Private health insurance helps protect you from costs arising from medical emergencies. As government regulations grow more stringent and insurance providers hike their premiums, it is becoming more and more difficult to find the right health insurance plan.
1. The Type of Cover You Need
There are two major types of private healthcare covers offered. Hospital cover takes care of all costs directly incurred by your stay in the hospital as a private patient. These include surgery (theatre) costs, accommodation, and meals. It covers at least 25% of the MBS (Medicare Benefits Schedule) fee for each procedure.
Additionally, depending on the policy, you might be covered for some or even all of the medical procedures and services covered by Medicare.
The general treatment cover (also known as extras cover), takes care of costs incurred when you undergo procedures that Medicare does not cover, such as orthodontics, physiotherapy, speech therapy, and home nursing.
Unlike the hospital cover, extras cover usually will not cater for the full cost. It will only cover a percentage of the cost for each service you undergo, so make sure to ask your provider for the details.
2. Ambulance Cover
Ambulance cover is the coverage offered for emergency medevac or other ambulance services. Depending on your state, you may or may not need this coverage. If you live in a state where ambulance costs are taken care of by a state authority, organize with your healthcare coverage provider to reimburse you the state ambulance subscription amount.
3. Your Demographic
Healthcare providers usually tailor their offerings towards different groups of people. The premiums and coverage for each of these products usually take into account the targeted demographic. Singles, couples, and single parents, for instance, get varying premiums and levels of coverage.
In the same breath, seniors health insurance is more tailored to the needs of the ageing population. Think about management of chronic illnesses such as arthritis or diabetes and access to specialized treatment on cardiac-related issues.
Additionally, certain categories of people might qualify for rebates, so always check what demographic the plan you’re considering is targeted towards.
4. What is Covered
All hospital insurance products in Australia are classified in one of four classes, Gold, Silver, Bronze, and Basic. An insurance plan is assigned a tier based on the amount of coverage it offers against some predefined clinical categories.
Your policies may offer no coverage for some categories, limited or restricted cover for some categories, or unrestricted coverage against all categories.
If your provider offers plans that cover more than the required minimum of a particular tier, they are allowed to market their policy as Basic plus, Bronze plus, or Silver plus. Some of the clinical categories that determine the policy tier include:
Assisted reproductive services, such as IVF
- Back, neck, and spine
- Blood, such as bone marrow transplants
- Bone, joint, and muscle
- Brain and nervous system
- Breast surgery (medically necessary)
- Chemotherapy, radiotherapy, and immunotherapy for cancer
- Dental surgery
- Diabetes management
- Digestive system
- Heart and vascular system
- Ear, nose, and throat
5. What is Not Covered
Most healthcare plans have restrictions and exclusions. It is important that you know what your plan’s coverage does not extend to. Restrictions, on the one hand, are services covered only in part. Exclusions, on the other, are services that are simply not covered by the policy. These two often vary between policies, so think long and hard about them as you compare different health coverage plans.
What Else Should You Keep an Eye Out For?
Always make sure you read through the whole policy document. Doing so might sound about as exciting as watching paint dry, but it might save you a lot of stress in the future. You might, for instance, discover that the plan you’re considering doesn’t cover air ambulance services or that it only covers for extras when you’re in a public hospital.