Check back with your old fund if you haven't received it within one or two weeks.
  
• Keep a copy of both statements and send them to the new fund.
  
• Check your bank statement to make sure membership has commenced with the new fund and there's no overlap. If you pay via direct debit, cancel this with the old fund and advise your bank of the cancellation.
  

Tip: Health funds may offer special incentives such as free cover for a period of time. Ask the fund you'd like to join if it has any special offers or is prepared to to match an offer from another fund. Some health funds reward long-term members with special bonuses such as a higher claims limit for extras treatments. If you're entitled to these bonuses with your old fund, some funds may match them if you ask.

[SASydneysider]

I'm sure I posted a question asking if anyone belonged to HCF. What happened to my posting?

[Bob]

We've been insured with Medical Benefit's Fund (M.B.F.) for the past few years. They offered the best rebates, at the time, for dental care.

It would pay you to do your homework, online and by browsing their brochures, on what specifically each health fund covers and what amount you get back.

Each family has different needs, so go for a health fund that covers your family's most needs.

It's no use getting cover with a health fund if you find you have a lot of back pain and need chiropractic help a lot, only to find they don't cover chiro.

Similarly, if your family has good teeth but you need glasses every year for someone in the family, it may help to check on the rebates for spectacles and just look briefly at dental.

All Australian health funds, by Law, have to provide insurance cover on a "Community basis" . . that is, they offer premiums and rebates according to the community rating that they are covering. Friends of mine years ago from South Africa stated that they couldn't get cover for one of their kids because of the child's disability. This would not be allowed in Australia. An individual is NOT discriminated against no matter their state of health nor age, etc.

There are however, waiting periods for pre-conditions. If you have a heart problem, for instance, no rebate will be payable to you for a ceratin period . . . usually one year . . . if you go to hospital for cardiac purposes.

[Riekie]

SASydneysider, I did a search for you on HCF to see if I could trace if for you, but I could not. Maybe you should ask Hendie if there's another way to find it. It would not have disappeared completely..... it should be somewhere.

[SASydneysider]

Thanks Riekie. I'll watch this thread, as someone having info on HCF might still make a posting.

SAS