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FAQs About Private Health Insurance

Maybe. It depends on your circumstances and what you want from your insurance. You should take time to read through our health insurance information and consider your own personal circumstances before deciding.

Of course, having peace of mind is always an added benefit when it comes to your health, knowing that should you become ill or need any remedial treatment, that you would be entitled to some additional extras.

An excess is a single payment that you make directly to the hospital if you are admitted, whether as a day patient or longer stay. The amount can vary, but generally, the more excess you pay, the less the cost of your policy is overall.

Some insurance companies may charge an excess per in-patient stay, whilst others have an annual cap. Some also charge an excess if you call an ambulance.

A co-payment is an additional amount that you pay as an in-patient, but it is calculated on a daily basis. For example, you may pay between $50 and $250 per day for staying in hospital. You should check with your health fund to make sure that your policy does not include both co-payments and an excess as this would make a hospital stay expensive. It may also be worthwhile seeing whether a co-payment or an excess option is more financially beneficial to you, especially if the annual amount is capped.

Most states and territories will charge you if you call an ambulance and require treatment. This is because they are not covered by Medicare. However, if you are a concession holder you may be entitled to a discount or a free service. See below for details – prices correct as at October 2018. This is not a definitive list and may be subject to amendment or exemption by the individual state or territory authority.

Maybe. Every time you call an ambulance you will be charged a “call-out” fee even if a paramedic treats you and you don’t need to attend hospita. If you need to go to hospital, you will be charged an additional amount. It is best to check with your health fund to see if just one or both portions are covered.

Since the fees and charges vary per state, you will need to check with your health fund to see if you are covered for ambulance call outs if you are in a different state or territory from the one you live in. For example, if you live in New South Wales and need an ambulance whilst on holiday in Queensland, you may not be covered.

One would expect that an “emergency” situation is classified as a life-threatening injury or condition. However, it depends on the individual health fund and what their definition is, so it’s best to check with the provider to see what you would be covered for.

It will be written in your policy whether you are covered for private ambulances, transport and air ambulance. This may vary from policy to policy.

If you have hospital cover on your policy, you will be treated as a private patient which means all or most of your costs will be paid for. This includes, your accommodation whilst in hospital, any treatment you have (including operations or procedures), any medication you receive. 75% of this is covered by the Medicare Benefits Schedule, whilst the remaining 25% is covered by your health fund.

If you have hospital cover on your policy you can typically choose your hospital as long as it is a hospital affiliated with your chosen health insurance provider. You can also choose your doctor and it will not affect your fee coverage. This does vary between insurers and their variety of affiliated hospitals - with your coverage depending on your policy.

This gives you additional “extras” that are not covered by Medicare. For example, they may include dental, podiatry, chiropractic, optical or physiotherapy. The number of extras you are entitled to will depend on the level of cover you receive and are usually set at annual or lifetime limits.

A waiting period is the length of time you must wait until you are able to use a particular service on your health fund. For example, some policies state that you must wait 12 months before using any pregnancy benefits, whilst others say you must have your policy for 2 months before using any physiotherapy benefits.

Each health insurance provider will have their own set waiting periods and some may even transfer any waiting time served from your current policy to your new one. However, if you are upgrading your policy, you will have to wait until you have served the waiting period for the additional services.

If you do not have private health insurance and you are earning over a certain amount, you may have to pay the Medicare Levy Surcharge. This is a percentage of your taxable income that goes towards providing the Medicare service.

If you are unsure or need more advice on this, you should contact the Australian Tax Office or consult your own financial advisor.

There are so many different providers and policies so it is hard to give a figure for a monthly cost. Call us on 1300 786 045 or complete the online comparison for now.

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