Deciding what to include in your health insurance cover can be very confusing and many families simply don’t know how to strike a good balance between keeping the costs down and making sure that your policy includes the things you may need.
For the most part, these “must have” services will vary from family to family depending on your health situation, but there are a few treatments that are definitely worth including if you want to avoid big out-of-pocket costs.
- 1 #1 – Major Dental and Orthodontics
- 2 # 2 – Obstetrics
- 3 #3 – Joint Surgery
- 4 #4 – Removal of Tonsils
- 5 Disclaimer: The above information is correct and current at the time of publication.
#1 – Major Dental and Orthodontics
Medicare doesn’t offer a great deal of help when it comes to dental health for your kids and this support may decrease even further in the future. There are plans to axe the Child Dental Benefits Scheme (CDBS), despite its success in helping over 1 million Australian children to access dental care. This currently provides up to $1000 per eligible child over 2 consecutive calendar years and can be used towards basic dental services such as examinations, x-rays, cleanings and fillings and more complex things like root canal work and extractions.
Even if your family is eligible for the CDBS, you could still have out-of-pocket costs to deal with if any relatively major dental work is needed. Fillings and extractions can cost hundreds of dollars each, while root canal therapy can potentially cost well over $1000. If your child needs orthodontic treatment, this can run into thousands of dollars if braces are needed on both the upper and lower jaw.
Many families would struggle to pay these kind of costs and this is where Extras health insurance can really come into its own. Basic Extras policies tend to include general/preventative dental services, but you’ll usually need mid or top level Extras cover to be sure of having major dental and orthodontics services as well. This can cover you for things like braces, crowns, bridges, root canal therapy, implants and wisdom teeth extractions. It’s worth shopping around as the amount that you can claim per year on major dental and orthodontics can vary a lot between health funds and this can make a big different to how much you may potentially have to pay out of your own pocket.
# 2 – Obstetrics
The main advantage of forgoing the public hospital system during pregnancy and delivery is the freedom to choose the obstetrician that attends you. In the public system, there are no guarantees for continuity of care and it’s not uncommon to find yourself seeing someone different for each appointment. Having a private obstetrician is expensive if you don’t have private Hospital cover, but you can cover some or all of the costs with a policy that includes pregnancy and birth services.
Not all Hospital policies do include pregnancy and birth services, and they are usually excluded or heavily restricted on basic cover levels to keep premium costs down. There is a 12 month waiting period for obstetrics so it’s something that you will have to have included on your Hospital at least a year in advance of actually needing it.
#3 – Joint Surgery
Most people assume that joint surgery is something that only be needed when you get older but this can be a big myth. Sometimes, they may be needed for children too (especially the active ones!) and there can be long waiting times in the public hospital system. Joint investigations are often included on basic Hospital policies and have a 2 month waiting period if the issue is not pre-existing (and 12 months if it is). Joint reconstructions can sometimes be included on basic Hospital policies too but you may need mid level Hospital cover depending on the health fund. Joint replacements generally require mid to top level Hospital cover.
#4 – Removal of Tonsils
You can obviously choose for your child to have their tonsils and/or adenoids removed in a public hospital but the average waiting time can mean that it’s much better for them to be treated privately, especially if they keep getting infections in the meantime. In the public system, it’s not that uncommon to wait months or even years for non-urgent surgery to remove tonsils/adenoids. You can potentially cut the waiting time a little bit if they are treated as a private patient in a public hospital but this could still be longer than being a private patient in a private hospital.
Most basic Hospital policies include tonsils and adenoids removal surgery. The waiting time is only 2 months if your child has issues with their tonsils and/or adenoids that are not classed as being pre-existing (and a 12 month waiting period if they are deemed to be pre-existing).
These services are likely to be important for many families in helping to reduce out of pocket costs and reduce waiting times for surgery, especially if you’re not sure what to look for in a policy.
What other treatments do you consider to be “must haves” when it comes to health insurance? We’d love to get your thoughts!