Private Health Insurance

[North to South]

Hello,

Sitting here in quarantine on day 6 my focus is on arranging private health insurance, but not sure who I should consider and who I shouldn't.  I've always had health cover, but it's always been via my company so now having to search a provider is a new thing, so really would appreciate anyones guidance on who I should use and who I shouldn't.

All comments and tips on what I should or shouldn't include would be most welcomed.

Thanks

[Marisawright]

2 hours ago, North to South said:

Hello,

Sitting here in quarantine on day 6 my focus is on arranging private health insurance, but not sure who I should consider and who I shouldn't.  I've always had health cover, but it's always been via my company so now having to search a provider is a new thing, so really would appreciate anyones guidance on who I should use and who I shouldn't.

All comments and tips on what I should or shouldn't include would be most welcomed.

There are several  companies that compare health insurance, but they are the same as mortgage brokers and insurance brokers - they are paid by the insurance companies, not you. They compare only the funds that are willing to pay them, so you don't get a full and fair comparison.  This is your best bet:

https://www.choice.com.au/money/insurance/health/compare

Choice is the Australian equivalent of Which? magazine in the UK, so it has no axe to grind.  You have to join to get a comparison, but you'll find that handy, because it will let you compare things like electrical appliances, internet providers etc. too.

Edited January 19, 2021 by Marisawright

[Guest AltyMatt]

If you have a job already lined up then check if your employer has a preferred insurer. Larger companies often have staff deals for insurance etc, although it might not apply for overseas visitor cover which is usually pretty eye-watering.

[Freemantle]

https://www.comparethemarket.com.au/health-insurance/

https://www.iselect.com.au/health-insurance/best/

https://www.productreview.com.au/c/health-insurance

https://www.comparingexpert.com.au/health-insurance/companies/

As it has been said, many employers give if not all,  a large proportion of your medical insurance , we certainly are given a very generous allowance . As with all insurance look very carefully at what they offer you with a fine tooth comb as to change companies can cost your your 12 month waiting period for a procedure. 

 

 

[Mike@Bonbeach]

My bugbear about Private Health cover is the way Extras work. They all say you are covered to a certain annual amount, for example Optical $300 dollars, but to actually get $300 dollars back you have to normally pay out $500 or so. Can't complain about Hospital cover as fortunately have rarely had to use it, and on the odd occasion I have then I've been satisfied. I think they are all much of a muchness especially since the government standardised the Hospital offerings.

[Marisawright]

16 minutes ago, Mike@Bonbeach said:

My bugbear about Private Health cover is the way Extras work. They all say you are covered to a certain annual amount, for example Optical $300 dollars, but to actually get $300 dollars back you have to normally pay out $500 or so. Can't complain about Hospital cover as fortunately have rarely had to use it, and on the odd occasion I have then I've been satisfied. I think they are all much of a muchness especially since the government standardised the Hospital offerings.

There are quite big differences.   It's all in the detail.    Some will give very little for some kinds of dental work whereas others will allocate hundreds of dollars, for instance. Some don't cover some things at all, and some cover unusual items.  It's all very confusing,  which is why the Choice Magazine comparison table is worth paying for.

[rammygirl]

Generally the cheaper cover requires higher co payments. It would seem very few cover all expenses.  Some occupational ones are good too.

You can still shop around for treatments as some places will charge more for the same procedure and you have to pay the difference, it pays to check with your insurer before committing to avoid an unexpected bill!

we actually decided not to take out private health care as we do the same as we did in UK. We use the public system but have our own “fund” to buy services as required.  So far after 7 years we are thousands of dollars in pocket.

[Marisawright]

19 minutes ago, rammygirl said:

Generally the cheaper cover requires higher co payments. It would seem very few cover all expenses.  ...

You are right.    Unlike overseas health insurance, Australian health insurance always requires a co-payment, called a "gap" (what we'd call an excess if it was car insurance).  Occasionally you'll see opticians and dentists offering "no gap" services but they're the exception not the rule. 

21 minutes ago, rammygirl said:

we actually decided not to take out private health care as we do the same as we did in UK. We use the public system but have our own “fund” to buy services as required.  So far after 7 years we are thousands of dollars in pocket.

Some Australians, especially older people, are horrified at the idea of not having private insurance - but my husband has never had it and as you say, he's thousands of dollars in pocket. But he's an ex-insurance guy and he calls it "self-insuring" - you put the equivalent of the insurance premium away in savings each year, so you've got the money when you do want to go private.  If you don't do that and spend it instead, you might be in trouble!   

[Quoll]

9 hours ago, Mike@Bonbeach said:

My bugbear about Private Health cover is the way Extras work. They all say you are covered to a certain annual amount, for example Optical $300 dollars, but to actually get $300 dollars back you have to normally pay out $500 or so. Can't complain about Hospital cover as fortunately have rarely had to use it, and on the odd occasion I have then I've been satisfied. I think they are all much of a muchness especially since the government standardised the Hospital offerings.

I believe the extras refund relies on the procedure number and how much the provider charges. My husband got his dental check up free because his provider obviously charged the going rate for each item. Mine obviously charged more for each item and  I had more x rays and a filling so I had a gap of about $85.  I have a procedure coming up which will cost me the best part of $2.5k and my insurer has a maximum of $950 refund for that type of procedure, then I'd better hope I don't need anything else significant for the rest of the year in that dental portion. Still, that's 3 months worth of payments I get back. 

We debated long and hard whether we self insure or not and in the end we decided not to but we've saved close to $25k by being away for the last 8+years anyway. At the moment we are OK with the insurance but we are playing it by ear and will see how things turn out in the longer run. Before we left, though, I had had a couple of procedures which were well worth the premiums we paid. 

[Mike@Bonbeach]

I think the point I am trying to raise about Extras is that if you are covered for up to $300 for optical and I go to an optician and find a pair of frames plus lenses for $300, when the claim goes in (my experience is with BUPA and NIB) then I will only get back about $180. Similarly for dental, you are covered say for up to $1000 and your treatment costs $1000 you will only get back in the region of $600. Both NIB and Bupa do give you free dental inspections, cleaning, xrays and fluoride treatment twice a year but you do have to visit specific dentists.  IMO you should be able to claim up to your limit and only pay once the limit has been reached.

[Marisawright]

1 hour ago, Mike@Bonbeach said:

I think the point I am trying to raise about Extras is that if you are covered for up to $300 for optical and I go to an optician and find a pair of frames plus lenses for $300, when the claim goes in (my experience is with BUPA and NIB) then I will only get back about $180. Similarly for dental, you are covered say for up to $1000 and your treatment costs $1000 you will only get back in the region of $600. 

Yes, because you have to read the detail.   That $300 for optical covers specific things - and the split will differ from insurer to insurer.   Same with dental, your $1000 cover will be split up into x dollars for this treatment and x dollars for that. 

[Mike@Bonbeach]

15 hours ago, Marisawright said:

Yes, because you have to read the detail.   That $300 for optical covers specific things - and the split will differ from insurer to insurer.   Same with dental, your $1000 cover will be split up into x dollars for this treatment and x dollars for that. 

Sorry, I am obviously not making myself clear. I think that if I am covered for $300 for say Opticals, then I believe I should be able to claim $300 and not have to pay $500 or whatever to get the covered sum back. And yes I do and have read the detail but I still believe the way it is done is wrong. After all, regardless of the way it is done, the insurer would only pay out the insured sum so it would make no difference to them.  

[Quoll]

Just now, Mike@Bonbeach said:

Sorry, I am obviously not making myself clear. I think that if I am covered for $300 for say Opticals, then I believe I should be able to claim $300 and not have to pay $500 or whatever to get the covered sum back. And yes I do and have read the detail but I still believe the way it is done is wrong. After all, regardless of the way it is done, the insurer would only pay out the insured sum so it would make no difference to them.  

I thought the refund depended on the item number not the total amount spent. If the service provider charges more than the refund amount on an item then your refund would only cover the amount that particular item is due.   There are usually multiple item numbers for any service and if your service provider adds a bit over the refund amount on each item then your total bill will be more of course. 

[Marisawright]

2 hours ago, Mike@Bonbeach said:

Sorry, I am obviously not making myself clear. I think that if I am covered for $300 for say Opticals, then I believe I should be able to claim $300 

But you are not covered for Opticals. That's just a Category.  Let's take HCF's Top Cover Extras as an example.   Under the Opticals category, you are covered for:

1. Spectacle frames   up to $135
2. Spectacle lenses - pair (excludes add-ons such as high index material, coatings and tinting)  up to  $150
3. Contact lenses - pair     up to $160

However you can't claim all of them in a single year, because there's an annual limit for the whole category of $275.  So if you got a frame and lenses, for instance, you wouldn't get $285, you'd only get $275.  And if you then bought contact lenses, you'd get nothing, because you've used your annual limit. 

Also notice that the lenses don't include add-ons like coatings or tinting, so you might buy lenses costing $250 -- but you are only covered for the base lens, not the coating or the tinting etc, which can easily account for half that cost.  

 

[Mike@Bonbeach]

I give up, all I wanted to do was to mention my bugbear about the way things are as far as Extras (the ones in my experience) are concerned. Didn't expect to get into all this. None of this has alleviated my bugbear, or changed the way I think. I'm sure the responders have tried to explain things as they see it but I see it a totally different way.

[Marisawright]

33 minutes ago, Mike@Bonbeach said:

I give up, all I wanted to do was to mention my bugbear about the way things are as far as Extras (the ones in my experience) are concerned. Didn't expect to get into all this. None of this has alleviated my bugbear, or changed the way I think. I'm sure the responders have tried to explain things as they see it but I see it a totally different way.

The way you expressed your opinion, it seemed as though you didn't understand how the Extras insurance cover works.  So we explained it to you.  

If you were just saying, I understand it works that way but I think it's wrong - that's a different thing. You're entitled to your opinion, but equally the insurance companies are entitled to run their business the way they see fit.  

Bottom line - you don't have to spend $500 to get $300 back. You just need to check what the individual allowances are for each sub-category and then choose products that are under that price.  Naturally enough, the shop is going to try to sell you the expensive stuff. That's life.

Edited February 11, 2021 by Marisawright

[llessur]

On 09/02/2021 at 13:23, rammygirl said:

we actually decided not to take out private health care as we do the same as we did in UK. We use the public system but have our own “fund” to buy services as required.  So far after 7 years we are thousands of dollars in pocket.

Likewise. The public health system here is excellent and in the last 10 years of being here neither my partner or I have regretted not taking out insurance. We have ambulance cover and put aside some savings in a health fund each month but other than that we're going it alone and are already thousands of dollars better off for it.

The way I see it is that if need to go to hospital in an emergency you'll be in a public hospital anyway. Other than arguably silly things like being able to decide your surgeon/obstetrician etc (as if I know them well enough to choose...) the only benefit I can see from private cover is getting quicker access to elective surgeries like knee and hip ops which are more likely to be required with age. In the years in between that's one hell of a lot of money going to an insurance company for something you might never need - seems a much better idea to put it in the bank.

I know lots of people who bang on about all the 'free' stuff they're getting from their extras cover like some money off of glasses, a bit of physio or remedial massage etc but seemingly forgetting they're paying a grand a year in extras premiums to start off with. I'd need to access one hell of a lot of physio *every single year for the rest of my life* to make that remotely worthwhile.

Unless you're paying for a top tier policy to begin with, none of the expensive stuff like dental work appears to be covered for anything more than a token amount which would still leave you considerably out of pocket if you need a crown or something (plus, again, you've already been paying for the policy for the X years prior to needing it).

We had our two babies in the public system -  it was an excellent experience all round with private rooms, great medical staff and great follow-up for a couple of issues we had with one of them - and it didn't cost us a cent. We know various couples who have had their kids in the private system, had a similar experience (but maybe with some slightly nicer food and a choice of obstetrician - although I'm pretty sure that mid-labour my wife would have been happy with pretty much anyone in scrubs) and they still came out with a $2000 bill to pay at the end of it all despite paying thousands of dollars for coverage in the years prior. Plus, if the pregnancy is anything other than routine then you'll most likely be transferred to a public hospital anyway thus meaning all of your premiums to date for pregnancy cover will have been completely wasted.

I've had the odd ultrasound and x-ray since being out here and for the infrequency of this type of thing being needed (maybe once every 3-4 years) being a couple of hundred dollars out of pocket for the gap at the time seems like a bargain.

I'll continue to put money aside for knee ops and kid's braces in case they're needed in the future but if they're not then I'd be much happier passing that very substantial amount of money onto my kids than giving it to Bupa or similar.

Edited February 11, 2021 by llessur

[rammygirl]

8 minutes ago, llessur said:

Likewise. The public health system here is excellent and in the last 10 years of being here neither my partner or I have regretted not taking out insurance. We have ambulance cover and put aside some savings in a health fund each month but other than that we're going it alone and are already thousands of dollars better off for it.

The way I see it is that if need to go to hospital in an emergency you'll be in a public hospital anyway. Other than arguably silly things like being able to decide your surgeon/obstetrician etc (as if I know them well enough to choose...) the only benefit I can see from private cover is getting quicker access to elective surgeries like knee and hip ops which are more likely to be required with age. In the years in between that's one hell of a lot of money going to an insurance company for something you might never need - seems a much better idea to put it in the bank.

I know lots of people who bang on about all the 'free' stuff they're getting from their extras cover like some money off of glasses, a bit of physio or remedial massage etc but seemingly forgetting they're paying a grand a year in extras premiums to start off with. I'd need to access one hell of a lot of physio *every single year for the rest of my life* to make that remotely worthwhile.

Unless you're paying for a top tier policy to begin with, none of the expensive stuff like dental work appears to be covered for anything more than a token amount which would still leave you considerably out of pocket if you need a crown or something (plus, again, you've already been paying for the policy for the X years prior to needing it).

We had our two babies in the public system -  it was an excellent experience all round with private rooms, great medical staff and great follow-up for a couple of issues we had with one of them - and it didn't cost us a cent. We know various couples who have had their kids in the private system, had a similar experience (but maybe with some slightly nicer food and a choice of obstetrician - although I'm pretty sure that mid-labour my wife would have been happy with pretty much anyone in scrubs) and they still came out with a $2000 bill to pay at the end of it all despite paying thousands of dollars for coverage in the years prior. Plus, if the pregnancy is anything other than routine then you'll most likely be transferred to a public hospital anyway thus meaning all of your premiums to date for pregnancy cover will have been completely wasted.

I've had the odd ultrasound and x-ray since being out here and for the infrequency of this type of thing being needed (maybe once every 3-4 years) being a couple of hundred dollars out of pocket for the gap at the time seems like a bargain.

I'll continue to put money aside for knee ops and kid's braces in case they're needed in the future but if they're not then I'd be much happier passing that very substantial amount of money onto my kids than giving it to Bupa or similar.

Exactly. Although it may depend on where you live as to how good the access to the public system is.

Interestingly our son turns 30 this year and earns over the threashold for extra levy. He currently does not have private health care. He has said he doesn’t intend to take it out but I wonder if he might. He is a pretty good saver and reasonably disciplined. 

[MacGyver]

24 minutes ago, llessur said:

Likewise. The public health system here is excellent and in the last 10 years of being here neither my partner or I have regretted not taking out insurance. We have ambulance cover and put aside some savings in a health fund each month but other than that we're going it alone and are already thousands of dollars better off for it.

The way I see it is that if need to go to hospital in an emergency you'll be in a public hospital anyway. Other than arguably silly things like being able to decide your surgeon/obstetrician etc (as if I know them well enough to choose...) the only benefit I can see from private cover is getting quicker access to elective surgeries like knee and hip ops which are more likely to be required with age. In the years in between that's one hell of a lot of money going to an insurance company for something you might never need - seems a much better idea to put it in the bank.

I know lots of people who bang on about all the 'free' stuff they're getting from their extras cover like some money off of glasses, a bit of physio or remedial massage etc but seemingly forgetting they're paying a grand a year in extras premiums to start off with. I'd need to access one hell of a lot of physio *every single year for the rest of my life* to make that remotely worthwhile.

Unless you're paying for a top tier policy to begin with, none of the expensive stuff like dental work appears to be covered for anything more than a token amount which would still leave you considerably out of pocket if you need a crown or something (plus, again, you've already been paying for the policy for the X years prior to needing it).

We had our two babies in the public system -  it was an excellent experience all round with private rooms, great medical staff and great follow-up for a couple of issues we had with one of them - and it didn't cost us a cent. We know various couples who have had their kids in the private system, had a similar experience (but maybe with some slightly nicer food and a choice of obstetrician - although I'm pretty sure that mid-labour my wife would have been happy with pretty much anyone in scrubs) and they still came out with a $2000 bill to pay at the end of it all despite paying thousands of dollars for coverage in the years prior. Plus, if the pregnancy is anything other than routine then you'll most likely be transferred to a public hospital anyway thus meaning all of your premiums to date for pregnancy cover will have been completely wasted.

I've had the odd ultrasound and x-ray since being out here and for the infrequency of this type of thing being needed (maybe once every 3-4 years) being a couple of hundred dollars out of pocket for the gap at the time seems like a bargain.

I'll continue to put money aside for knee ops and kid's braces in case they're needed in the future but if they're not then I'd be much happier passing that very substantial amount of money onto my kids than giving it to Bupa or similar.

I did a lot of research when I first moved to Australia many years ago and basically came to the same conclusion. For a long time I still felt like I "should" get insurance until I read an article about funding the public sector. Basically the idea was that many people get basic (crappy) private insurance only to avoid paying the Medicare Levy Surcharge, meaning that their money goes into the pocket of private companies for an insurance product that is almost worthless. One can instead make a choice not to get private health insurance and instead choose to pay the additional MLS in order to fund public healthcare services for others who may need it. This appealed to me, so I do not have private health insurance, happily pay the MLS and pay a set amount per pay into a personal savings account (my health fund) for those times I may need more expensive healthcare in the future. There are downsides to this arrangement, but it feels the right balance for my current circumstances.

[Paul1Perth]

On 09/02/2021 at 10:53, rammygirl said:

Generally the cheaper cover requires higher co payments. It would seem very few cover all expenses.  Some occupational ones are good too.

You can still shop around for treatments as some places will charge more for the same procedure and you have to pay the difference, it pays to check with your insurer before committing to avoid an unexpected bill!

we actually decided not to take out private health care as we do the same as we did in UK. We use the public system but have our own “fund” to buy services as required.  So far after 7 years we are thousands of dollars in pocket.

I think if you're younger and in good health that's the way to go, unless your employer has a good deal. 

If you are really sick, in an accident or something serious the care here and A&E are as near as the NHS as you could imagine. 

When I was younger trips to the dentist were rare, I didn't have to go to an optomotrist till I was in my late 50's. I had great cover from my employers GUHealth, carried it on since I've been retired. When you have to pay for it you realise how expensive it is. We get a lot back though.