Avant Insurance

CAUSE FOR QUESTIONING UNDERSTANDING YOUR health cover In the last issue of Connect, I discussed the next round of private health insurance reforms and how they will affect treating doctors and consumers. Now the reforms are being implemented, there are some essential questions you should ask your private health insurer to ensure you are still getting the cover you need and at the best value. What category is my hospital policy in? From 1 April 2019, private health insurers will classify their policies as either; Gold, Silver, Bronze or Basic, depending on the clinical categories the policy covers. Gold is the highest tier and covers all 38 new clinical categories, while Basic policies are only required to cover three categories (rehabilitation, hospital psychiatric services and palliative care). Further information about the clinical categories can be found at health.gov.au These categories should improve transparency by standardising terminology and make comparison between policies easier. Also look out for 'Plus' policies, which signify that the policy offers higher cover than the minimum required in its tier. What excesses do you offer? Health insurers will be allowed to offer a higher excess of $750 per year on their hospital policies (limited to $1,500 for couples and family policies). Ask the fund whether they have a cap on their excess payment in their couples and family policies. Some funds (including Doctors' Health Fund) will cap the excess payment to $750 for every person on the policy, meaning the same person will not pay more than one excess per year. Higher excesses will reduce your hospital policy premiums, although you should consider the savings in the context of the higher excess that may be payable. Am I likely to pay an out-of-pocket cost? Even on a Gold cover, you may incur out-of-pocket medical costs. This can arise where the treating doctor charges in excess of the fund's medical schedule. You should make enquiries about the proportion of services that the fund pays with no out- of-pocket costs. This is an indication of the quality of the fund's medical schedule. Also ask whether your fund operates a 'known-gap' schedule as well as 'no-gap' schedule. Known-gap allows the treating doctor some flexibility to charge a predetermined gap above the schedule fee, while the medical fees still qualify for benefit payment by the fund. Finally, enquire whether your fund has any restrictions on paying medical fees in uncontracted hospitals, including public hospitals. Do you have a preferred provider network? Some funds operate preferred provider networks for their Extras policies. This means some of their policy benefits may only be available at providers either owned or contracted by the fund. Always ask whether the benefits offered will be the same at your chosen allied health provider as they are at the fund's preferred network. Do you offer discounts for 18 to 29 year olds? From 1 April 2019, insurers can offer discounts to members aged between 18 and 29 on their private health insurance hospital policy. This new initiative is designed to make private health insurance more affordable for young people. The discount is voluntary and health funds can choose to implement it. If you are under 30 years old, make sure you ask whether this discount is available. These reforms are a step in the right direction. Time will tell whether they achieve their objectives of simplifying private health insurance, while improving affordability and sustainability of the system. As always, we will be closely monitoring developments and keeping our members informed. Peter Aroney BComm, ACA CEO Doctors' Health Fund Join the health fund dedicated to delivering choice, value and service. Switching is easy, it takes just five minutes and we take care of all the paperwork for you. For more information or to switch, call our expert Member Services team on 1800 226 126 or visit doctorshealthfund.com.au Private health insurance products are issued by The Doctors' Health Fund Pty Limited, ABN 68 001 417 527 (Doctors' Health Fund), a member of the Avant Mutual Group. Cover is subject to the terms and conditions (including waiting periods, limitations and exclusions) of the individual policy.

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