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Your private health cover options

Private health insurers offer a range of different products to suit the needs of people at different stages in their lives and seeking different levels of financial cover for their healthcare. When you purchase health insurance you need to consider the level of cover that fits your needs, not simply the price or the tax and other government health cover initiatives that affect you.

Always feel free to ask for more detail or to clarify any questions you have about health insurance products.

The health insurance options you are offered will vary in a number of ways. The price of each package or plan will be influenced by the amount of benefits it can provide you with. For example, hospital insurance may allow you to use a private hospital but only cover the costs of accommodation in a shared ward. You need to consider if you would want to share a room or would you want a private room?

Read the descriptions of health insurance packages carefully. Take note of the categories of services that are included in the cover and consider whether they include everything to meet your healthcare needs and expectations.

Once your membership starts, a 30 day cooling off period commences. During this time you can choose to cease your membership, or if you have increased your cover you can revert to your previous level of cover, and we will refund the contributions you paid. Of course, if any claims have been paid they will be deducted from the contributions before they are refunded.

The price of health insurance varies depending on what services and conditions are included and excluded. Other mechanisms that manage the level of benefits you will receive and the degree of risk you agree to share are described below. Remember that while each of these reduces the up-front cost of your health insurance, they will at the same time reduce the benefits you can claim and increase your out-of-pocket expenses when you do use healthcare services. 

Exclusions

By excluding some medical conditions or healthcare services from the cover provided the cost of a health insurance can be reduced. You will not be able to claim benefits when you have these conditions treated or services performed. Hospital insurance might exclude particularly high cost procedures. Think realistically about your personal situation and the relevance of those procedures to you. If you don’t think you need them covered now consider when in the future you should review or upgrade your insurance.

Co-payments

When health insurance includes co-payments it will reduce its cost as you are accepting responsibility for paying some of the costs of the services delivered. An example of a co-payment is that you will pay a fixed amount and your health insurance will pay the remainder of the cost of each day of your accommodation in hospital. You need to be quite sure you understand how much the co-payments might be in total and that you will be able to manage the cost of the co-payments if you need to go to hospital.

Excesses

An excess on health insurance will reduce its cost. An excess may also be called a front-end deductible. An excess is an amount you agree to pay before your health insurance starts to pay for your hospital accommodation costs. Health funds apply different rules to the application of excesses. Check whether the excess is paid once a year or per hospital visit. As with co-payments consider whether you will be able to manage the cost of the excess if you go to hospital.

When you move to a lower level of excess or no excess cover, in certain situations you may be liable to serve a waiting period during which you will continue to pay the higher level of excess for any admissions within 12 months

Restricted benefits

Some conditions may have treatment restrictions. One example of restricted benefits is when you have a specified condition you may only be treated as a private patient in a public hospital. If the treatment was delivered in a private hospital you would face considerable out-of-pocket expenses. Another example is when plastic surgery is only covered where a medical condition is being treated and not when it is chosen for cosmetic purposes.

Benefit Limitation Period

Restricts benefits for a set period of time. For example, for a major procedure you may have to be a fund member for 2 years before you would be eligible for the full benefits for that procedure. Benefit limitation periods commence at the end of any waiting period. Pregnancy services will have a waiting period of 12 months,  if the policy has a 2 year benefit limitation period you would have to wait 3 years to be eligible for full benefits.

Doctors' Health Fund does not apply benefit limitation periods to its products.

Limits

Ancillary or extras health insurance will have benefit limits on different types of services or items. A limit is a maximum annual pay out for a particular service or group of services. The higher the limit the more you can claim and of course, the cost of your cover will be higher.