Managing your Health Cover

Remember to review your cover

Many of us choose our health cover and don't take the time to review it. This can lead to the realisation when healthcare becomes necessary that you should have thought ahead and adjusted your cover to account for 

  • changes in your health 
  • getting married and planning a family 
  • just getting older 
  • government changes to the health system and possibly other influences

Take a moment when there are changes in your life to consider the impact on your health cover needs.

Plan ahead when upgrading your cover

You can upgrade your cover at any time, but if your new level of cover will provide higher benefits for any services you will have waiting periods before you are paid the higher benefits. You may also have to serve waiting periods, during which time no benefits will be payable, for any services for which you were not previously covered. The waiting periods are:

  • 24 months for hearing aids
  • 12 months for pre-existing conditions
  • 12 months for obstetrics
  • 12 months for major dental services
  • 12 months for aids and appliances
  • 2 months for psychiatric, rehabilitation, palliative care and all other treatments
  • None for accidents

Waiting periods may also apply when you change to a cover with a lower excess or no excess. If a waiting period applies to your situation, you will need to pay the higher excess applicable to your previous cover. The Private Health Insurance Ombudsman provides more information on upgrading in this brochure.

If limits apply to any benefit payments, the benefits paid under your previous level of cover will be taken into account. The Doctors' Health Fund manages the calculation of benefit payments and limits for extras or ancillary services on a calendar year basis, commencing 1 January each year.

Keeping covered – the financial angle

With busy lives we don't always manage our bills as well as we would hope. Many times this isn't going to cause a crisis but with insurance it really counts. Remember, you are not covered if your contributions are more than 2 months in arrears.

Many of our members choose to set up automatic payments or direct debit, from their bank account or credit card. This ensures their cover stays in place. Even if something goes awry with a payment transfer, because the Fund's systems identify the problem, we will either sort it out with the bank or contact you if necessary.

With automatic payments your authorisation also covers any price changes. We will send you notice of any price changes before they happen.

Keeping your student dependents covered

Your children can be covered by your family membership up to the age of 21. After 21, if they are a student dependent, they can continue to be covered by the family's membership. They are a student dependent when they are dependent on your financial support and 

  1. enrolled as a full-time student at a school, college or university
  2. have not already gained a tertiary degree or diploma, and 
  3. have not reached 25 years of age

To continue a student dependent's cover under the family membership a confirmation of their status needs to received by the Fund each year. The Fund writes to all members with dependents in this situation requesting the details needed to continue their cover. If a response is not received by the date requested the dependents cover is terminated and the Australian Taxation Office is notified of the change in your membership.

Remember, any dependent coming off their family's cover is eligible to take their own cover with The Doctors' Health Fund. Plus, by continuing their cover they do not have to serve waiting periods completed while they were covered by the family's membership.  

Keeping everyone covered when you're having a baby

If you are planning to have children, check that your hospital cover includes Obstetrics. These are the services associated with pregnancy and the birth of a baby. Hospital cover has a 12 month waiting period for making claims for all in-patient services related to an obstetrics admission, so it is important that you have the right level of cover when planning for a baby.

After the birth, all you need to do for your baby to be covered, is to add them to your membership within two months from the date of their birth. This means moving to a family membership if you are not already on that level of cover. This will ensure your child does not serve any additional waiting periods. 

Commonwealth government initiatives supporting Australians taking private health cover

The Private Health Insurance Rebate on your membership contributions.

  • Have you authorised The Doctors' Health Fund to deduct your rebate so you only pay the reduced amount for your contributions? If not fill out this form and send it to us
  • You can also claim the rebate by tax rebate in your annual tax return
  • You must be eligible for a Medicare card to claim this rebate
  • When you buy private health cover, the government may pay a rebate towards the cost of your contributions dependants on your taxable income
  • People aged from 65 years to 69 years may be eligible for a maximum rebate of 32.457% and for those people over 70 years of age the rebate available is a maximum of 37.094% dependant on your taxable income

High income earners Medicare Levy surcharge 

  • All The Doctors' Health Fund hospital cover products meet the requirements, so you don't pay this surcharge
  • Are you single and earning more than $90,000 taxable income per year or a couple or family earning over $180,000 combined taxable income per year?
  • When a family has more than one child their combined income can be an additional $1,500 for the second child and each child thereafter before they incur the Medicare Levy surcharge 
  • If your income is above the threshold, and you don't have hospital cover - or your hospital excess is high – you may pay an extra 1.5% Medicare Levy surcharge at tax time
  • Choose hospital cover with an excess of $500 or less if you are single, or $1000 or less for couples and families and don't pay the surcharge

Lifetime health cover 

  • If you are about to turn 31, have you got yourself hospital cover? Ancillary cover won't protect your from this one
  • This extra charge applies to private hospital cover only 
  • It is applied to everyone born after 1 July 1934 who is over 30 and taking out hospital cover for the first time after 1 July 2000
  • For each year you are over 30 when you first take hospital cover you will be charged an extra 2% in contributions
  • For example, if you were 35 when you first took hospital cover you would pay 10% more in contributions than someone who had cover since they were 30
  • The maximum loading a person can be required to pay is 70 per cent, payable by people who first take out hospital cover at age 65 or older
  • The government has announced that changes are to be made to lifetime health cover
  • People who have paid a lifetime health cover loading on their private health insurance for 10 continuous years, will be entitled to have the loading removed. It is expected that the first loadings will be removed in 2010 for people who are currently paying the loading.