kirsty&al

Hi

I have read several previous posts about Private Health Insurance on this forum, and have checked out various providers. Having never had PHI before I have some questions.

If I take out insurance, but elect not to have cover for a particular area (say open heart surgery) and then need to have this procedure will I have to pay the full cost myself, or just 'the gap'?
How about if I take out insurance to include this option but need surgery before the 12 month waiting period has passed?
Is it correct that if I have PMI I must declare it/use it every time I visit the doc/hospital?
I know there have been big increases in premiums this year. Do companies have a standard amount by which they increase all premiums, or is it based on the individual's medical history for the proceeding year (doesn't bode well for me after the quadruple bypass in this case!)?
Most policies have a pregnancy/birth delay of 12 months. If I get pregnant 6 months after taking out cover, is it just the first 6 months that is not covered or also the birth 9 months later?

More generally, our situation is that we mainly want to take out insurance to avoid the additional 1% medicare levy and are in our thirties and currently healthy. I have looked at the iselect and choice sites but still don't know what kind of package to go for, so any advice gratefully received.

Thanks, Kirsty

NickyC

I've never heard of being able to choose what you're covered for in the way of specific procedures. Never heard of anyone opting out of cover for (say) open heart surgery. If you have hospital cover you're covered for all hospital procedures (allowing for the relevant waiting periods).

If you don't have private hospital cover you're covered under Medicare. Might mean you have to wait longer to be seen or operated on. You don't have to use your private cover - it's up to you whether you use it. If you use it, you then have to pay any gap amount. There's nothing to pay if you use Medicare for hospital procedures.

Premiums are the same for everyone (allowing for age of joining fund and cover required), although you can get lower premiums if you opt to pay a higher excess. It's not like car insurance where they charge you more if you've claimed a lot.

Regarding obstetrics - you have to wait 12 months before you can claim for any birth/pregnancy related fees. If the birth occurs after that period (which it would in your example) then you're covered for it. You get one (big) obstetrician bill after the birth so the fees happen then, rather than in the early stages.

We took out health insurance purely to avoid the extra 1% medicare levy. Most health funds offer a very basic hospital plan which satisfies the requirement to have private insurance but costs the least amount. If you're healthy - that's the type of plan to go for. Once you start adding in extras cover the prices begin to rise.

Trevglas

With regard to your other questions re waiting periods, check out the iSelect site, which allows you to compare each company's products.

What may be of interest is HCF have a special offer of waiving the waiting periods. I dont know how long this will last, but they have been offerinhg it since last November

John Howard

We are with NIB on a policy called couples plus. It covers us for all emergency and major surgery, labour ward etc. It also covers Physio/chiro general dental, optical- glasses/contact lenses. Ambulance cover is automatically covered by PI in NSW but differs in different states.

You can chosse to add specific things like- hip replacement surgery, major dental etc. These are normally listed as extras to the standard policys. We choose NIB as they waived the 12 month waiting period on non-existing problems and we are planning to start a family. Most policys will only cover you for childbirth etc if you have had a Family policy for one year which is a real rip off as you are paying extra for a year. So make sure you read the small print!!

joh117

Hi Kirsty,

Was good to speak to you last week. We have just taken out health insurance with HCF mainly to avoid the 1% levy and also as we both use opticians/dentist and Shami with his sports has visited physio's in the past.

We choose HCF as they were offering the waiver on treatment (not pregnancy though).

Will be in touch soon to meet for drinks

Jo

Jacqui

Can anyone elaborate on "the gap"? Why pay an annual fee of say $2500 for private insurance, only to find that you have to pay a gap of several hundred/thousand more? With Medicare, you don't pay anything at all, just have to wait longer.

And how does the annual premium compare to the 1% levy? Is this 1% of your gross wage? If so someone on $60,000 would pay a levy of $600, much less than a $2000+ premium.

How long do the Medicare waiting lists compare to NHS?

We don't currently have health insurance, but we insure everything else (the car, house etc). Can't decide whether to take it out or not, and hope that Medicare sees to us ok if anything bad happens, and maybe use our savings to pay if the wait was too long.

Anyone out there that can post some figures to back up the arguments for and against?

bondipom

Not all treatments are covered by medicare and you will often have to pay a gap for treatments with medicare.

The Mrs has had $300s worth of physio and I was out of pocket by $100 by treatments that were no covered or where medicare only covered some of the costs.

Dental treatment is not covered by medicare.

Your point about the value for money comparatively to medicare does stand.

kirsty&al

Thanks everyone. To be honest I am sick of trying to compare policies, so hubby is going to give it a go.

Jo, I have lost the scrap of paper I scribbled your phone number on, so I will PM you again about meeting up.

Kirsty