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3 Questions You Should Ask Your Private Health Insurer

Australian citizens all have public health coverage thanks to Medicare,…
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Australian citizens all have public health coverage thanks to Medicare, which provides free hospital care as well as free or reduced-cost care outside of hospitals, providing the healthcare provider accepts Medicare benefits. While public health coverage may be enough for many people, there are big advantages to taking out private coverage that are worth considering.

Firstly, private coverage can offer individuals more choices regarding hospitals and doctors when in need of emergency care. Private coverage can also guarantee individuals private rooms during their treatment, and certain private plans offer ambulance coverage. Without this, the individual will be responsible for the costs of an ambulance ride.

Private plans can also offer coverage for up to all clinical categories outside of hospital treatment. This could be perfect for someone who suffers facial pain or dental pain, as they could be covered for orofacial pain diagnosis and potentially have their treatment covered as well. Many residents choose a combination of public and private insurance options to increase their quality of life. It’s important to know what you’re getting into, however, before signing up for a new health insurance policy or upgrading an existing one. Here are some of the most important questions to ask a potential provider.

What tier policy will I have?

Thanks to private health insurance reform, private plans are now broken into four major policy tiers: Basic, Bronze, Silver, and Gold. The higher your plan’s tier, the more private hospital coverage you have. Hospital coverage is broken into a total of 38 clinical categories. A Gold plan will cover all of these categories, whereas a Basic plan is only required to cover the following three.

Rehabilitation: This refers to hospital treatment that helps a patient recover from illnesses, surgery, or injuries. Examples could include physical therapy, cardiac rehabilitation, prosthetic services, speech therapy, and more.

Psychiatric services: This includes the hospital treatment of patients with psychiatric, behavioral, or addiction disorders. Examples include treatment of psychosis disorders, depression, hospital detox, and addiction therapy.

Palliative care: This is all care meant to improve the quality of life for a patient with a terminal illness, including management of pain.

Important additional categories for many people include reproductive services, back, neck and joint treatment, chemotherapy, and pregnancy care. Make sure you understand what tier your proposed plan is on and what it covers before purchasing it.

How long are my wait times?

New or upgraded private healthcare plans typically have waiting periods before benefits will be paid out. This is to prevent people from only purchasing private insurance when they know they need it, which would be much more costly on insurance companies and would result in higher premiums for contributors.

Hospital coverage for pre-existing conditions and pregnancy typically have wait times of 12 months. You’ll want to plan and organize private coverage well ahead of time if you suspect you’ll need it for these reasons. Psychiatric, palliative, and rehabilitation services usually have a two month wait time for hospital coverage. All other circumstances have wait times of two months. When it comes to services outside of hospitals, individual providers may impose their own wait times.

What if I become unhappy with my costs?

Just because a plan works for you one year doesn’t mean it’ll still be great the next. Costs for private plans typically change during April each year, and you may find your new premiums difficult to afford. You might also incur more out of pocket expenses than you anticipated with your current plan. If you find that your current plan is no longer working for you, you can switch plans or providers at any time. Compare health funds with iSelect to find the plan that best suits your current needs.