GOOD HEALTH: It's wise to regularly review and revise your health insurance cover.
GOOD HEALTH: It's wise to regularly review and revise your health insurance cover. ThinkStock

What to look for in your health insurance

COMPLACENCY about your health insurance cover could be costing you a lot more money than you know, so it's wise to regularly review and revise your cover using these tips.

Private Healthcare Australia advocacy group chief executive officer Dr Rachel David particularly recommends double-checking to people whose income is fixed and have stopped working.

By December 2016 there were about 13.5 million Australians with health insurance. Prudential regulator APRA reported about 38% of them were aged 50 and over.

As Australians are living longer and their health in the second half of their lives is generally a lot better than those people who grew up during the Depression, Dr David said seniors aged 50 to 70 should be focusing on prevention while those over 70 should be looking a specific health complaints and how they manage themselves so they can remain productive and out of hospital.

"We do have a very good public hospital system in Australia, but it tends to be at its best when it covers people in emergencies like trauma situations where people need intensive care," Dr David said.

"For things like non-emergency surgery or elective surgery, there can be very long wait times and it is often unpredictable when people will be called in for surgery.

"There are also a number of procedures and treatments that public hospitals, even at their best, struggle to provide, and they are treatments for a number of mental health conditions because they are really stretched dealing with mental health emergencies, and treatments for elective surgery in some states and territories where the health services are just unable to cope with demand.

"The other issue with a public hospital is you don't get continuity of care. In private health, once you do find a medical specialist, they are your doctor and they continue to provide your care over a period of time.

"If you go into a public hospital you will get seen by a different person each time and there is a likelihood they could be a shift worker or a trainee.

"If your condition isn't particularly serious that's not an issue, but some people they are much more reassured if they have a doctor who there for them 24/7 who is responsible for their care and who is fully trained."

What cover should I have?

The older you are it's best to have the highest cover you can afford.

Dr David said there is roughly two categories of cover to consider when reviewing your health cover -

  • Top hospital cover which covers everything, and
  • Other levels of cover which are more affordable, but which have some exclusions and products with excess cost.

1. Revisit your cover by calling your fund and asking for details of the cover you have now.

2. Review the existing list of items covered based on your age and your specific health issues. You need to ensure you are covered for treatments and any possible complications.

3. Some health issues you should consider within your cover are heart disease, diabetes, arthritis, orthopaedic, cataracts and eye disease, hearing and dental.

The higher cover level often means a higher cost so when top hospital cover is out of financial reach, Dr David said there are products that cover ageing conditions, but exclude things like pregnancy and IVF.

"After the age 50 and if money is an issue, people should check around for products which exclude those things," Dr David said.

"Look at products with obvious exclusions that reasons of just biology, you are not going to need if you are over 50 and in reasonable health."

4. Under Extras look for a generous dental care option.

"Some funds own dental practices or have contracts with practices that offer a very good deal on preventative dentistry."

Cover for hearing and eye tests are also worthwhile including.

5. If using a broker website, such as iSelect or Compare the Market, pick from the list a health fund and then call that fund directly to double-check your health issues are covered by the product being promoted by the broker.

"These sites can be useful, but most of them get commissions and they don't compare all products on the market," Dr David.

"One of the risks of using a broker is that often they encourage you to select product based on price and not your health needs.

"It can be important to ring the health fund to ask, 'do you offer gap cover for doctors fees?'. The broker or aggregator won't necessarily know that so it's important to ring the chosen fund just to just what is being covered."

6. Check in advance with your doctor if they have an arrangement with health funds to cover the cost of the gap when you are in hospital.

"Health funds are not allowed to do gap cover for out-of-hospital consultations, but they are for any admission to hospital," Dr David said.

"Some doctors, not all, charge large fees and it is important to know that your health fund will pick up any of that."

First timers

If it's your first time, the premium will carry a loading which is designed to discourage people from leaving taking out insurance until they need to claim.

This means you will be paying a lifetime cover loading and usually there is a claim waiting period of 12 months for any pre-existing condition.

It may still be worth taking out health insurance when the public system waiting time is as long as 12 months and you then want to have the procedure done in the private system. Once you consider how long it will take to save for the procedure and then pay its full cost, it may be financially viable to take out health insurance in your later years.

The lifetime loading will still apply for 10 years which is why Dr David recommends seniors consider taking out health insurance earlier rather than later.


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