FAQs

Why do I need health insurance?

Here are some great reasons to protect yourself with insurance:

  • Avoid long waiting lists for surgery: Private patients generally have much shorter waiting periods and greater flexibility in scheduling elective surgery than patients on public hospital waiting lists.
  • Choose your preferred doctor and hospital: Private health insurance allows you to choose your own doctor and participating hospital for treatment.
  • Save money on tax: Avoid the Medicare Surcharge Levy by taking out hospital cover. This applies for singles earning over $90,000 per annum or couples and families earning over $180,000 per annum.
  • Access extra fitness & lifestyle services: Many health funds give you access to a great range of extra services like reduced gym membership fees, approved weight loss, quit smoking programs and more, depending on the policy you choose.
  • Extras cover: Receive benefits toward the cost of dental, optical, physiotherapy and other 'non-hospital' services that Medicare generally doesn't cover.
  • Choose a cover that suits your needs: Get cover for the things you want and don't pay for services you don't need.
  • Lock in a low premium: Take out hospital cover before 1 July following your 31st birthday to ensure you won't be affected by a Lifetime Health Cover age loading.

 

What is "Hospital Cover", "Extras Cover" and "Combined Cover"?

Hospital Cover

Hospital cover refers to coverage by your health fund for in-patient hospital treatment. It covers hospital accommodation, medical costs, theatre fees and doctors' fees. Generally, any medical service listed under the Medicare Benefits Schedule (MBS) can be covered by private hospital insurance. Some services which are not listed, like elective cosmetic surgery or laser eye surgery, may only be covered to a limited extent or not at all.
Many people choose hospital cover because you could:

  • Save on tax if you're earning over $90,000 per annum as a single or $180,000 per annum as a couple or family, by avoiding the Medicare Levy Surcharge
  • Avoid lengthy waiting periods for elective surgery in a private hospital
  • Choose your  doctor and participating private hospital
  • Save money in the long run by taking out hospital cover early in life and minimising your Lifetime Health Cover age loading
  • Hospital cover can be taken out separately as a 'hospital only' policy, or combined with extras cover.


Extras Cover

Extras cover pays benefits for out-of-hospital services that generally aren't covered by Medicare, such as dental treatment, prescription glasses, contact lenses and physiotherapy. There is a wide range of extras features that you can choose from to ensure you get covered for the things you're likely to use.
Extras cover can be offered separately or combined with hospital cover. The level of extras cover that you choose will determine the services included and how much you can claim for each service each year.

Combined Hospital and Extras Cover

Combined hospital and extras cover includes benefits for both in-patient hospital treatment and out-of-hospital services that generally aren’t covered by Medicare, such as dental treatment. You may choose a pre-packaged policy that health funds design for different life stages, or you may prefer to mix and match different hospital and extras covers to choose a combination that's right for you.

What are waiting periods and why do I have to serve them?

A waiting period is the amount of time that needs to pass from the start date of your health insurance policy to the time that you can claim on certain services. This is to ensure that no member can make a large claim straight after joining a health fund, then drop their membership, as it would lead to increased premiums for other members.
Most benefits have short waiting periods of just 2 or 6 months, but pre-existing conditions and specific benefits like pregnancy and obstetric services generally have a 12 month waiting period. Before deciding on a policy make sure you are aware of the waiting periods that apply.
Once you've served your waiting periods with one health fund, you generally won't have to re-serve them even if you switch to another health fund, provided you switch to an equivalent or lower level of cover.

What is a benefit limit?

Benefit limits refer to the extent of cover offered by your health fund for certain features.

Benefit limits for hospital cover

For hospital cover, benefit limits may include:

  • Full cover: the cost of treatment is fully covered by the health fund up to the Medicare Benefits Schedule.
  • Partial cover: your health fund will only pay part of the cost of the treatment, and you will be liable for the remainder.
  • No cover: your health fund does not pay any part of the cost of treatment.

Benefit limits for extras cover

For extras cover, benefit limits refer to the dollar amount that your health fund will pay up to for a particular service. For example, one policy may pay up to $500 per person per year, for general dental benefits, while another may pay up to $1000. Overall policy limits may also apply. For example, a policy may have a general dental limit of $1000 for all persons covered by the policy.

Benefit Limitation Periods

A Benefit Limitation Period (BLP) is an additional waiting period that the health fund may impose in order to reduce the cost of your health insurance premium. During the BLP you are generally entitled to limited benefits for a particular condition or treatment for a set period of time. After that period of time has elapsed, you would normally be entitled to full benefits for the condition or treatment. BLPs usually commence after the standard waiting periods have been served. For example, hip replacement services may come with a BLP of 12 months, which means you'll need to wait an additional 12 months on top of your regular waiting period before you can claim on this feature.

I am turning 31 soon - do I have to buy private health insurance?

You can avoid paying extra on your premium by taking out hospital cover by 1 July following your 31st birthday.

This is under the terms of Lifetime Health Cover, which is a Government initiative to encourage people to take out health insurance earlier in life and to keep it. If you do not have Hospital Cover and wish to take out a policy after July 1st following your 31st birthday, you will incur an extra 2% loading on top of your premium for every year you are aged over 30.

Is it okay to switch health funds?

It's smart to regularly review your health insurance policy to make sure it still suits your lifestyle and ensure that it's good value for money.

Switching health funds is easy. Simply choose the new health insurance policy you want to take out and apply for cover with Choosi. If you indicate that you're switching health funds, your new health fund will manage your transfer with the relevant authorisation. Any premiums you've overpaid will be refunded to you.

Switching health funds won't affect your Lifetime Health Cover status or any waiting periods you've already served with your previous health fund. If you switch to an equivalent or lower level cover with the same or a new health fund, your waiting period status will transfer with you.

Choosi offers a range of options based on your needs so you can easily compare the best cover to suit your changing lifestyle and budget at any stage in life.

How do I make a claim?

All health funds issue you a membership card which you can use with most service providers - they simply swipe your card after you've been treated and they can claim benefits directly from your health fund. If there is a difference to be paid, you'll need to pay it from your pocket to the service provider.

For other claims, you'll generally need to complete a form either printed or online form and provide proof of the claim (e.g. a receipt) to your health fund either at the point of claiming or at a later date if you are claiming online. You should lodge your claim as soon as possible after the service has been performed, as most health insurers will not pay on claims made one to two years after the service has been provided. Make sure you check the time limits that apply to your cover with your fund once you've chosen the cover that is right for you.

How do you calculate health insurance premiums?

Health insurance premiums are not calculated on 'risk' factors like some other types of insurance. Instead health funds use a community rating system which means everyone pays the same premium for their health cover. However factors such as your age for the Lifetime Heath Cover loading, rebate percentage, your income, product details, level of cover and any excess or co-payments you nominate will affect your health cover premiums or the amount of government benefits that are available to you to offset those premiums.

The Australian Government has a number of initiatives aimed at making it more affordable for Australians to take up private health insurance.

Can I take out cover on behalf of my partner?

Yes, if you are including them on your policy application. You will need their Medicare number and current health fund details in order to complete the application.

Can my partner take out cover for me?

Yes, if they are including you on their policy application. They will need your Medicare number and current health fund details in order to complete the application.

How do I find the best Health Insurance Cover to suit my needs?

The best way to find the right cover to suit you and your family's lifestyle and budget is to compare different health insurance policies, however, this can be confusing and time consuming. At Choosi, we do the shopping around for you and help you to easily compare covers from a selection of funds, so you can quickly choose the best cover to suit your needs. And best of all, it's a completely free service.

What should I look for when choosing Private Health Insurance?

Different health funds provide a variety of policies for people at different stages of their life. When comparing health insurance policies, you should take into account the services that are included and excluded, the associated waiting periods, benefit limits and the excess options. Like any other financial product that you purchase, we recommend you read all the information available before deciding to proceed.

Important Note:

The answers above are to be used as a reference guide only and do not substitute or replace your insurance contract, the Product Disclosure Statement (PDS) or Certificate of Insurance.