- The public healthcare insurance scheme termed as Medicare does not cover everything, leading to a need for private health insurance that offers a more comprehensive cover with a broader variety of healthcare options.
- However, not every private insurer covers all. There are limitations on what and when one can claim with a particular policy and how
- As with all types of insurances, one needs to research to zero in on a detailed plan by plan and service by service research.
Healthcare has emerged as a significant sector during this pandemic period. The outbreak of Covid-19 has had a detrimental effect on global healthcare systems with an undulating effect on every aspect of human life. With a pandemic like this one, the sector of healthcare is bound to be under spotlight.
In Australia, the government has developed private health insurance (PHI) based on a system of community rating. This suggests that everyone is entitled to buy the same product, at the same price. Also, everyone is guaranteed the right to renew their policy. The public healthcare insurance scheme of the country termed as Medicare covers most of the Australian residents for healthcare. However, Medicare does not cover everything. Hence, there arises a need for private health insurance that offers a more comprehensive cover with a broader variety of healthcare options.
What private health insurance covers?
With private health insurance, one can avoid public waiting lists for important medical procedures, get subsidised physio sessions, eliminate ambulance costs and much more.
Private health insurance covers hospital, general treatment cover, and ambulance cover. One can buy policies that cover for hospital and general treatment or combined. Even Ambulance cover may be offered independently or pooled in with other policies. Sometimes, even the state government covers it.
However, not every private insurer covers all. There are limitations on what and when one can claim with a particular policy and how.
The private health insurance rebate, the lifetime health cover rules, and age-based discounts affect how much one is going to pay for private health insurance.
Private Health Information Statements
Private Health Information Statements (PHIS) are also available for all private health insurance policies sold in Australia. There are three types of PHIS – Hospital, General treatment and Combined. A private health information statement provides a gist of main product features. . However, it does make a person see if his broad needs are covered or not.
Private Insurance players in the market
Latrobe Health Services
Latrobe Health Services is an Australian-owned not-for-profit registered private health insurer with more than 81,000 members across Australia.
Latrobe Health was founded in 1951 by power industry workers to meet healthcare needs of Latrobe Valley residents of Victoria. At that time, medical services such as hospitals and ambulances were the primary focus.
At present, the cover options feature various categories like Gold Hospital, Sliver Plus Hospital, Silver Hospital, Bronze Plus Hospital and Healthy Start Hospital Package.
The Gold Hospital category covers nearly everything including rehabilitation, psychiatric services, palliative care, brain and nervous system, tonsils, adenoids and grommets, kidney and bladder, hernia and appendix, gynecology, diabetes management, plastic and reconstructive surgery, podiatric surgery and many other ailments.
Similarly, the Silver Plus Hospital category covers a lot many services restricting hospital psychiatric services and excluding pregnancy and birth, assisted reproductive services and weight loss surgery.
The Silver Hospital package restricts rehabilitation, psychiatric and palliative care services while excludes a lot many treatments like cataracts, joint replacements, dialysis, pregnancy and birth, assisted reproductive services, weight loss surgery, insulin pumps et al.
In the same way, there are other plans like basic cover, healthy start basic hospital and bronze plus hospital package.
Besides, there are many other services like Premier Extras covering general dental, optical, allied health and others; Premier Singles and Couples; Premier Families; Core Extras and others.
TUH Health Fund
A not-for-profit organization, TUH Health Fund was founded in 1972 by a group of Queensland teachers to assist peers and the education community avail top class healthcare. The members hold 100% ownership of the fund.
Here, private hospital cover applies for medically necessary inpatient (the one who has been admitted to the hospital) treatment as determined by law. At the hospital, all the covers include accommodation, theatre charges, intensive care, industry approved prostheses and hospital medications.
The Bronze + Young Choice package includes services like psychiatric service, palliative care, brain and nervous system, eye, ear, nose and throat treatment, tonsils, adenoids and grommets, bone, joint and muscle, kidney and bladder, male reproductive system, hernia and appendix, gastrointestinal endoscopy, gynecology, miscarriage and termination of pregnancy, chemotherapy, radiotherapy and immunotherapy for cancer, pain management, skin and many others. The Extras cover involves dental, optical, therapies like acupuncture, myotherapy, massage therapy and chiropractic services along with Osteopathy, psychology, physiotherapy ones. The extras also include health screenings, health management programmes and healthy lifestyle programmes.
Besides this package, the hospital covers include Gold hospital, Silver + Family Hospital, Silver + No Pregnancy Hospital, Bronze + Hospital and Basic + Hospital.
The Extras covers include comprehensive extras, family extras, everyday extras, healthy options extras, mid-range extras and basic extras.
health.com.au Pty Ltd
health.com.au covers feature Entry Hospital + Basic, Base Hospital Co-Pay + Bronze, Base Hospital + Bronze, Bronze Plus Essential Hospital, Care Hospital + Silver among others. GMHBA Limited acquired the company in July 2015.
The Hospital cover includes the cost of bed, meals, nurses, theatre, intensive care fees and government approved prostheses. The public cover takes care of the back, neck and spine, blood, bone, joint and muscle, brain and nervous system, breast surgery, cataracts, chemotherapy, radiotherapy and immunotherapy for cancer, diabetes management, digestive system, ear, nose and throat, heart and vascular system, implantation of hearing devices, male reproductive system, kidney and bladder, lung and chest, skin, sleep studies, rehabilitation, palliative care, dental surgery, joint reconstructions, podiatry et al.
As with all types of insurances, one needs to research and ponder a lot. Similarly, various firms require a lot of study and analyses, specially on the lines of one’s requirement. Therefore, it is advisable for the individuals to zero in on a detailed plan by plan and service by service research.