This section provides information to help you get the best out of your private health insurance by helping you manage your policy, explaining what is covered by public and private health insurance, providing information to help you lower your premium and explaining your rights when switching funds
For quick information about how to get the best from your private health insurance, watch the two minute video above. You can also ask a question of the Private Health Insurance Ombudsman, or call 1300 737 299, if you need more information.
- Manage Your Policy
- Must Know: Before using health services
- Switch Funds
- Suspend Your Cover
- Leave Your Fund
- Going Overseas
- Make a Complaint
Manage Your Policy
There are many ways you can manage the cost of your policy. You could pay your premiums in advance and benefit from rate protection, or you could share the costs of more of your health expenses with your fund in exchange for lower premiums by having a policy with an excess or co-payment.
Policies with restrictions or exclusions are also usually less expensive, however, to avoid not being covered at all for a particular treatment, you should consider taking out the highest level of hospital cover you can afford and choose a product with an excess rather than restrictions or exclusions to keep costs down
Minimise out of pockets
Out of pocket expenses,or ‘gap’, is the amount you pay either for medical or hospital charges, over and above what you get back from Medicare or your private health insurer. Some health funds have gap cover arrangements to insure against some or all of these additional payments. To minimise your out-of-pocket expenses, search the Gap Cover Doctors associated with your fund.
Must Know: Before using health services
Know what you are covered for
Before using health services, you should know what is and is not covered by your policy. You can consult your policy’s Standard Information Statement or ask your fund directly. A SIS is sent to you when you purchase your policy. If you are unsure where to find it, you may request a copy to your fund. Read more about SIS and Policy Exclusions and Restrictions
Your Right to Know
You should also ask your services provider the expected costs of treatment and provide them to your fund to find out your likely out of pocket expenses. Before receiving treatment you should provide your service provider an Informed Financial Consent, preferably in writing to acknowledge that you are aware of the costs involved.
To help you we compiled a series of Questions You Should Ask your insurer and service provider
Your Right to Change
It is your right to change your health insurance policy whenever you want without incurring financial detriment. This right is called portability. If you switch for a higher level policy, you may have to re-serve waiting periods. Read More: Can I change my insurer?
To be able to change fund, your existing fund will need to provide your new fund a transfer certificate also call clearance certificate
Compare policies and health funds
For information on how to get insured with a new insurer click here.
Suspend Your Cover
Talk to your fund
If you are experiencing financial hardship, travelling or working overseas or temporarily unemployed, you may be able to negotiate with your fund to suspend your cover for an agreed period.
While your policy is suspended you will not be able to claim benefits, and may be required to pay the Medicare Levy Surcharge if you are over the income threshold. During this suspension period you will not accumulate time towards any waiting periods and when resuming your cover, your fund may require that you serve waiting periods again. If your health fund agrees to suspend your hospital cover for a short period, this period of suspension will not affect your Lifetime Health Cover loading as you will be considered to be maintaining your cover.
Leave Your Fund
If you leave your fund and do not wish to purchase a new policy you may become liable for government surcharges.
Even if you do not have private health insurance, you will continue to benefit from Medicare and the public health system.
Suspend your cover
If you are going overseas, you may be able to suspend your cover, see the section above.
If you are travelling to a country with which the Australian Government has a Reciprocal Health Care Agreement you may be able to access that country’s public health system.
Make a Complaint
It is advised to first contact your fund to clarify any concern you may have in relation to your cover and try to address the issue informally.
If you are unable to resolve the situation with your fund, you can contact the Private Health Insurance Ombudsman hotline on 1800 640 695 or complete the complaint lodgement form. Read more: Make a Complaint. Read more: I have a problem with my private health insurer – who can help me?