Confused about how health insurance works

[Skani]

2 hours ago, Marisawright said:

So, while I'm sure there are long waiting lists in the public system for some things, it's by no means true for everything.

It varies tremendously between different areas in Australia so  it's important to check the situation in one's own area if having to make the choice between going public or private.  Two years ago I had my gall bladder removed.  At the public hospital there was a minimum 5 month waiting list...and then no guarantee...it could be longer.  As it was excruciatingly painful  I was very glad I had the option of choosing private.  A friend of mine was referred to a gynaecologist in the public system for constant and excessive bleeding.  It took 2 months before she could get even  an appointment with him ....and another 18 months before a hysterectomy.  It affected her life so badly that she had to resign from her job.   Currently in Hobart there is a minimum 6 month wait for a colonoscopy in the public system.  That could mean the difference between a cure and death if bowel cancer is detected.

[Bulya]

4 minutes ago, The Pom Queen said:

It’s the time frame that can be for ages. An example being I was referred by a private specialist to a Professor who is based at the PAH and is the only one in Australia who can help  that’s because he studied overseas and although he isn’t fully versed with my condition as it’s rare (Without going in to too much detail my organs are shutting down so I have different specialists for each part and then one overall specialist who organises everything) he is the only one who has any knowledge at all. Now I’ve seen him twice and I’ve now been waiting to see him since January, now don’t get me wrong I’ve had to cancel multiple appointments with him as I’ve been in my own hospital, but it’s around 3 - 4 months between each new date, which for my condition is a long time.

 I suppose it really depends what’s wrong with you. Hubby and my sons are on the policy it’s a family policy and since we took it out there is only Rob who has used it once and the boys never.

 

My problem very minor compared to yours, and far better infrastructure here than Qld 

[Toots]

15 minutes ago, Skani said:

It varies tremendously between different areas in Australia so  it's important to check the situation in one's own area if having to make the choice between going public or private.  Two years ago I had my gall bladder removed.  At the public hospital there was a minimum 5 month waiting list...and then no guarantee...it could be longer.  As it was excruciatingly painful  I was very glad I had the option of choosing private.  A friend of mine was referred to a gynaecologist in the public system for constant and excessive bleeding.  It took 2 months before she could get even  an appointment with him ....and another 18 months before a hysterectomy.  It affected her life so badly that she had to resign from her job.   Currently in Hobart there is a minimum 6 month wait for a colonoscopy in the public system.  That could mean the difference between a cure and death if bowel cancer is detected.

It sure does.  I had my gall bladder out in a public hospital in Sydney.  After the scan I had a wait of only a month before it was removed.  You are right though - it's very painful.  I thought I was having a heart attack.    I also had a problem similar to your friend.  Went to GP.  Went for a scan the next day and I was in Latrobe (public) hospital for treatment the next week.

[Quoll]

1 hour ago, Skani said:

It varies tremendously between different areas in Australia so  it's important to check the situation in one's own area if having to make the choice between going public or private.  Two years ago I had my gall bladder removed.  At the public hospital there was a minimum 5 month waiting list...and then no guarantee...it could be longer.  As it was excruciatingly painful  I was very glad I had the option of choosing private.  A friend of mine was referred to a gynaecologist in the public system for constant and excessive bleeding.  It took 2 months before she could get even  an appointment with him ....and another 18 months before a hysterectomy.  It affected her life so badly that she had to resign from her job.   Currently in Hobart there is a minimum 6 month wait for a colonoscopy in the public system.  That could mean the difference between a cure and death if bowel cancer is detected.

It sure does. I’ve had both those procedures mentioned and in Canberra I was told there would be an 18 month wait for gall bladder removal (I paid for it within 4 weeks and that was because he was the best surgeon around) and my wonderful gynaecologist said that I would never have got to the top of the waiting list for a hysterectomy although my reasons, in the same way as your friend, would have rendered me suicidal before too long! (She was amazing, it was done within 2 weeks) I saw on the front page of the Canberra Times recently, the waiting list for urology was 6 years!!! Fortunately here in  Cambridge my dad got a urology specialist appointment within 6 days and was well on the road to recovery after a minor op within 6 weeks (and that included Christmas!). My uncle had a carpal tunnel op within a couple of months that I would, again, never have got to the top of the list for in Canberra. 

[Skani]

4 hours ago, Toots said:

  You are right though - it's very painful.  I thought I was having a heart attack.   

Me too!  The first attack I had I rang the ambulance...not the 000 number, but I thought I should check...and they did send the ambulance to get me.

Quote

 I also had a problem similar to your friend.  Went to GP.  Went for a scan the next day and I was in Latrobe (public) hospital for treatment the next week.

Crazy, isn't it?  Same state...but she was in Hobart...and it took her 20 months from GP to operation.  She obviously should have gone to Devonport - she's a born and bred northwest coaster, so all the right credentials.  

[Quinkla]

On 04/09/2018 at 17:42, Toots said:

I had my gall bladder out in a public hospital in Sydney.  After the scan I had a wait of only a month before it was removed.  

Waiting times for public health are based on need.

We have private health insurance (against my better judgement). My wife was admitted to hospital with internal pain and as it was an emergency it was public. It was gall stones - the gall bladder was out within 48 hours and we didn't pay a penny and nor did the health fund - all paid by taxpayers. I think this stuff about private health insurance is just scaremongering. In my experience, very little is covered by private, there are huge gap fees to pay and if you do get really sick, you'll probably lose your job and no longer be able to afford private health care anyway. Most health care costs are incurred in the last year of your life. 

[Bulya]

5 hours ago, Quinkla said:

Waiting times for public health are based on need.

We have private health insurance (against my better judgement). My wife was admitted to hospital with internal pain and as it was an emergency it was public. It was gall stones - the gall bladder was out within 48 hours and we didn't pay a penny and nor did the health fund - all paid by taxpayers. I think this stuff about private health insurance is just scaremongering. In my experience, very little is covered by private, there are huge gap fees to pay and if you do get really sick, you'll probably lose your job and no longer be able to afford private health care anyway. Most health care costs are incurred in the last year of your life. 

Agree 100%.  

[Melbpom]

Be aware also of Lifetime Loading on private health insurance. Basically it is a measure brought in by the government to encourage people to take out insurance while they were young and healthy and to encourage them to keep it going. This loading starts from the age of 30 and if a person doesn't have private health insurance then they will pay an extra 2% for every year above this age when they take out insurance. So a 40 year old taking out a policy for the first time would pay an extra 20% on their premium than they would have done if they had always been insured.

Also if you earn over a certain amount (don't know the figure) and you don't have hospital cover then you would get charged a Medicare Levy Surcharge. So for a lot of people it's cheaper to have the insurance.

[NicF]

On 12/10/2018 at 02:29, Melbpom said:

Be aware also of Lifetime Loading on private health insurance. Basically it is a measure brought in by the government to encourage people to take out insurance while they were young and healthy and to encourage them to keep it going. This loading starts from the age of 30 and if a person doesn't have private health insurance then they will pay an extra 2% for every year above this age when they take out insurance. So a 40 year old taking out a policy for the first time would pay an extra 20% on their premium than they would have done if they had always been insured.

Also if you earn over a certain amount (don't know the figure) and you don't have hospital cover then you would get charged a Medicare Levy Surcharge. So for a lot of people it's cheaper to have the insurance.

Figures are around $90k for single's and $180 for couples and families.  Exact figures can be found on the ATO website.

[LouDYorkie]

Hi everyone
We've just moved to Australia with my partner's work on 457 visas. His work arranged private health insurance for both of us before we came, and we've got a copy of this policy but it doesn't go in to any detail of how the process works and I haven't been able to find out. I take regular medication so at some point will need to register with a GP here and start getting more medication. The insurers are aware of all the medication and told us it would be covered. As we already have health insurance does anyone know:
1. Do we need to get Medicare cards as well? (I don't think we do but could be wrong)
2. When I go to the GP and get medication, how do the appointment fees and prescription fees work - do I pay them upfront and then claim back from the insurance provider? Or is there some other system for paying through health insurance? Do I need to take a copy of the health insurance with me to register with a GP?
If anyone could enlighten me I'd be really grateful. I have tried googling for this information but just seem to get bogged down in information about Medicare. 

That your partners employer has covered health insurance for you solves a couple of problems (provided it is an eligible policy) you won’t have to pay a Medicare Levy Surcharge & you have the option to ‘go private’ for procedures.
Just because you have private health insurance does not mean you have to or should (in some cases) go through the private system. You may decide to wait it out to have it dealt with in the public system to avoid gap fees etc.
Health insurance does not generally cover investigative/preventative work. I enquired as to whether I could get a better policy to include it and was told no policy would (haven’t investigated further).
Nor does private health insurance cover GP visits etc, so if you don’t have a bulk bill doctor available, you will pay something every time.
You definitely need a Medicare card. Even with private health, I don’t believe they cover the Medicare portion so you need to be registered. It is inconvenient, in our local office it is open 9:30-4:30 Monday to Friday.... who cares if you have a job, right?!
No need to register with a GP. You could go to a different practice every time if you wanted. I see the same GP every time by choice so I don’t have to re-explain, but there’s no need to do that. It’s good to know what your policy covers though should the GP ask, they can direct you better with referrals.
Consider registering on mygov....you can link up to Medicare and add your bank details so that when you pay for a GP visit that is not a bulk bill, the rebate can go direct to your bank account. Otherwise you have to join that CentreLink queue again between 9:30 and 4:30 Monday to Friday!!
(You can also use MyGov to do your tax return)
Bear in mind that there may still be some annual limits for families etc for medical where you can get some money back if you exceed an annual figure. I’m not familiar with this area fully but worth checking out if you are a regular user of health services.

[TandT]

On 17/10/2018 at 23:03, LouDYorkie said:

Health insurance does not generally cover investigative/preventative work. I enquired as to whether I could get a better policy to include it and was told no policy would (haven’t investigated further).
Nor does private health insurance cover GP visits etc, so if you don’t have a bulk bill doctor available, you will pay something every time.
You definitely need a Medicare card. Even with private health, I don’t believe they cover the Medicare portion so you need to be registered. It is inconvenient, in our local office it is open 9:30-4:30 Monday to Friday.... who cares if you have a job, right?!
 

Sorry I didn't come back to this thread sooner! Just wanted to provide some clarification to the above incase it helps anyone else now that I have submitted claims and received the money. I paid for everything up front and then went back to my insurer with a claim, and received full reimbursement.

My health insurance covers all GP visits and I have had the money reimbursed in full. I am not sure exactly what investigative/preventative work would include, hopefully I won't have to test that one out! I could arrange to see a GP and other specialists without paying up front at all, if I use GPs and other medical professionals provided by my insurer. I didn't know that at the time.

I also got reimbursed the full ongoing cost of five different medications, some of them new. It didn't make any difference to the insurer that I didn't have a Medicare card and I didn't have to pay that portion. So it all worked out fine.

[Marisawright]

40 minutes ago, TandT said:

My health insurance covers all GP visits and I have had the money reimbursed in full. I am not sure exactly what investigative/preventative work would include, hopefully I won't have to test that one out! I could arrange to see a GP and other specialists without paying up front at all, if I use GPs and other medical professionals provided by my insurer. I didn't know that at the time.

I also got reimbursed the full ongoing cost of five different medications, some of them new. It didn't make any difference to the insurer that I didn't have a Medicare card and I didn't have to pay that portion. So it all worked out fine.

I wonder what kind of policy it is?   It sounds very unusual - lucky you, if your employer is paying for it.   Most Australian health insurance doesn't cover the cost of visits to the GP, or the cost of medications.  

[TandT]

1 hour ago, Marisawright said:

I wonder what kind of policy it is?   It sounds very unusual - lucky you, if your employer is paying for it.   Most Australian health insurance doesn't cover the cost of visits to the GP, or the cost of medications.  

I’m not sure - it’s my partner’s work who arranged it and are paying for it. I believe it’s just some kind of Expat policy (though it’s specifically for Oz) so maybe that’s why it’s not the same a standard Australian policy? 

[Marisawright]

22 minutes ago, TandT said:

I’m not sure - it’s my partner’s work who arranged it and are paying for it. I believe it’s just some kind of Expat policy (though it’s specifically for Oz) so maybe that’s why it’s not the same a standard Australian policy? 

Yes that would explain it 

[TandT]

15 hours ago, Marisawright said:

Yes that would explain it 

I've just checked the policy and it doesn't actually give a brand name/title to the policy, so I am none the wiser! As I said previously, we had no direct contact with the insurers as the company did everything. At least we know that the health insurance rules posted previously don't necessarily apply to everyone/all health insurance, I presume it's only those who have citizenship (and residency? not sure).

[Marisawright]

43 minutes ago, TandT said:

I've just checked the policy and it doesn't actually give a brand name/title to the policy, so I am none the wiser! As I said previously, we had no direct contact with the insurers as the company did everything. At least we know that the health insurance rules posted previously don't necessarily apply to everyone/all health insurance, I presume it's only those who have citizenship (and residency? not sure).

How strange that you don't know who the insurer is.  Who do you claim from, then?   

The rules posted previously apply to residents, but they also apply to 457/482 holders who have the usual medical cover.  Citizenship is irrelevant as far as health care is concerned.

However, it does sound as though your husband's company has gone above and beyond the minimum required, and that's unusual. 

It's worth  noting that these days, it's unusual for employers to offer a benefit like this as a perk, in addition to salary.  It's more usual for it to be part of a salary package.  It might be worth checking if that's the case here.  If it is part of his package, then he could downgrade to a cheaper health insurance (potentially costing about half the price) which would fulfil your legal requirements, and then he'd have more cash in his pocket.

 

https://www.finder.com.au/457-visa-health-insurance

Edited November 30, 2018 by Marisawright

[TandT]

15 minutes ago, Marisawright said:

How strange that you don't know who the insurer is.  Who do you claim from, then?   

The rules posted previously apply to residents, but they also apply to 457/482 holders who have the usual medical cover.  Citizenship is irrelevant as far as health care is concerned.

However, it does sound as though your husband's company has gone above and beyond the minimum required, and that's unusual. 

It's worth  noting that these days, it's unusual for employers to offer a benefit like this as a perk, in addition to salary.  It's more usual for it to be part of a salary package.  It might be worth checking if that's the case here.  If it is part of his package, then he could downgrade to a cheaper health insurance (potentially costing about half the price) which would fulfil your legal requirements, and then he'd have more cash in his pocket.

 

https://www.finder.com.au/457-visa-health-insurance

I know who the insurer is! I just don't know what the policy would be branded as - you asked 'what kind' of policy it was previously and I said I thought it was an expat policy. I checked as that was a guess, and it doesn't say anything about it being an expat policy. I just wanted to update that I don't know what kind of policy it would be classed as, incase it's useful for others to know, rather than being misleading and telling people it was an expat policy.

We are on 457 visas. Having adequate health insurance was a requirement for the visa and ours was obviously accepted. I can't see anything anywhere saying that 457 visa holders have to have any exclusions on their insurance - i.e. that GP visits and prescriptions cannot be covered by the insurance. It just says that certain things have to be included, which they obviously are with our insurance. Maybe others on 457s have taken out different insurance which just isn't as comprehensive, and this has led people to believe that no insurance covers GP visits etc?

The health insurance isn't part of a salary package, so wouldn't save us any money to ask the company to downgrade it. I guess it depends who you work for as to what they're prepared to offer.

[Marisawright]

1 hour ago, TandT said:

I know who the insurer is! I just don't know what the policy would be branded as - you asked 'what kind' of policy it was previously and I said I thought it was an expat policy. I checked as that was a guess, and it doesn't say anything about it being an expat policy. I just wanted to update that I don't know what kind of policy it would be classed as, incase it's useful for others to know, rather than being misleading and telling people it was an expat policy.

We are on 457 visas. Having adequate health insurance was a requirement for the visa and ours was obviously accepted. I can't see anything anywhere saying that 457 visa holders have to have any exclusions on their insurance - i.e. that GP visits and prescriptions cannot be covered by the insurance. It just says that certain things have to be included, which they obviously are with our insurance. Maybe others on 457s have taken out different insurance which just isn't as comprehensive, and this has led people to believe that no insurance covers GP visits etc?

The health insurance isn't part of a salary package, so wouldn't save us any money to ask the company to downgrade it. I guess it depends who you work for as to what they're prepared to offer.

If you look at the policies on the link I gave you, you'll see that they go all the way from hospital cover only to fully-covered for GP visits and the lot. Even the ones with hospital cover only are enough to satisfy the requirements for a 457 so obviously, since yours covers so much more, it's satisfying the requirements plus a whole heap more.

If it's not in the salary package then that's great to know, you can sit back and enjoy.

[TandT]

5 hours ago, Marisawright said:

If you look at the policies on the link I gave you, you'll see that they go all the way from hospital cover only to fully-covered for GP visits and the lot. Even the ones with hospital cover only are enough to satisfy the requirements for a 457 so obviously, since yours covers so much more, it's satisfying the requirements plus a whole heap more.

If it's not in the salary package then that's great to know, you can sit back and enjoy.

Yes I'm aware different levels of insurance cover exist and I'm aware our insurance has always met the criteria, otherwise we'd have never been given a visa to start off with. I think we were getting our wires crossed. I was trying to just point out that the previous advice given - i.e. that private health insurance simply does not cover GP visits or prescriptions, and that this applies to 457 visa holders - isn't always the case. It might just be helpful to others who are on 457 visas (and maybe others more generally, I can only speak for the 457) to know. I know that this was confusing for me reading this thread.

Edited November 30, 2018 by TandT