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Beyond Medicare: Private Health Insurance Information

February 28th, 2012 0 comments
Private health insurance

Medicare is an excellent service to ensure that all Australians have access to quality health care. No one should ever feel that they can’t afford to see a doctor or receive emergency treatment should it become necessary. However, the existence of private health insurance makes it easier for those who can afford it to receive the best care available at hospitals of their choosing without long waits.

Someone who is in the market for private health insurance is of course looking for better financial cover to help them with health care costs. Figuring it all out is not too daunting a task; there is some important information to know, and then a well-researched health insurance comparison can find you a solid policy adequate for your needs.

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How Private Health Insurance Works

Having a private health fund enables the patient to access private hospitals and physicians. You can choose from two types of coverage or a combination of both; there’s hospital cover, which insures you for a hospital stay, as well as service cover, which insures you for required services.

Hospital Coverage

Within each category there are several subcategories. Within hospital, there are generally the following options:

  1. Top – This premium tier of coverage provides cover for most treatments in a hospital setting.
  2. Medium – This covers you for most treatments with some exceptions, which you can generally choose yourself.
  3. Basic – Covers for many treatments with more exceptions than medium.
  4. Public – Covers only default treatments, and only in a public hospital setting.

When you compare health insurance funds, each insurer will outline their own version of these categories, which might differ slightly from fund to fund. Health fund representatives can walk you through their hierarchy and explain what the differences are, as well as help you choose and customize a plan to maximize value.

Services Coverage

These policies cover outpatient care and ancillary services such as physiotherapy and dental. The three main levels are:

  1. Comprehensive – Covers most services such as dental, optical and pharmaceuticals.
  2. Medium – Leaves out certain services.
  3. Basic – Covers many necessary services.

Excess and Copay

Private health funds typically require an excess or copay that is agreed when you register. An excess is an amount that the patient has to pay out of pocket when making a claim on the policy. You can normally choose your excess amount and this may affect your premium. The larger your chosen excess, the lower your premium tends to be.

Someone who doesn’t feel that she is likely to use her policy often might choose a higher excess for a lower premium. Someone who knows he will use his policy may decide for a lower excess at a higher premium, since he will then have to pay less out of pocket when he makes a claim.

A copay is similar to an excess, but requiring the patient to pay a certain amount for each day spent in hospital care as an inpatient.

Waiting Periods

When you register for a private health fund, you are likely to need to wait a certain amount of time before you can start to receive cover benefits. This can be as short as two months for services such as psychiatric and rehabilitation, or a full twelve months for some pre-existing conditions and for obstetrics.

Compare health insurance funds

Every fund offers different packages and provides different services. You may discover significant savings from one private health fund to the next, as some may offer a variety of opportunities to save money. Checking around before you put your money down can save you substantially.

Still have questions? Let's talk!

Confused? Not sure if this applies to your situation? Phone us on 1300 643 355 for some free, no obligation advice!

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