Switching Health Funds

It must be harder to change my Health Fund than changing my bank!? Sound familiar? It’s not! It’s easy and we are here to help and explain why. People’s needs change all the time and with this, so should your health insurance. Most of these changes occur during ‘life stages’ or ‘events’.

  • You’re looking to start a family and would like cover for pregnancy
  • You’ve finished with having children and it’s time to remove it from your cover
  • It’s time to get some major work started on your teeth
  • Playing sport means more trips to the physiotherapist?
  • You took out a policy a decade ago and just want to make sure its still relevant to you!
  • Cost of living is putting pressure on you/family and its time to check what we are covered for
But you probably already know that, this is why you’re here.

Let’s get into the most common questions around switching.

What about my waiting periods? Someone told me I have to start them again?!

That’s simply not true. If this was the case, you wouldn’t see hundreds of people across the country changing private health insurers every day! The private health industry is heavily regulated and designed for situations with this in mind. People’s needs change. This policy within the legislation is called ‘Portability’. It allows members to switch funds to an equivalent or lower level of cover without having to restart waiting periods for services on the policy.

For more information on Health Fund Waiting periods, click here.
How does this happen though between two different health funds?

I see you’re paying attention!

Simple; with the use of what we call a clearance or transfer certificate. The old insurer will provide this certificate to the new insurer with all of the relevant information to complete the transfer. It is this request that will also finalise any payments and debits to the old insurer.

*This process can take between 14-21 working days, so don’t be alarmed if you see additional payments being deducted. These will all be refunded back to you.

I need to claim during the transfer? Am I still covered?

As long as you’re a current member of a health fund, covered for that service, have served your relevant waiting period and are not in arrears with your premium, absolutely yes! This can be completed a number of ways however this will be fund specific.

Ok, I’m ready to compare my cover, what do I do?

The best way would be;

  • Find your current policy information
  • Set aside 15 minutes
  • Give us a call!
  • Enjoy your new benefits

Pre-existing conditions

Under the Private Health Insurance Act 2007, a health insurer may impose a 12 month waiting period on benefits for hospital treatment for a pre-existing condition. Some important facts to remember about this rule:

  • A pre-existing condition is defined by law as any ailment, illness, or condition that you had signs or symptoms of during the six months before you joined a hospital cover or upgraded to a higher hospital policy.
  • It is not necessary that you or your doctor knew what your condition was or that the condition had been diagnosed. A condition can still be classed as pre-existing even if you hadn’t seen your doctor about it before starting the hospital cover or upgrading to a higher hospital policy.
  • The decision is made by a medical practitioner appointed by your insurer.
  • In forming an opinion about whether or not an illness was pre-existing, the medical practitioner must take into account information provided by your own doctor.
  • Your health insurer will need time to advise you if your condition is pre-existing, so check with your insurer well before you go to hospital to make sure you are covered.
  • Even if you have a pre-existing condition, health insurer must allow you to purchase any type of cover, at the same price as any other person. Once you have served any waiting periods, you will be entitled to claim.

The exceptions to the 12 month waiting period for pre-existing conditions are psychiatric treatment, rehabilitation and palliative care. These services have a two month waiting period, even if the condition pre-existing.

In some cases, you may be able to access an exemption to the two month waiting period for upgrading psychiatric benefits - see Mental health - waiting period exemption.

For more information, see the Ombudsman's factsheet on the pre-existing conditions rule.

Finding the right level of cover

Navigating your way through the landscape of Private Health Insurance can be confusing and complex.

I’m still young enough, do I need cover for joint replacements? We think we’ve finished with pregnancy, should I take it off now or wait a little bit longer? I don’t know what extra services are, how do I know what I should or shouldn’t have?

These are all great questions.

I’ve never had health insurance; how do I even start?

By talking to us! It’s a mine field - legislation, tax, age penalties? Do any of these apply to you and if so, why?

I think it’s time for me to switch?

You’ve been thinking of switching for a while, what’s prompted this?

You’ve had a chat with friends at a BBQ? Your current health fund is increasing premiums? You’re at a very different point in my life and it’s time to upgrade my policy? If you haven’t checked your health insurance in a number of years, it’s time to do it! Comparing health insurance is not like comparing apples with apples. Every policy and every fund is different. You need to find the right level of cover for you.

So, what should I do?

Have a conversation with an expert. Most people put comparing health insurance in to the ‘too hard basket.’ It’s something they know they need to do, but the investment at the time doesn’t feel important. Sound familiar? Take 15 minutes with us to figure out how we can help. If you’re on the right level of cover, what have you lost other than 15 minutes?