What Do I Need To Know When Claiming On My Private Health Insurance?

Make sure you know what you are covered for

Once you have gone to all the effort of finding the best health cover, the last thing you want is to not know how to claim on your cheap health insurance plan. We know health cover can be complicated and frustrating, but if picked a Frank cover, you would know already that we are different. We want health cover to be cheap, affordable and simple. Working out how to claim on your cheap health insurance plan should be just as simple. Despite this, there are a few things you still need to know. There are different ways to claim your hospital and extras covers. Hospital insurance could cover you when you are admitted to hospital for either an injury or emergency, or an elective treatment.

* 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

We have hospital policies that allow you to be treated in either a private or public hospital as a private patient. Private health cover could also include extras cover, which provide benefits for treatments not offered in hospital, such as dental, physio, optical and chiro. Our two extras policies offer benefits of either 50% or 80%, which is important. We also believe that simple and affordable health cover should also offer choice and flexibility. There is little doubt when you are working out how to claim on your cheap health insurance plan, it should be flexible. Before you claim, and hopefully before you go to hospital or arrive at your extras appointment, it’s important to know exactly what you are covered for. Use our webchat or give us a call if you aren’t sure. There would be nothing worse than thinking you are covered for a treatment and find out afterwards that you aren’t.

How do charges work?

Before you work out how to claim on your cheap health insurance plan it is important to know how the charges work. It is different for hospital and extras covers. When it comes to hospital, the first thing to do is before you go into private hospital, check that the treatment or service that you’re planning on having is included in your cover and check whether the private hospital is on our participating hospitals list. Once you have had your treatments, and hopefully you are OK, it is time to pay the bill. That’s not all you need to know about how to claim on your cheap health insurance plan after hospital treatment. There will also be doctors’ or specialists’ bills. We pay these medical bills based on a set fee created by Medicare called the Medicare Benefits Schedule (MBS) fee. When you go to hospital, Medicare pays 75% of the MBS and we pay the other 25%. However, doctors can charge more. We have gap cover which can cover you up to a further 20% of the cost. Anything above that and you will need to pay the gap. Make sure you talk with your doctor or specialist about this before you go under the knife.

As mentioned above, when it comes to extras cover, you can choose a product with either 50% or 80% back for treatments. So, if your dentist charges you $100, you can claim either $80 or $50 depending on what product option you take out. So, why would you take the 50% option over the 80% option? Well, the main reason has to do with annual limits. Annual limits are a cap on how much you can claim back in a calendar year.  If you have our Lots Extras policy, for example, the annual limits are the same, and you can choose either 50% or 80% benefit. This is designed simply for more choice. If you think you will visit the dentist a lot, then having the 80% option could lead to you hitting your annual limit quicker than you would if you had the 50% option. 

How do I claim?

After you have been treated in hospital, the first few bills to pay will be yours. If you have excess or co-payments, then you have to pay them first. The hospital will then bill us for the rest of their agreed costs, for things like accommodation and everything that comes with it. Doctors or specialists will send their bills directly to us and Medicare. If there are any fees above the MBS, then they will send that bill to you. How to claim on your cheap health insurance plan when it comes to extras is even easier. The most convenient way is to claim is using the electronic claims and payment system (HICAPS). This way the claim can be processed on the spot at your appointment, and you just pay the difference. HICAPS is like an eftpos machine, and we will give you a card when you sign up.

However, not all providers have this facility so another way to claim online through the Frank online Member Area.

When working out how to claim on your cheap health insurance plan, whether it be for hospital or extras, there are a few final things to remember. Make sure your contributions are paid up to the date of the service and that all waiting periods have been served. You can’t claim before the treatment.

Skip 2 & 6 month waits on extras* when you join on combined cover by April 30

*For new members (if you have been a Frank Health Insurance member in the last 12 months, sorry you don’t qualify). 12 month waits, annual and sub limits apply. Offer ends 30 April, 2018.