Health & Family Private health insurance

Discussion in 'Living Room' started by febstyle, 21st Mar, 2016.

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  1. Dan Donoghue

    Dan Donoghue Well-Known Member

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    I went a few months ago, I was told to as part of my treatment but that was the first time in 20 years lol, why do we not care about our teeth?

    It's a bizarre feeling now though, the back of all my teeth are individual teeth again :p
     
  2. EN710

    EN710 Well-Known Member

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    We usually do not... until the dentist said yeah need root canal. :confused:
     
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  3. JohnPropChat

    JohnPropChat Well-Known Member

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    In WA, CTP doesn't cover third party property only third party people.
     
  4. Raydar

    Raydar Well-Known Member

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    Don't forget if you work for a big employer, you might be entitled to a corporate rate.
    We went from bottom level cover to top hospital for the same price! Just because of that we threw on extras to get regular benefit from it. We currently pay $315 /m with BUPA.
    Mind you, we haven't compared to the market. We have got our premiums back to this day in the form of being privately covered for 2 delivery of kids and a weeks stay in a private room on both occasions.
     
  5. Dan Donoghue

    Dan Donoghue Well-Known Member

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    Same in NSW, CTP (Compulsory Third Party) is the green slip and MUST be purchased at rego time every year. This covers other people but not their vehicle (Although lots of people think it does and get into trouble in the event of an accident)

    Third party (not compulsory) will cover the other person's vehicle but not your own

    Comprehensive covers other vehicles and your own :)
     
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  6. JohnPropChat

    JohnPropChat Well-Known Member

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    HCF Top hospital cover in WA with $500 excess.

    A few things to consider. Almost never mix hospital cover and extras cover. Last time I researched this, all funds with good hospital cover didn't have good extras. HCF is great for hospital cover and **** for extras. NIB, Frank etc are worth considering for extras.

    When you renew your policy each year, do a quick check for the current price of top hospital cover with the same fund. You'll find that you are likely paying a bit more than what you can get if you signed up now. When you call them to find out why, they always point to some benefit that was available in the original policy and you can decide if that benefit is worth the extra you are paying.If not just sign-up for the new policy and cancel the old one.

    You may also have been slugged with lifetime health cover loading.

    Compare health insurance policies
     
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  7. JohnPropChat

    JohnPropChat Well-Known Member

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    Prices on that website are before rebate.
     
  8. JohnPropChat

    JohnPropChat Well-Known Member

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    Extras insurance is a joke with costs rivaling that of top hospital cover. Most people are compelled to maximize benefits from extras cover just cuz they are paying for it. Decent dental cover with some extras costs $25/month from NIB, which should cover general upkeep unless you need more cover.
     
  9. Propagate

    Propagate Well-Known Member

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    @JohnPropChat @EN710 looks like I'll have to give them a call. We've had it since we entered Australia on Permanent Residency Visas at age 31 & 35, so 9 years with no claims and no break in cover. It was the top HCF hospital only cover at the time. No loading as, although we were over 30, new migrants get to start off with no loading regardless of age as long as there's no break in cover.

    The only thing we did change is that we are over the top tier for any government rebate, so the $450+ we pay is the full premium with no rebate taken off, (rather than what they did all the years before and applied a 30% rebate guess each month which we then had to pay back at the end of the year as we weren't entitled to it after the tiers were monkeyed with).
     
  10. JohnPropChat

    JohnPropChat Well-Known Member

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    http://privatehealth.gov.au/dynamic/download.ashx?id=HCF/H23I/VJVX20 - $390 for 2 people with no rebate.

    Wow, compared that with top cover in WA http://privatehealth.gov.au/dynamic/download.ashx?id=HCF/H23I/WJWD20 - $298 for 2 people no rebate. Looks like community rating(number of people making claims) for Victoria is worse than WA
     
  11. Propagate

    Propagate Well-Known Member

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    Thanks @JohnPropChat just logged in and checked our cover, we're paying $411 per couple but for what used to be called Top Plus $250, which was their top hospital cover but only $250 excess, so probably about right then. Cheers.
     
  12. Darlinghurst Boy

    Darlinghurst Boy Well-Known Member

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    Get rid of your " extras" cover you dont need it !
    By the time you pay excess and thungs not covered by the dentist your out of pocket anyway .

    I just used the dentists ... By about the 5 th visit they said its not free anymore so i had to pay anyway.
     
  13. Bran

    Bran Well-Known Member

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    Nope, it's wrong. The hospital pays the excess. No cost to you.
     
  14. Bran

    Bran Well-Known Member

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    Basic Hospital cover gives you nothing. Waste of time.
     
  15. EN710

    EN710 Well-Known Member

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    What would be recommended to be in the cover? I only choose one that said exempt me from the levy :confused:
     
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  16. Bran

    Bran Well-Known Member

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    I don't know to be honest. I do know that my public patients who have Basic Cover cannot have anything done with me privately. It seems that they get covered to have their procedures done in the public hospital. This is pointless. Great for the hospital, pointless for the patient.

    I have top level cover. Not something I negotiate on. No one I see ever planned to become unwell. It's not about money for me. I'll scrimp and save elsewhere. I still hope to never get my money's worth (although I have already).
     
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  17. Propagate

    Propagate Well-Known Member

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    A couple of links that may be of interest. As a UK expat, I found the whole private health cover thing extremely hard to get my head around. Horror stories from both sides, i.e. those that had no cover yet had to pay for medical issues and those that HAD cover, yet paid even more?? It's tough to get your head around.

    @EN710 @Bran The first link is interesting, it explains what each "level" of Hospital cover should be, so if you have Top level hospital cover it must cover you for everything that Medicare pays a benefit for.

    How it works

    What confuses me is who pays for what if/when you do claim on either system? The paragraph below is from my HCF PDF:-

    "Hospital benefits and ‘the gap’ Hospital benefits are payable to formally admitted hospital patients at the time of the service. If you are a private patient in a non-participating private hospital, you may face a large gap depending on the hospital charges. Prior to treatment, please check with your doctor to obtain Medicare item numbers and call HCF to clarify benefits payable. Medical Gap: Medicare will cover 75% of the Medicare Benefits Schedule (MBS) fee for medical charges and HCF will cover the remaining 25%. Some doctors may choose to charge more than the MBS fee, which may result in additional expenses, known as the ‘Medical Gap’. HCF has no-gap arrangements to assist you in eliminating the gap. Always ask your doctor what your charge will be and if they’ll participate in HCF’s no-gap arrangement"

    The way I understand it is:-

    Scenario 1 - I need work done, I use HCF and the surgeon etc charge based on the "MBS" - Medicare pay 75%, HCF pay 25% ann there's no out of pocket "Gap".

    Scenario 2 - I need work done but the doctor wants a new Porsche, they charge double the MBS rate. Medicare pay 75% of the MBS rate, HCF pay 25% and I pay everything else above the MBS rate...

    Scenario 3 - I decide not to use the HCF policy and stay public - does Medicare now pay 100% of the MBS, (i.e. all is free), or do they still only pay 75% but because I have no private insurance, or chose not to use it, do I have to pick up the remaining 25% of the MBS?

    I'm assuming when treated publicly the 75% Medicare rule does not apply and you are 100% covered? But as I said above, I have heard of people going public yet still being charged so I I have no real idea.

    What surprised my is that, even though you elect to go private and use your insurance, it seems from reading the HCF PDS that Medicare is still footing 75% of the bill? (up to the MBS scheduled rates).

    It is so confusing. Like others have said, we initially only took out cover as it was cheaper than the surcharge, (not anymore BTW), but that annoyed me in itself as it meant by not paying the surcharge, but also not using the cover, Medicare are still paying for me anyway and the health fund is getting free premiums which makes me feel rather guilty.

    Seems with HCF, if you have top level hospital cover and go to a HCF hospital there will be "Gap" but what if you are rushed in for something, somewhere - who has time to ask for a full quote of everything you need doing before you decide what to do?

    Is there a fund that just simply covers you for everything? So you can rock up to the hospital, give them your policy number, say you want to go private and not worry about a massive surprise bill?
     
  18. lewy89

    lewy89 Well-Known Member

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    Why would the hospital pick up the excess on MY policy on this? That doesn't make any sense.
     
  19. Cadbury99

    Cadbury99 Well-Known Member

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    Hospital gets additional funding from private health fund that they would not otherwise get. The additional funding is far higher than your excess.
    They don't actually pay the excess for you they just discount the bill to the private insurer by he excess amount.

    When you get asked by the hospital if you want to use private health cover in the public hospital you should ask if they cover the excess. My experience is they don't always do this if your stay is very short.
     
  20. JohnPropChat

    JohnPropChat Well-Known Member

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    @Propagate This is my understanding.

    If you are treated as a public patient in a public hospital then ignore MBS fees. As long as the procedure is "necessary" they'll do it on taxpayers dime and you'll just have to join the queue. You can also ask to be treated as a private patient in a public hospital which can incur fees and bypass queues. I don't think there are many that charge just the MBS fee for hospital services (not talking about GP and such). More often than not, it is full MBS fee or more. Now for private patient expenses, Medicare will only pay 75% of the MBS fee unless you hold a concession card or some such (don't know the exact details).

    Private health funds will cover the 25% (Easy peasy). Now if the procedure costs more than the MBS fee you have to look at your health cover and any agreement between them and your provider. A few scenarious(My research is over 2 years old and I may be wrong on some details. Do your DD).

    Known Gap vs No Gap
    Medicare sets out schedule fees for all items in the MBS. Health funds also set their own fees for all items in the MBS. If a procedure costs $1000 in MBS then a Known Gap fund lists it at $1200 and a No-Gap fund may list at $1300(for example). What No-gap funds are trying to do is to get the doctors to agree to do the procedure for $1300 or less. If they agree then there is no gap(out-of-pocket costs) to you. In the case of Known-gap, if the doctor charges you $1300 then you are out of pocket by $100($1300-$1200).

    Straightforward right? Not really. If the doctor charges $1400 dollars then the gap for Known-Gap fund will be $200($1400-$1200) but the gap for No-Gap fund will be $400($1400-$1000). What just happened here? The gap in a No-Gap shot-up by quite a bit. What No-Gap essentially means is that they don't entertain any gap and if the doctors charges more than their prescribed fee then the benefit for that procedure drops to MBS fee. Ouch. But what happens if the procedure costs $1701. Then the gap with Known-gap fund is $701($1701-$1000) and No-gap fund is also $701($1701-$1000). What happened here? With Known-Gap funds once the gap crosses a known-amount-of-gap(say $500 - check your fund) then the benefits drops to just MBS fee.

    On top of that add other things like per item gap, per policy gap etc (again depends on the fund) it gets even more confusing.

    Now for some wisdom:
    If you get hurt and in an emergency, ALWAYS go to a public hospital. They'll stop you from dying, stabilize you, figure out what to do next and let you know. This is where you get to make a choice. If they tell they'll operate on you straight away - just go for it unless you want to be treated by a specific doctor. If they say you have to go on a 2 month queue then call your health fund and ask for network-doctors that participate in their fund. Ring them up, ask for a written quote and get your procedure done. That's the big picture anyways.

    EDIT: HCF seems to be doing both No Gap and Known-gap and the provider gets to pick when they signup. I think Medibank does Known-gap only - don't quote me on that though.
     
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