Private Health Cover in Western Australia -

Article by: Elizabeth
Last updated: Tuesday, 11-Jul-2006 00:00:00 CEST

Private Health Insurance & Private Health Cover is widely used in Australia. Health care insurance is just like any other type of insurance cover. The various companies providing (selling) health care insurance offer a wide variety of insurance plans within their product range. Shop around to find the most suitable and cost effective cover for you, your family and your circumstances.

Getting Private Health Cover

There are companies who have done the shopping around for you and act as an insurance broker specialising in healthcare cover. They can provide an effective and time saving method to getting the insurance cover for you.

Some of the NHS services you may have accessed in the UK but would need to have private medical insurance for here in Australia are listed below:

Private patient hospital fees including accommodation and theatre fees Dental examinations and treatment Ambulance services Glasses and contact lenses Medicines Contraceptives Physiotherapy or other specialist treatments Home nursing Hearing aids or other appliances The cost of prosthesis Cosmetic surgery if not clinically necessary Medical services which are not clinically necessary Acupuncture Complementary medicines or treatment Medical costs incurred overseas Meedical costs for which someone else is responsible Examinations for life insurance or superannuation

Costs The cost of insurance cover is totally dependant upon your personal circumstances, family needs and existing ailments. Some larger companies offer a corporate scheme or your trade union / your trade association may be able to offer cover at preferential rates. You will need to explore these opportunities as there is a potential cost saving available.

The level of cover you choose will dictate the level of premium you will have to pay. However, there are other aspects of limiting the costs which include:

introducing a policy excess
a company payment excluding benefits for certain treatments annual limits on the total benefits for some services certain conditions having restricted cover or no cover

Gap Payments This is the difference between the medical fees charged by the service provider (the doctor, dentist, etc) and the amount of benefit paid directly over to your service provider by your health insurance company.

The gap happens when your service provider charges over the limit set by your insurance company. In these instances, you will be liable for paying the difference i.e. the gap. Your insurance company will have a list of service providers who charge within the limit that they have set and it would be wise to obtain this list from them and seek those providers out for the services you require.

There are a number of health insurance membership categories which include: Single membership - providing cover for one named person
Couple Membership - providing cover for the member and his/her nominated partner
Family membership - providing cover for the member, nominated partner and or dependant(s)
Single parent membership - providing cover for the member and nominated dependant(s)

Not all health insurance companies offer these 4 membership types and some funds have simplified these categories into either single or family membership categories.

Waiting Periods Conditions usually apply when you join a health insurance company the main one being waiting periods. Typically these are: 1 year for treatments relating to existing conditions or ailments 1 year for pregnancy services 2 months for all other hospital treatments except accidents Make sure you understand the conditions that are being imposed. Health funds can waive or reduce waiting periods but they CANNOT increase them. If you choose to take out additional cover after your original policy cover date then you will normally have to apply an ADDITIONAL WAITING PERIOD for the extra cover that you have taken out. You can be treated free in any public hospital in Australia but remember ... Australian public hospitals provide excellent health care but are under tremendous strain. Medicare The Australian equivalent to the National Health Service is Medicare which was introduced within Australia in 1984, its 3 objectives being: 1. make health care affordable to all Australians 2. To give all Australians access to health care services with priority according to clinical need 3. To provide a high quality of care Medicare provides access to: Free treatment as a public (Medicare) patient in a public hospital. Free or subsidised treatment by practitioners including doctors, specialists, participating optometrists or dentists (specific services only). The service is funded by contributions made through taxes and a Medicare levy which is based on taxable income Who is eligible for Medicare treatment? People residing in Australia if they meet any of the following criteria: They hold Australian citizenship They have been issued with a permanent visa They hold New Zealand citizenship They have made application for a permanent visa although there are some restrictions to this for persons who have applied for a parent visa Enrolment into Medicare Applications are made by completing an application form and providing documentary proof that they are eligible. Applications are available from your local Medicare office. Medicare does NOT cover the following: Private patient hospital fees including accommodation and theatre fees Dental examinations and treatment Ambulance services Glasses and contact lenses Medicines Contraceptives Physiotherapy or other specialist treatments Home nursing Hearing aids or other appliances The cost of prosthesis Cosmetic surgery if not clinically necessary Medical services which are not clinically necessary Acupuncture Complementary medicines or treatment Medical costs incurred overseas Medical costs for which someone else is responsible Examinations for life insurance or superannuation Private health care can be purchased to cover a number of the above services Note: In some instances, Medicare will cover some of the items should your doctor refer you for this treatment. You will need to check carefully PRIOR to receiving the treatment otherwise you will be liable for the cost yourself