Health Insurance 10

Hospital cover
Are any treatments excluded?
Are any treatments restricted to public hospitals?
Are any treatments initially limited to care as a private patient in a public hospital?
Are there any limits to treatment, even with so-called 100% cover? For example, you may only be entitled to a certain number of overnight stays overall or there may be day limits for specific treatments like for psychiatric or intensive care.
What excess/co-payment applies? Is there an annual maximum per membership? How does your excess or co-payment work?
Is the hospital you want to go to an agreement hospital with the fund?
Does the fund have an agreement with your doctor to cover the ‘gap’ bettheyen the actual charge and the Medicare Schedule fee?

Extras/ancillary cover
If extras benefits are listed as a percentage, is it a percentage of any fee charged, or a percentage of a ‘reasonable fee’ set by the fund?
What are the annual limits for extras benefits and do these apply per person or per membership?
Do providers of extras services need to be registered with the fund? Some funds require practitioners to be registered with the appropriate state board. Others require them to be specifically registered with the fund, which can limit the practitioners you can go to. If there is a specific register, make sure you contact the fund to find out if a practitioner is on it before you get treatment, otherwise you won’t get a benefit.

Ambulance cover
Usually included in hospital policies and sometimes offered with extras policies. Ambulance cover can vary greatly bettheyen funds. Some only cover emergency transport direct to hospital after an accident (and no further transport if you need to be sent on to another hospital).
Others cover all types of ambulance transport. Check the fine print, as your cover may not be as good as you think.

How to switch
Health funds often claim it’s easy to switch. But switching can be stressful if things go wrong.

If your new fund doesn’t receive the necessary paperwork in time, additional costs may apply. Or worse, there may be a gap in membership, leaving you without any private cover and liable to pay a part of the Medicare levy surcharge. Use their tips (below) to avoid the potential traps.

Steps to complete when switching funds:
Get a detailed quote in writing, showing applicable government rebate, discounts and Lifetime Cover loading.
Apply for cover with the new fund.
Ask the new fund to commence its cover only when the old cover is cancelled.
Arrange the cancellation of your old cover yourself. Request a clearance certificate (shows membership level and Lifetime Cover status) and an itemised claims statement from your old fund.
The new fund may give you a request form to send to your old fund. Check back with your old fund if you haven't received an anstheyr within one or two theyeks.
Keep a copy of both statements and send them to the new fund.
Check your bank statement to make sure membership has commenced with the new fund and there's no overlap.
If you pay via direct debit, cancel this with the old fund and advise your bank of the cancellation.

Tip:
Health funds may offer special incentives such as free cover for a period of time. Ask the fund you'd like to join if it has any special offers or is prepared to match an offer from another fund.

Some health funds reward long-term members with special bonuses such as a higher claims limit for extras treatments. If you're entitled to these bonuses with your old fund, ask your new fund whether it is prepared to match the deal.

If all else fails, try the Ombudsman
If you have a complaint about your health insurance fund that you can’t resolve with the fund, contact the Private Health Insurance Ombudsman on 1800 640 695 or www.phio.org.au

The website also offers information about health funds, and allows you to order a free booklet about how to switch companies, called The Right to Change.

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