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Tips for choosing a Health Fund

Tips for choosing a Health Fund

We are often asked who we recommend for health insurance, but of course, we can’t give advice because it depends on your circumstances and needs.

Here are a few things for you to consider. Taking a bit of time to research thoroughly will literally save you thousands of dollars in the long term.

  1. If you taking out health insurance for the first time: you will have 12 months of membership before being covered for surgery that is elective.
    If you are really only joining to be covered for one surgical procedure, it may not be worth your while.
  2. If you are wanting to switch private health insurance companies: We actually strongly recommend that you do if you are with Medibank Private, MBF, NIB , BUPA, HCF *, see information below.
    Regardless of how long you have been with an insurer, you get absolutely no additional benefits or treatment. Switching from one insurer to another is easy and provided you do not change the level of cover you currently have, you will be covered immediately by your new insurer for all that you were covered for by your previous insurer (and probably more!).
  3. What does your policy cover? It is important to make sure your health fund covers the procedure you are considering, so you need to specifically ask if they cover the Medicare item numbers of the surgery you are looking at. You will find item numbers at the top of the surgical quotes provided. Ideally get the fund’s agreement that they cover a particular item number in writing.
    You should think carefully about what you want from a health insurer and investigate thoroughly when they recommend “exclusions”. Make sure that you understand exactly what you agree that you do not need. Eg “plastic surgery item numbers” are often construed as cosmetic surgery, when they in fact also include skin cancer surgery, mole removal and many reconstructive surgeries that you may one day need.
  4. Comparing funds: In Australia, many funds are run to benefit members, however those mentioned above are public listed companies, which have a legal obligation to maximise profits for shareholders. This will predictably result in worse outcomes for their policy holders. One independent source for comparing funds is the government website www.privatehealth.gov.au. It allows you to look at funds you are considering and then assess their pay-out-ratios (how much they pay to policy holders Vs the premiums they collect).

These private health insurers are trying to steer Australia towards the American model of care in which funds dictate what services will be provided to policy-holders. We don’t believe this is the best outcome for patients. The American health system is famous for being terrible! Australia needs to avoid this at all costs.

As well as the above, these same companies are making some appalling changes to their members cover. Some of these changes are:

  • No longer covering any radiology (X-rays etc.) or pathology.
  • No longer covering many surgical procedures.
  • Refusing to pay any hospital fees if you have a non-Medicare eligible procedure at the same time as a Medicare eligible procedure.

Which Australian health funds are not-for-profit?

According to privatehealth.gov.au, the following health funds operate in Australia on a not-for-profit basis. Funds are noted as ‘restricted’ if membership is limited to certain groups or industries. Information about them can be found at www.memberschoice.com.au.

*These are not all of the “for-profit” health insurance companies. These are the major companies only.