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Private Health Insurance - ABCs

Health Insurance Waiting Periods

A waiting period is the time you need to wait for before you are allowed to make any claims for benefits on your cover through your health insurance fund. Waiting periods apply for the new or increased levels of cover for both hospital and extras cover.

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Health Insurance Comparison Frequently Asked Questions

Depending on the policy, private health insurance can help cover the cost of your medical treatments in or out-of-hospital that Medicare sometimes won’t cover. Out of hospital treatment can include services such as Dental, optical, physiotherapy or even remedial massage

Private health insurance can help cover medical treatment received when hospitalised. Therefore, it is important to select the right level of cover for the clinical categories that are necessary to you.

Your private health insurance should change as often as needed to ensure you are covered at all the different stages of your life.

Also, private health insurance gives you the ability to choose your own doctor and avoid any public waiting lists for categories covered by your policy.

There are many top competing health funds, however you want to find one that is best suited to your individual health requirements and not just a health fund that is the best in the market.

This can sometimes be a difficult task for individuals, therefore companies like Health.Compare can offer comparisons of different health insurance policies to help you choose a policy that is catered to your health circumstances and budget.

Excess is the amount you pay upfront to cover some of the hospitalisation expenses if you ever get hospitalised. The higher the excess, the lower your private health insurance premiums will be. This usually applies to people with relatively lower health concerns who do not see themselves being in hospital anytime soon and in the event that they are hospitalised, they can agree to pay a higher excess, ultimately reducing their regular premiums.

Please be aware that excess amounts do vary depending on the health insurance provider, so it may be beneficial for you to consider your individual health and financial circumstances at the time of buying the insurance policy before agreeing to the Excess amount.

In Australia, health insurance is not tax deductible however you can receive rebates for your private health insurance. When taking out Private Health Insurance you choose whether or not to claim a rebate from the government. The government rebate is dependent on a number of factors including age and taxable income.

This can be applied to Hospital, Extras or combined products.

According to a recent report by APRA, 55.2% of Australians have extra cover, and 45.2% have hospital cover. These are the verified figures as of June 2022.

While the average cost of private health insurance adds up to $160 per month per person, your premiums may go up or down depending on the type of cover you choose or the excess amount you agree upon.

The starting point for many, is to look at your individual needs, preferences and financial circumstances.

We will help guide you through this conversation by first understanding and then matching your needs to a tailored level of cover. Ultimately, what’s best for you and your situation will be completely different to many others who are eligible for Private Health Insurance.

Yes you can have a private hospital insurance policy with one health fund and extras cover with another. This can be helpful as some funds might have a hospital policy you like, but not the extras cover you require for the specific out-of-hospital treatments.

Is it legal to have two private health insurance policies?

Yes, it’s totally fine and legal to have two private health insurance policies. However, you should make sure you understand the terms and conditions of both policies before making a decision.

What are the reasons people may have two health insurance policies?

You are a married couple and each of you have separate private health insurance through your own employers.
You are under 26 years of age and your parents are divorced and you are listed on both parents policies as a dependent.

Will having two private health insurance policies affect my Medicare benefits?

No, having two policies will not affect your Medicare benefits.

How do I choose which health policy to claim from?

If you have two private health insurance policies and need to make a claim, you will need to choose which policy to claim from. To do this, you will need to consider the benefits and coverage of each policy and what you are claiming.

How do I get two private health insurance policies?

To obtain two private health insurance policies, you will need to apply for each policy separately. You can do this by contacting each health insurance provider directly or by using a health insurance comparison website.

Private health insurance provides many benefits to its members giving them access to a wide choice of health providers, faster access to medical services and the ability to avoid long wait times experienced in the public hospital system. In this FAQ we will answer some of the common questions about private health insurance.

What are the benefits of having private health insurance?

  • Access to private hospitals and faster treatment times
  • A wider range of treatment options
  • Ability to choose your own doctor and hospital
  • Reduced out-of-pocket expenses
  • Access to many health services and treatments not covered by the public system

Can I choose my own doctor and hospital if I have private health insurance?

Yes, with private health insurance you have the ability to choose your own doctor and hospital, giving you greater control over your health care to achieve a better overall health outcome.

How can I choose the right private health policy for me?

When choosing private health insurance, there are a few factors to consider:

type of cover required (hospital or extras)

  • your budget
  • your age and pre-existing medical conditions
  • the level of cover required
  • the range of health services you need to be covered for

Why should I get extras cover?

extras cover will give you further coverage on a range of treatments such as dental, optical, chiropractic, massage and physiotherapy.
some extras health policies also include further natural therapies such as acupuncture and Chinese medicine

How much does private health insurance cost?

The cost of a health policy in Australia varies depending on what type of cover you choose, your age, if you have any dependents and any pre-existing conditions. On average, the cost of private health insurance is around $2,000 per year for an individual and $4,000 per year for a family.#

In Australia, private health insurance is available to provide financial protection and contribution to medical expenses, but not all medical expenses are covered by your private health policy. In this FAQ we will explain the questions you have around what is typically covered and what’s not covered with private health insurance.

What is not covered by standard private health insurance?

The most common exclusions from private health insurance policies in Australia include:

  • Elective cosmetic operations, such as cosmetic surgery and cosmetic dentistry
  • Weight loss surgery, unless it is deemed medically necessary
  • Infertility treatments, such as IVF
  • Alternative therapies, such as homeopathy, aromatherapy, kinesiology, reflexology and iridology
  • Mental health services, such as counseling and psychotherapy, unless they are part of a hospital treatment plan
  • Non-medical services, such as transportation and accommodation for medical treatment
  • International travel for medical treatment
  • Experimental treatments or procedures that are not yet widely accepted or covered by Medicare

Does private health insurance cover dental services?

No, private health insurance does not generally cover routine dental services, such as check-ups, cleanings, and fillings. However, some private health insurance policies may offer coverage for more extensive dental procedures, such as orthodontics and oral surgery, that are performed in a hospital setting.

Does private health insurance cover optometry services?

Similar to dental, optometry services are not covered by private health insurance such as eye examinations although prescription glasses and contact lenses are covered by private health extras policies.

Am I covered for ambulance services?

Not all private health policies cover individuals for ambulance services. However, some states in Australia automatically cover policy holders through their state or territory.

Will my private health policy cover prescription drugs?

No, private health insurance policies in Australia do not cover prescription drugs. Prescription drugs are covered by the Pharmaceutical Benefits Scheme (PBS), which is a government-funded program.

In conclusion, it’s important to understand what is not covered under your policy to avoid any surprises when you need to make a claim. While most health insurance policies provide coverage for a wide range of medical expenses, there are still some things that are not covered, and it is important to understand these exclusions.

So, you have private health insurance and want to know how much you might have to pay for medical treatments out of your own pocket? We’ve got you covered with our easy guide FAQ.

What does ‘no gap’ mean when it comes to private health insurance?

Basically, it means that you won’t have to pay anything out of your own pocket for certain medical services, these are covered by your private health insurance. It’s the difference between what your doctor or hospital charges and what Medicare and your private health fund will pay and it’s known as the ‘gap’. With a ‘no gap’ arrangement, your insurance will cover the full cost of the service.

So, I won’t have to pay anything extra?

That’s right! With the ‘no gap’ arrangement, you won’t be left with any unexpected bills to pay. Your private health insurance will cover the full cost of the medical service, so you can focus on your health and recovery.

How does it work?

To be eligible for a ‘no gap’ service, you’ll need to use a provider who is part of your private health insurance provider’s ‘preferred provider’ network. This means that the provider agrees to charge you a set fee for a particular medical service, and your private health insurance will cover this fee in full. This way, you can be sure that you won’t have to pay anything out of your own pocket.

Can I get ‘no gap’ for any medical procedure?

Unfortunately, ‘no gap’ is only available for some medical services, and only if you use a provider who is part of your private health insurance provider’s ‘preferred provider’ network.

Is ‘no gap’ the same as ‘bulk billing’?

No, they’re not the same thing. ‘Bulk billing’ is when medical providers bill Medicare directly for their services, so you don’t have to pay anything out of your own pocket. ‘No gap’ is a service that’s offered by private health insurance providers, and it covers the full cost of certain medical services.

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