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What Health Insurance Do You Need?

While you don’t need to be able to list every last thing that you want covered by your prospective health insurance policy, having too many grey areas may cost you time. Make sure you have an understanding of your health insurance needs before you compare health cover.  Not only is this a good way to speed up your health insurance comparison, but it may help you to avoid purchasing inadequate health cover.  Identify the basic health care requirements you have, including prescription costs, whether you want dental cover, and so on.

If you have an existing private health insurance policy, perhaps you could look at what you like and don’t like about it as a good starting point.  Sometimes using one policy as a basis for comparison can lead you on the right path to choosing your next private health cover.

Get Heath Insurance Quotes

Try online health insurance comparison tools to research health insurance quotes.  Also consider calling insurers on the phone to get a quote for a policy.  Choosing your contact methods according to how you work fastest will help to make the most of your time.

Remember that you can also obtain quotes for your health insurance comparison in person, but physically visiting an insurer might waste time – that could take over 30 minutes in itself.  Use the Internet and your phone to get some faster health insurance quotes.

Compare Health Insurance Quotes

At this point, consider what are your most important criteria when you compare the health insurance quotes that you receive. Also, ensure that your quotes take into account any added cover extensions that may increase your premium. You should be able to read the policy in its entirety to check that the coverage and limitations are suitable for your private health insurance needs.

You need to drill down to the most important details first of all, to save time – there’s no point looking through the whole policy if there’s something you can see from the start that doesn’t match up to your requirements. Eliminate any health insurance that doesn’t quite sound like what you need, then compare the cover and cost of your remaining shortlisted health insurance policies.

So, that’s the health insurance comparison tackled within half an hour. Take as long as you need to think it over before you make your choice of private health fund and policy.

Weighing Up Customer Reviews

Let’s imagine that when you compare private health funds online, you find some bad reviews on what otherwise seemed to be a great health insurance plan.  As you read the reviews online, you wonder to yourself: “Should I forget about this policy due to these bad reviews?”

That’s a very good question.  Let’s be honest in saying that there is no way to be absolutely sure, so you will have to use your judgement in each case.  However, some basic guidelines can help you determine how significant a bad – or good – review may be in the bigger picture of your health insurance choices.

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The more consumer reviews you have before you, the better able you will be to see what’s going on.  After all, consistently bad reviews in their hundreds would be convincing.  Two poor reviews out of thousands would suggest that most of that health fund’s customers are happy. It would be easy, after all, to find a couple of bad reviews by disgruntled customers who didn’t fully understand their policy.

Meanwhile, two poor reviews out of only two reviews can’t be taken to mean much, as there would not be enough data to establish a true pattern. Try to get more opinions.  Also, remember that a range of sources is often better than a single source of health insurance reviews.

Look for Detailed Health Insurance Reviews

Whether they are good or bad, how much will you get out of researching consumer reviews if they don’t mention the details?  A general sense of “good” or “poor” customer satisfaction may be helpful when you compare health insurance, but details are of far greater use. Keep an eye out for reviews that state specific details: how easy it was to contact the customer service department; whether claims were paid in good time; whether there is anything unique about the health fund that you should know. Detailed reviews are more helpful and more convincing than vague ones.

How Important are Reviews?

Could consumer reviews be a tiebreaker in your health insurance comparison? You might be comparing health insurance policies and run into a difficult decision between two similar products at similar prices from different health funds. It will be up to you, ultimately.  However, these questions may help you to decide:

• What do you know about the company?
• How good or bad are the customer reviews?
• Are the reviews detailed enough to tell you the insurer’s strengths and weaknesses?
• If there were poor reviews, were they over a minor issue or something more important such as a history of rejecting a lot of claims?

Weigh up in your mind the various reviews and other information you’ve found in your health insurance comparison. Take your time to think about how any poor reviews reflect on the relevant health funds, but don’t be scared off by just one negative customer comment.

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Start with the Basics

There are some areas of health insurance cover that naturally will be relevant to your mental health needs.  However, it is important to also cover the basics of your overall health.  Hence, you may choose to start your health insurance comparison by considering or more of the following:

• Specialist Practitioners: Depending on your needs, you might need to see a psychiatrist or a psychologist for a course of treatment.  From talking therapies to any physical therapy or alternative therapies, you will need to get the details on what will and what won’t be covered by your health fund.
• Cover Limitations: Can you see a specialist for any mental health condition and be covered by your health insurance?  Does coverage depend on admission into hospital for treatment?  Some basic health insurance policies impose rather strict limitations or institute a lot of out-of-pocket expenses for mental health cover.  Some policies may require you to spend a certain amount of time as a policyholder before coverage goes into effect.  Your health fund may also place more specific limitations on mental health treatment, such as a maximum number of therapy hours covered per year.

With some of the restrictions on mental health cover offered by basic levels of private health insurance, you may want a policy that provides more cover for this particular area of your health.  There are yet more factors that can make a big difference in your health insurance comparison when mental health cover is important to you.

More Mental Health Insurance Factors

Consider your requirements in terms of medications, both over-the-counter and prescription drugs.  Some medications for mental health treatment can be rather pricey, which may affect the rest of your budget.  When you compare health cover, you will certainly want to check the costs and coverage for any medications that you currently need.

What if you want to change the locations or practitioners that currently provide your mental health care? Does your health fund have a network of practitioners they cover?

Make sure you are aware of what is covered by Medicare, which offers a rebate on some mental health services provided by GPs, psychiatrists, psychologists, and occupational therapists.  You may find that you don’t necessarily need private health insurance for your mental health, though you may have other reasons to look at private health funds. You may opt for private health cover to have a choice of doctors for in-hospital treatment.

Overview

Health insurance comparison is no easy task when you have specialist health care needs.  If you have a tough time locating a good policy for your needs, you may choose to see a professional for expert advice.  He or she will be able to help you choose a policy to suit your budget and your health needs.  Mental health conditions can add some complications to the health insurance comparison, but there are still several options open to you for suitable cover.

Start Your Research

When you compare health cover, you must take account of your needs and find the appropriate policy – at the right price.  Sound simple? Of course, it can become complex when you begin to think about the many factors to be taken into account.  If you have a specific need, such as an existing heart condition or a strong possibility of future heart problems, further complexity arises from that, too.  Take a look at what could be involved in your health insurance comparison:

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• Normal Health Care Needs: Aside from heart related conditions, you have to search for the right overall policy.  Excesses, premiums, coverage limits, treatment networks, prescription coverage, and other areas are still important, regardless of your special needs.  Don’t focus too hard on any one feature – balance is important.
• Heart Related Needs: Examine the treatments and health consultations in which your cardiac care needs are likely to result, from prescriptions to the potential costs of an operation, if that may become necessary.

You must consider how important some of these factors will be in your health related needs.  For instance, will you need a good network with access to quality specialists?  Do you have particular prescription needs that you should spend some time researching in any prospective policy?  Either of these can be costly, should your health insurance not cover it.

Compare Health Insurance

Once you identify your needs, you can compare health insurance options that best suit your situation.  Take a look at the most important areas first, such as coverage for specialists that you’ll need to see.  You should also consider the role of Medicare in your health insurance.  Coverage from Medicare can give you more options, as you may only need to pay a co-payment, and private health funds base their coverage on the Medicare Benefits schedule anyway.

Moving on, aim to compare health insurance policies that meet your budget as well as your health and heart care needs.  If you are buying a policy to take care of special needs for your heart, it could pay to look at the details – for instance, how much would your current prescriptions be under a new policy?  Are your current doctors covered or would you have to switch to a new doctor to be able to claim?

Once you look at all of these details, you can begin to make decisions.  Contact potential insurers or use a health insurance comparison website to receive quotes.  Once again, make sure that your current condition will be covered by your future health insurance policy.  From current doctors and specialists to your medications and other therapies, you should thoroughly investigate how your health insurance choices will work with your cardiac care requirements.  The expected costs will be crucial to your financial health, of course, and you will have to work out how much you can afford to spend on your health insurance.

Overall, heart related conditions may make health insurance comparison more complex, but not impossible.  Along with the normal criteria of any health insurance comparison, such as price, there are simply some additional criteria related to your health condition that need to be considered.  Give some thought to having an insurance professional guide you in this if you wish.  They may help to show you your options and give you advice to help you get the best health insurance policy for your heart.

This is why it is very important for us to take good care of our eyes, because compromised vision may equal compromised abilities and skills as well. Unlike physical things like cars or houses, we cannot do without good health. That makes health insurance an important consideration– if you want to rest assured that you have financial help with eye care, health insurance can help provide that protection.

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Eye Care Cover is Separate

Most private health insurance plans cover the basics: expenses for treatment of injuries, examinations and check-ups you might need like X-rays or CT scans, diseases or other ailments that need treatment, hospital stays, labor and maternity costs and so on. However, most medical insurances don’t include eye care cover. Vision or eye care insurance is generally a supplement or extension of a medical insurance policy. You may have to pay additional fees to your health insurer to obtain eye care cover, or buy this cover through a separate insurer.

Medical insurance systems for eye care cover depend on the private health fund. Some may choose to include this as part of their health insurance plan while others may sell it as a different policy. Now what exactly does eye care cover provide, and what does regular medical insurance cover?

What is Eye Care Cover?

Eye diseases or eye injuries are typically covered by most health insurance policies. The diagnosis and treatment of such may be fully covered. But things like routine eye exams, corrective lenses, contact lenses, eyeglasses and eyeglass frames all fall under the category of vision or eye care insurance. LASIK and PRK vision correction methods are also included in this category.

If you wear glasses, or need regular eye exams, it would be best for you to look into health insurance comparison for eye care cover, since expenses for eye care can add up to quite a lot over time. But if you have normal vision and don’t really think you need this extra cover for your eyes, you can always just stick to Medicare or a basic private medical insurance policy. You can also choose just to enroll in discount plans at places that offer eye care services. While these are not insurance policies, you can save yourself a lot off retail prices.

When doing your medical insurance comparison for eye care cover, look at what vision services are covered, how often and for how long. Check which services you’ll have to pay for, how much your additional premium will be for extensions, what rules and regulations you should follow regarding vision care coverage.

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What is the Pharmaceutical Benefits Scheme?

The PBS covers a big chunk of prescription costs to make them more affordable. This means that Australian residents, and visitors from countries with Reciprocal Health Care Agreements with Australia, pay less for prescriptions that are on the PBS list. You just need to show a valid Medicare card when you pick up medicines.

What does the PBS cover?

PBS medicines are included as a Medicare benefit. From January 1st 2012, you’ll pay $35.40 for most PBS medicines (or $5.80 with a concession card). The rate will almost certainly change in the future, so be sure to check.

Medicines for most health conditions are covered. Some of the medicines covered include those for:

• Diabetes
• Acid-related disorders
• Gastrointestinal disorders
• Cardiac therapy
• Urological issues
• Topical treatments for joint and muscle pain
• Bone disease
• Epilepsy
• Drugs to treat Parkinson’s Disease
• Cough and cold preparations

Only medications on the Australian Register of Therapeutic Goods can be listed on the PBS, though. Not sure if a certain medicine is covered? Browse the online list of current PBS medicines. The list is altered on a regular basis to reflect changes.

The PBS Safety Net

If you are spending a lot on prescriptions, the PBS Safety Net can help. The current threshold is $1363.30 (or $348 with a concession card). If you reach this, you may apply for the PBS Safety Net card to cut your costs. Your payments when you have the card will reduce to $5.80 for the rest of the calendar year. If you have a concession card, they will be free for that period.

Non-PBS medicines

Sometimes you may be given non-PBS medicines. These are full price. They do not count towards the PBS Safety Net. While the PBS list is fairly extensive, it does not cover everything that may be prescribed to you. Sometimes you may get a prescription costing more than the cheapest brand.

However, private health insurance may cover non-PBS medicines as an optional extra. This will often be up to a certain amount, and typically carries a two-month waiting period for new cover. Be sure to compare health cover for pharmaceutical benefits to make the right choice. The annual limit can vary, so compare private health funds to see your options.

A lot of medicines are covered by the PBS, so you may find you get everything you need for less. If you or your family are getting a lot of non-PBS medicines, health insurance extras may start to look like a good idea. Spend some time on health insurance comparison to compare health cover for pharmacy benefits.

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Are you an in-patient or an out-patient?

You’re classed as an inpatient if you’re admitted into hospital for a same-day or overnight stay. This means you may be covered for the costs of operating theatres, intensive care and labour wards, diagnostic tests, medications included on the Pharmaceutical Benefits Scheme and allied services. However, you should spend some time on health insurance comparison to assess your options, as you’ll only be covered for the services included in your level of coverage. There will often be restrictions or exclusions on more basic levels of private hospital cover, so compare health insurance policies as well as premiums.

Medical costs (for example, from your doctor, surgeon and anaesthetic) can also be covered through private hospital cover – as a private patient, Medicare will cover 75% of the Medicare Benefits Schedule fee and your health fund may cover some or all of the remainder. If medical costs exceed the MBS fee, be prepared to pay a ‘gap’ payment, as private hospital cover may not cover all of the difference. Depending on your private health fund, emergency ambulance cover may be included.

If you’re not formally admitted to hospital for a procedure, you’re deemed to be an outpatient instead. Outpatient treatments may be delivered on hospital premises, in consultation rooms or elsewhere, such as at community health centres. For example, a consultation with an obstetrician during pregnancy will typically be an outpatient service. As an outpatient, you won’t be covered by private hospital cover.  If Medicare pays benefits for a particular service, you may be able to claim the costs of Medicare instead.

Hospital cover and unplanned hospital stays

If you’re involved in an accident, many private health funds will allow you to be covered straight away after you become a member, so it may not be quite so important to compare health insurance for hospital cover as far as this is concerned.

Hospital stays that occur because of emergency treatment may be beyond your control. If you’re suddenly taken ill, the ambulance will most likely take you to the emergency ward of the nearest public hospital. Through Medicare, you can be treated as a public patient with no costs to yourself as Medicare will cover the full fee. If you have private hospital cover and would rather use that, you’ll admitted as a private patient and you should be prepared for some out-of-pocket expenses that will need to be covered by you.

There is also the option of going to the emergency ward of a private hospital but again, you won’t be covered through private hospital cover if you’re not admitted as an in-patient. Bear in mind that private hospital cover doesn’t extend to treatment in an emergency ward, as you’re not admitted as an inpatient in this scenario. Most private health funds will not pay benefits for procedures performed as an outpatient.

It’s easy to think that hospital cover will extend to any procedure performed while you’re in hospital, but in reality, private hospital cover will only pay benefits for inpatient procedures and not for outpatient procedures in which you’ve not been formally admitted to hospital. If you’re taken to an emergency ward for treatment, you can expect to be classed as an out-patient and this won’t be covered by private hospital cover.

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Eat Right and Get Regular Exercise

By now, we all know that eating plenty of fruits and vegetables, low fat proteins and fibre is the best way to maintain our health and our weight. But that doesn’t stop us from relying at times on a diet of takeout foods, unhealthy junk foods, and sugary soft drinks and snacks.

Changing the way we eat — and  the impact of our diets on our health — is easier said than done, but making small changes, slowly, can help you to get on the right track to better eating and better health. Just trading out full-fat dairy products for low-fat or no-fat options, replacing fried meats for baked, broiled or grilled dishes, saving soft drinks for special occasions and watching the salt and sugar you add to foods are small, manageable changes that can set you on the path to better health without totally overhauling your diet.

Adding some regular exercise to your routine will also help. Getting regular exercise, even if it’s just 20 to 30 minutes, three or four times a week, may help you lower your body fat, cholesterol, blood pressure and risk for diabetes. What’s more, it will help build bone and muscle that can keep you strong.

The right diet and exercise won’t just improve your well-being and reduce your weight – it may also help you save money on prescription medications, medical care and health insurance excesses or co-payments. A poor diet and lack of exercise may catch up with you one day in financial, as well as health, terms.

Get Regular Checkups

We often think we’re too busy or strapped for cash to have regular checkups, but in truth, going without is something neither your budget nor your health can afford. Waiting until you’re in seriously poor health to see a doctor is like waiting until it starts raining before you close the windows — by then, some of the damage is already done.

The importance of seeing your physician regularly for a checkup can’t be overstated; seeing a physician at least once a year may help you to catch some health conditions early, and may help to prevent others altogether. Medicare and most health insurance plans allow for yearly checkups that can help you to keep healthy without spending a lot of money.

Take Care of Your Teeth

Having a mouth full of pearly whites won’t guarantee good health for life, but simply taking better care of your oral health can help you to avoid some health problems. Poor flossing habits have been linked to everything from oral cancers to heart disease, and failing to brush regularly can result in painful and expensive dental clinic visits. Even if your private health fund doesn’t include cover for dental care, you can do a lot to contribute to your health by brushing and flossing every day.

Making an effort to keep yourself healthy is not just the key to a longer life — it’s the key to avoiding expensive medical conditions.  And if you have only public or basic level private health insurance cover, it’s the best way to avoid letting a small health problem snowball into a huge one that you can ill afford.

When you’re looking to compare private health insurance for the whole family, it may often be the case that a Family policy may provide the best value for money. Within this, there will be things to think about when you’re looking to compare private health cover that will benefit everyone.

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How long can children remain on a family policy?

For most, Family cover will be the most cost effective type of private health insurance policy and while you’ve still got dependent children living at home, they can be kept on your private health insurance policy at no extra cost. According to the Private Health Insurance Ombudsman, a dependent child is “unmarried … under the age of 18 years,” but check with your health fund to confirm their specific criteria for what is classed as a dependent child.

Your health fund may also extend this up to the age of 25 for full-time students, provided that certain criteria are met. This will often mean that your child must be studying at a recognised educational institution or in a recognised apprenticeship or traineeship, is not married, and is not working full-time or earning over a set amount. Again, check with your health fund to find out their eligibility criteria for a student dependent.

If your child fits neither of these options, you may want to look into Extended Family Cover, which may cost more than standard Family cover.

Be selective

It’s natural to want to protect your family finances against as many potential scenarios as possible, but you may not need all of the policy extras that are available to you. By narrowing your selection down to just the optional extras that are relevant to you and your family, you may help to make your private health insurance cheaper while still making sure that you’ve got the right cover for your family.

If there are any extras that you feel may be needed further down the line but not right now, don’t forget to factor in waiting periods, especially for pre-existing conditions. Many private health funds impose waiting periods of up to 12 months for pre-existing conditions (with some exceptions, e.g. for psychiatric care), so if you only look to arrange the cover after you realise that there’s a health problem in your family, you may not be fully covered until the waiting period has been served.

Some of the optional extras that may benefit your family include:

• Dental. General dental cover covers things like dental check-ups, x-rays, fillings and extractions.
• Optical. Medicare will usually cover eye tests from approved practitioners, but to cover things like glasses and contact lenses, you’ll need optical cover.
• Orthodontic. If your children need things like braces to straighten their teeth or align their jaw, orthodontic cover may help to pay for these.
• Physiotherapy. If someone in your family has a neurological, developmental or respiratory condition which requires physiotherapy treatment, you may find this cover useful.
• Podiatry. Once your children are able to walk, they may need care for their feet. Adults may also have treatment requirements for foot health at any stage in life. Podiatry cover can help to pay for treatment costs.

Making sure that your new baby is covered

To make sure that your newborn is covered straight away, make sure that you have the relevant cover at least several months before the birth. If you don’t already have appropriate cover e.g. Family Cover or Single Parent Cover, you’ll need to switch to it before the birth.

When you’re looking to compare private health insurance for the whole family, think about the level of optional cover that your family may need. Benefits such as dental, orthodontics and optical can be important where children are concerned, but you may want to exclude cover that doesn’t seem relevant to your family. As your family grows, you’ll probably need to make some changes to your policy, but you may save money by not taking on extras that you don’t yet need, as long as you take waiting periods into account. If you’re about to start your family soon, don’t forget to make sure that you have the right cover in place before the birth, or your newborn may not be covered straight away.

If you have strong private health insurance coverage, you may not have as much to worry about in the event of an injury, as some costs may be paid by your health fund. That being said, there are still a few details here and there that you should keep in mind. You may think that all sports related injuries are covered by Medicare or by your private health fund, but this is not always the case.

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Know what is covered

As with any type of insurance, you need to know what is and is not covered by your policy. If you don’t know the answer to this question, contact your insurer for a detailed explanation. Although many types of injury and treatment will be covered, it is better to be safe than sorry. When it comes to your health insurance policy, knowledge is power.

Don’t Lie or Leave Anything Out

If you were injured playing sports, you need to be open and honest about it with any doctor or medical facility that you visit. If you stretch the truth, your diagnosis and treatment may be less effective based on incorrect or incomplete information about how your injury occurred. Tell your doctor what happened and deal with the insurance ramifications at a later date. Remember, the most important thing is that you get the help necessary to ensure your long term health.

Pre-existing Sports Injuries

When you apply for health insurance, you need to make your insurer aware of any preexisting conditions. And yes, this includes those that could be related to sporting injuries. Again, this is an area in which you have to be 100 percent honest. If you have a preexisting condition it is important that this is noted in your policy. Neglecting to do so could lead to your health insurance claim being denied should you need treatment for the same (or related) conditions in the future.

Medicare provides some essential treatments for accidental injury. However, there may be other insurance features and points of coverage available through private health funds. If you play sports, there is a good chance that you may need to receive medical attention for a sports related injury at some point in time. If you have health insurance that covers the types of sports injuries you’re most likely to experience, this offers some peace of mind, not to mention the fact that it will be more affordable then paying the costs yourself at short notice.

There is no denying your responsibility to yourself – how much do you know about your health insurance cover for sporting injuries?. Of course, this is something you may want to check on with your insurer to learn more about the finer details. Playing sports is fun and exciting, but getting injured can put a damper on your good time. As long as you have adequate health insurance cover for sports injury care, you may find this financial help with the costs of treatment very useful.