At Doctors’ Health Fund, we understand that the Private Health Insurance system can be a complex machine. It’s important to us that, as a member, you are well informed about your policy and benefits.
We encourage our members to contact us with any questions, and we receive more than 50,000 calls a year. We pride ourselves on fast and efficient service as we answer 97% of calls within 30 seconds. We know this level of service is important to members and contributes to our member satisfaction rating of 94%.
We have identified the three most common questions asked by our members:
What waiting periods will I need to serve?
Waiting periods can be complicated and depend on individual circumstances. They are an important part of private health insurance and are designed to protect existing members of health funds while maintaining low premiums.
- If you are new to private health insurance or upgrading from a lower level cover (either with us or another fund) you will need to serve out all relevant waiting periods. The maximum waiting period is 12 months but maybe lower in some circumstances.
- If you are new to private health insurance or upgrading your cover and have a pre-existing condition that you were not previously covered for, you will need to serve the 12-months wait before receiving benefits for services related to the pre-existing condition. This excludes palliative care, rehabilitation and psychiatric (see next point), which have a two-month waiting period. The condition must be deemed ‘pre-existing’ prior to serving waiting periods. Pre-existing conditions are defined by legislation and can be found here.
- If you are on a hospital policy which provides restricted benefits for psychiatric care, then to access higher benefits you usually upgrade and complete a two month waiting period. However, you can upgrade your cover without having to serve the waiting period for hospital psychiatric care. This exemption applies only once per lifetime and can only be accessed if you have already completed an initial two months of membership on any level of hospital cover.
- If you are switching from an equivalent level of cover, you should not need to serve waiting periods for those services previously covered, provided the waiting periods have been served.
- Reducing your excess may also incur waiting periods. For instance, if you were previously on a $500 excess policy and you upgrade to a no excess policy, you will need to serve a 12-month waiting period before you are eligible for the new excess. This excludes accidents which have no waiting period, or in the instance that a new condition has been identified after upgrading your cover or joining, only a 2-month wait applies.
A more comprehensive breakdown of waiting periods can be found on our website at doctorshealthfund.com.au/health-insurance-explained
What is the difference between inpatient and outpatient services
We often get queries from members about the difference between an inpatient and an outpatient service.
Put simply; an inpatient is someone admitted to hospital for medical treatment; this can either be through the hospital’s emergency room or through a scheduled surgery or treatment. You do not have to stay overnight to be classified as an inpatient, provided you receive the treatment or procedure during your stay in the hospital. An inpatient would need to be discharged from the hospital when it’s time to leave. You can choose to be an inpatient as either a public or a private patient. Hospital cover provides benefits only when you receive treatment as an inpatient in a hospital or day-only facility and only if your chosen hospital policy covers the procedure.
An outpatient is someone who receives medical treatments in a doctor’s surgery, specialists clinic or the emergency room (without being admitted). They can include procedures like injections, x-rays and ultrasounds. These treatments are not covered by your hospital cover, but you may be able to claim a rebate from Medicare for outpatient services.
How do I add my new baby to my policy?
We welcomed more than 750 new babies to our fund last year. To ensure your baby is covered on your policy, you need to let us know within 60 days from the birth date, and your baby will be added to your policy with no waiting periods to serve.
However, if you notify us after these 60 days, under the regulations, your baby will need to serve all relevant waiting periods before you can claim for any benefits. Furthermore, there may be tax implications if your baby is not added to your policy from their date of birth.
If you’d like to know more or have any other questions, you can email us at firstname.lastname@example.org or speak to our expert member services team by calling 1800 226 126.