PRIVATE HEALTH INSURANCE COVER

So you have landed in Perth and amongst everything else you need to decide if you should take out Private Health Cover?

In Australia we have 2 types of Private Health Cover.

1. Hospital Cover – This covers your costs as an in-patient in a hospital
2. Ancillary Cover – This is for the cost of other health services such as dental, optical, physiotherapy etc….

MEDICARE v PRIVATE HEALTH

Medicare is available to all who reside in Western Australia and hold citizenship or have a permanent visa.

If you do not fall into this category then you will need Private Health Cover.  You will not be covered by Medicare and will be responsibe for paying your health bills.

If you are being treated as private patient or a public patient in hospital then there is no evidence that your treatment would be any different.

The difference will be in the length of time you would have to wait. If you are a public patient for example you could be waiting months for surgery plus you would not get to select your Dr or Specialist.

If you want the option to choose your Dr and the comfort and your own room in a private hospital then you may prefer to take out Private Health Insurance Cover.

Medicare covers all visits to GP’s along with public hospital costs.

Medicare does not cover;

• Ambulances (you are advised to take out additional cover for this as a minimum)
• Dentists
• Optical
• Physiotherapy
• etc…..

Many Australians take out Private Health Insurance Cover. Some take out the cover for the choices it gives them. While others take out the cover to take advantage of the incentives provided by the government.

GOVERNMENT INCENTIVES

If you have private health care insurance and earn more than $50,000 per annum or $100,000 if you are a couple you will be able to claim a rebate on the additional 1% Medi Care Levy charged to higher wage earners. This levy is in addition to the 1.5% Medicare levy that is already paid.

Often high income earners will take out cheap hospital cover to avoid paying this additional levy. This is because the cost of the Private Health Insurance Cover will probably be less than the levy they get charged.

• To encourage people to take out Private Health Insurance Cover earlier in life, the Government introduced the ‘Lifetime Health Cover’ scheme.If you are under the age of 31 when you take out your Private Health Insurance Cover you will pay a lower premium (as long as you keep the cover). If you take out Private Health insurance Cover after you turn 31 then there is a 2% surcharge for each year you are over 31.NB: There are no age penalties for ancillary cover
• There is a 30 per cent rebate available on approved annual health fund premiums.

BE AWARE

When you are admitted into hospital as a private patient, Medicare covers 75% of the scheduled fee.

If you need medication during, a prescription must be obtained from a doctor and the medicine dispensed by a chemist.

The scheduled fee is the fee the Department of Health recommends a doctor/specialist should charge for a particular service.

The remaining 25% of the scheduled fee is paid by your Private health Care Cover Insurer.

It is not unusual for a specialist to charge more than the recommended scheduled fee.

If this happens then the difference between the recommended scheduled fee and the fee the Doctor or specialist charges is known as the ‘gap’. The ‘gap’ is the portion of the fee required to be paid by the private patient.

Some health funds offer gap cover schemes which allow the gap to be covered by the Health Fund. Specialists can choose to provide services under a gap cover scheme on a case-by-case basis.

As a patient you would need to ask your specialist or health fund if they participate in gap cover arrangement and if it will apply in your particular case.

COMPANIES OFFERING PRIVATE HEALTH INSURANCE COVER

HBA Health Cover

Medibank Private Health Insurance

SGIO Health Cover

WHICH IS THE RIGHT ONE FOR YOU?

MORE INFORMATION ON PRIVATE HEALTH CARE

Health Matters – The Australian Broadcasting Corporation’s online gateway to health

Closing the Gap – Australian Government Department of Health and Ageing