Do you understand your health insurance policy? If not, and if you haven't sought help and advice, you may have a policy that doesn't cover for your most pressing needs.
Unfortunate policyholders may have unknowingly entered into a policy that doesn't pay out in the instances they thought it would – a situation that often becomes apparent at the worst possible time and certainly doesn't help with your recovery.
As news publications examine the existence of "junk policies", we take a look at some frequently asked questions. After all, knowledge is power, and having even a basic insight into some key health insurance terms could put you and your family in better stead.
Here are five answers to some of the most commonly asked health insurance questions:
1) What is an excess?
In the grand scheme of making a health insurance policy more affordable, policyholders can agree to pay an amount should they be hospitalised.
So, for instance, if you require hospital treatment, you could pay $100 of the medical costs, with the rest covered by your health fund. This commonly accompanies a lower monthly or annual cost for your health insurance policy.
An excess comes in different forms. You may have an excess that applies once per year, or for the first two or three times you require hospital treatment. Other times, the excess amount is divided between the first two people on the policy as they're admitted to hospital.
If you would like to look into the excess option that works best for you, HICA can help you choose the one that's right for you as an individual, your family and ultimately, your budget.
2) Can I mix my coverage between different health funds?
Yes – this is a common way to lower the cost of your policy. With the Australian health insurance market quite competitive, health funds offer different rates for different policies. You may find that the most affordable insurer for hospital cover does not provide the best price for extras cover, such as dental and eye care. In this instance, buyers can shop around and build a policy from different insurers.
It's not all about cost, either; you may find your extras provider does not offer the level of hospital care you need. Essentially, it's about balancing cost with quality and looking at all the applicable health funds out of Australia's 36 providers to build the best possible policy for you.
3) What is a health insurance exclusion?
Another way to lower the cost of your health insurance premiums is by limiting the benefits your health fund will pay for.
Buyers can exclude certain elements of their health benefits – such as cardiac surgery or maternity cover – if they are comfortable doing so. This condition helps to make a policy more affordable, though customers should be aware of the risks should they need such excluded treatments in the future.
4) What are the benefits of private health insurance?
Private health insurance gives customers more control over their healthcare benefits. It allows people to choose the hospital they receive treatment at, as well as the doctor that will administer their care.
Health funds also have contracts negotiated with specific hospitals under a Hospital Purchaser Provider Agreement (HPPA). This allows the insurer to reduce or completely remove a policyholder's out-of-pocket costs for services at that hospital.
5) How do I make a claim on my health insurance?
In most cases, the hospital at which you receive treatment will claim directly from your health insurance provider – aside from any excess or co-payment you may be eligible to pay.
However, if you are unsure about your coverage before you receive treatment, policyholders can check with their health fund prior to their admittance to make sure they will be covered, when it's possible to do so.
Do you have further questions about health insurance? HICA is able to help you understand the terms around a health insurance policy, as well as find coverage that matches your needs and those of your family. Similarly, we have business health insurance experts to help organisations of all sizes find the right answers to their questions.
Call us today on 1300 44 22 01 for free help and assistance.