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• How Do I Get Insured?

Where Do I Start?

Choose the right policy

If you choose to take out health insurance, it is important that it meets the needs of you and your family.

Depending on where you are in life, there may be features of health insurance that are more important than others. For example, a policy that includes obstetrics cover may not be appropriate for a couple that is not planning to have children, while a young single person may decide they don’t need cover for joint replacement or heart conditions.

However, you should consider taking out the highest level of hospital cover you can afford. To save on premiums, you should choose a product with an excess rather than restrictions or exclusions.

Because your health needs will change in time, it is important to regularly review what your health insurance product covers. You can do this by consulting the Standard Information Statement (SIS) your insurer is required to send you each year, or you can download any SIS from www.privatehealth.gov.au.

Read more: Health Insurance explained and Choosing a Health Insurance Policy brochure.

Types of cover

There are two types of private health insurance – hospital policies cover you when you go to hospital, while general treatment policies (sometimes known as ancillary or extras) cover you for ancillary treatment (e.g. dental, physiotherapy). Most health funds offer combined policies that provide a packaged cover for both hospital and general treatment services, or you can buy separate hospital and general treatment policies to ‘mix and match’.

Both hospital and general treatment products are available with varied levels of cover, and few of the available range are exactly the same—products vary by a mix of exclusions, restrictions, benefit limitations, excesses and co-payments.

In general, products with lower levels of insurance cover are cheaper than more comprehensive cover. Four main levels of cover are commonly offered:

• top: a comprehensive level of insurance, covering the majority of insurable services, with benefit levels designed to minimise out-of-pocket expenses
• medium: a mid-level insurance cover, often specifying a select range of services which are not covered, generally with lower benefits then top cover options
• basic: low level insurance, covering a minimal set of services, which generally have low benefits and additional out-of-pocket expenses
• public: hospital treatment insurance that covers the lowest amount that an insurer is permitted to pay for a hospital service and generally designed to cover services provided in public hospitals.

 Waiting periods and pre-existing conditions

A waiting periods is an initial period during which time no benefit is payable for certain procedures or services. The government sets the maximum waiting periods that funds can impose for hospital treatment:

• 12 months for pre-existing conditions,
• 12 months for obstetrics (pregnancy),
• two months for psychiatric care, rehabilitation or palliative care, even for a pre-existing condition,
• two months in all other circumstances.

The waiting periods for general treatment (ancillary or extras) cover are set by individual health funds.

Even if you have a pre-existing condition, health funds must allow you to purchase any type of cover, at the same price as every other person. Once you have served any waiting periods, you will be entitled to claim.

When purchasing health insurance make sure you are fully aware of any waiting period you may have to serve. There is usually no waiting period if you need hospital or medical treatment because of an accident that happens after you join the fund.

Read more: Why are there waiting periods – and how long are they?, Can I get insurance if I have a pre-existing ailment/s or illness? and What does community rating mean?

Brokers and intermediaries

There are a number of brokers and intermediaries operating in the private health insurance industry that can offer assistance for consumers when they seek to purchase health insurance or review their existing cover.

Not all insurers make products available through brokers, and insurer offerings through brokers might also be limited, so the full range of products on offer in the industry is not available to be purchased through a broker.

Insurers generally pay brokers a commission for each policy holder referred, which is usually a percentage of the cost of the annual premium of the product sold.

The best way to compare and analyse all products, from all private health insurers, is to visit www.privatehealth.gov.au.