Benefits Of Having Private Hospital Cover. What Are They?
It turns out most of us have no idea how Private Health Insurance works. The reality is that Private Health Insurance is an extremely complex product. At Frank Private Health Insurance we offer cheap health insurance and information which assists people to make the best decisions for themselves as consumers. This article outlines some information regarding private hospital cover which will assist you; to understand the product, to highlight the benefits of having private hospital cover and to dispel the myths.
* The price shown is per week and applies to a {LIFESTAGE} living in VIC with a $500 excess. It excludes LHC loading and includes a Base Tier Government Rebate
| Extras services (when included on cover) |
|---|
| All extras benefits except as specified below. Waiting Period: 2 Months |
| Optical, home and domestic aids and medical aids. Waiting Period: 6 months |
| Major dental services (including full & partial dentures, orthodontics, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth including wisdom teeth). Waiting Period: 12 Months |
| Health appliances including nebuliser pump, blood glucose monitor, pressure garments, sleep apnoea monitor, extremity pump, hearing aids, orthopaedic appliances (GMHBA approved), prostheses (GMHBA approved non-surgical), tens monitor, podiatry surgical procedures and orthotic appliances (foot). Waiting Period: 12 Months |
| Hospital services (when included on cover) |
|---|
| Accidents - bodily injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover. Waiting Period: No |
| Obstetrics and maternity. Waiting Period: 12 months |
| Pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care). Waiting Period: 12 months |
| Any other benefit for hospital (or hospital substitution) treatment. Waiting Period: 2 months |
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by GMHBA (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.
A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:
New members
New members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members (transferring or upgrading)
Members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members (with at least 12 months membership)
Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover.
During your first 24 months of cover - after the standard hospital waiting periods have been served – Best Hospital and Best Hospital (no pregnancy) covers have benefit limitations on selected services.
This means that the benefits payable on these services are limited to the minimum shared room rate under the Private Health Insurance Act for private hospital admissions during the 24 month benefit limitation period.
Once the waiting period and benefit limitation period has been served you will have access to the benefits applicable on your level of cover.
Silver Hospital cover provides the same single room coverage as Gold Hospital, but co-payments of $100 per day up to a maximum of $700 per admission apply. Co-payments are not the same as hospital excess. Please note: Some private hospitals only have single rooms and co-payments will apply.
Co-payments do not apply.
There are actually two different types of Private Health Insurance cover: Hospital Cover and Ancillary or 'Extras' Cover.
Hospital Cover helps you pay for expenses you incur as a patient in a private hospital. You do not need private health insurance to be admitted to a private hospital. The benefits of having private hospital cover is that it simply helps you pay the costs associated with your admission and treatment.
Ancillary or Extras Cover helps you pay for the cost of outpatient medical treatments that aren't covered by Medicare including dental, optical, physio, chiro, osteo, natural therapies, alternative therapies, some pharmaceuticals and often a few others.
Most insurers offer bundled packages that include Hospital and Extras cover. There are few cheap health insurance options which will give you the peace-of-mind you want by do not break the bank.
Good reasons to use a Private Hospital
- 'Elective' surgeries - For many medical interventions that are considered non-urgent, the public system has very long waiting lists to get treatment. Depending on the treatment, the hospital and the seriousness of your condition the wait can take months and in some cases more than a year. In a private hospital with your own doctor, on the other hand, you will be able to get treatment very quickly.
- Some of the types of surgeries that are considered elective include wisdom teeth/tonsil removal, knee/hip/shoulder investigations/reconstructions/replacements, gall stone removal, hernia, neurosurgery, heart bypass surgery, and more.
- Choice of doctor - In a public hospital, you will be treated by whoever is available at the time. If you want to be able to choose your doctor, and be assured you'll have the same doctor seeing you throughout your treatment, you can do so in a private hospital.
- Pregnancy - Many expecting mother choose to use the private system for their pregnancies. The advantage is related to being able to choose an obstetrician and have that doctor see you throughout the whole pregnancy.
- Comfort - Private hospitals are generally more comfortable than public hospitals. You're more likely to get your own room.
So, what are the benefits of having private hospital cover?
Now that you have a better understanding of the benefits of having private hospital cover, it's important to understand exactly what Hospital Cover does to assist you in meeting the costs of treatment in a private hospital. It pays for (generally) 100% of the cost of hospital fees. When you are treated in a private hospital, the Private Hospital will charge you a certain amount for your stay. The amount they charge will depend on the length of your stay and the type of treatment you receive, but can be in the range of $1000-$5000 per day. Your Hospital Cover will pay all of these costs on your behalf, but will sometimes require you, to pay a co-payment/excess, which can be a few hundred dollars. This is generally the case for cheaper forms of Hospital Cover.
The Medicare Levy Surcharge
The federal government has implemented a Medicare Levy Surcharge of 1% for high income earners to incentivise them to take out private health insurance. You will be liable to pay the surcharge if you don't have approved Hospital Cover with a private health insurer; and have a taxable income of more than $80k for an individual or $160k for a couple or family.
Lifetime Health Cover
Private Health Insurance is optional - however if you don't purchase hospital cover by the 1st of July following your 31st birthday, you will pay the Lifetime Health Cover loading on top of the premium of any hospital cover you later purchase. Refer to the following website http://www.privatehealth.gov.au/healthinsurance/incentivessurcharges/lifetimehealthcover.htm for further information.
The Bottom Line: Should I Get Private Health Insurance Hospital Cover?
The best thing is to ask yourself the following questions:
- Would I otherwise be liable for the Medicare Levy Surcharge or Lifetime Health Cover?
- Would I want to have a baby in the next 3 years? And if so, would I want to choose my own obstetrician and/or have my baby in a private hospital?
- Am I likely to need at least one elective surgery in the next 5 years?
- If something 'serious' happens in the next 5 years, would I want to be in a private hospital?
If you have answered yes to any of these questions it is worthwhile taking out Private Health Insurance cover. There are cheap health insurance options available so you do not have to break the bank when you decide to take out a health insurance policy. There are various benefits of getting private hospital cover and at Frank Health Insurance we can offer you a range of different levels of cover to suit your individual needs.