- Will I have to pay for advice or assistance from Health Link Consultants?
- What does Medicare cover?
- What does private health insurance cover in a hospital?
- How do I change health funds?
- What are health fund waiting periods?
- Will I need to serve any waiting periods if I transfer from another health fund?
- Can I join two separate health funds?
- What are Agreement or Participating private hospitals?
- What is a hospital excess?
- What do ‘general treatment' or ‘extras benefits’ cover?
- What are pre-existing ailments or conditions?
- What is the Medical Gap?
- How can I avoid the cost of the Medical Gap?
- When am I not covered?
- What is Lifetime Health Cover?
- How does Lifetime Health Cover affect me?
- What is the Federal Government rebate on premiums?
- What is the Medicare Levy Surcharge?
- What is extended health cover?
- If I have a dispute with my health fund, what should I do?
1. Will I have to pay for advice or assistance from Health Link Consultants?
No. The health funds we act for pay us very similar fees for introducing new members and for providing services to our existing members, so our advice is impartial, careful and responsible.
The funds save money by outsourcing distribution and marketing costs to us. Therefore the premium you pay to the selected fund remains the same. Also, when you join via Health Link, you are able to receive ongoing service. If a health funds product no longer suits you, Health Link will help you make the change.
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2. What does Medicare cover?
Under Medicare, all Australian residents have the right to free treatment in a public hospital should they decide to be admitted as a public patient. This right remains intact if you join a private health insurance fund. Medicare provides free accommodation in a public hospital, doctor services, diagnostic tests and medications. You will be treated by a doctor appointed by the hospital.
Choosing to have private health cover (rather than solely relying on Medicare) means that you have faster access to medical services and a greater level of choice in many areas of your health care.
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3. What does private health insurance cover in a hospital?
Having private health insurance enables members who are going into hospital to choose whether they wish to be treated as:
- A private patient in a private hospital,
- A private patient in a public hospital, or
- A public patient in a public hospital (Medicare).
Being treated as a private patient in a private hospital:
More and more members are choosing to be treated in a private hospital. As a member you can:
- Avoid the long waiting times for public hospital treatment.
- Enjoy a better standard and quality of care in more pleasant surroundings.
- Have access to private room facilities, and be able to choose your own doctor.
Being treated as a private patient in a public hospital:
You may choose the doctor who will treat you, providing they are entitled to work at that hospital. Private room accommodation cannot be guaranteed and will generally be determined by the hospital based on clinical need.
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4. How do I change health funds?
Switching is easy. Just go to our Quick Quote page, make your selections and join online. For a Personal Recommendation, complete our Enquiry Form and we will send you a tailored health cover option with the relevant product fact sheets and application form.
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5. What are health fund waiting periods?
A waiting period is the time from when you join a fund until the time the fund will begin to cover your hospital or general treatment (extras) expenses. Waiting periods need to be served before benefits are paid, and apply to:
- New members.
- Existing fund members who upgrade to a higher level of benefits.
- Members transferring from another Health Benefits Fund who have not already completed the required waiting period for equivalent benefits.
- New dependants unless they transfer from another fund where they have completed the required waiting period for equivalent benefits or are newborns.
- Treatment of a pre-existing ailment.
If you join under a waiver offer, waiting periods are only waived for services with waiting periods equal to or less than the waiver. All other waiting periods in excess of the waiver still apply.
All pre-existing ailments or illnesses, and obstetric services, attract a 12-month waiting period for both hospital and extras services irrespective of any waiver. Waiting periods vary according to the type of treatment or service.
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6. Will I need to serve any waiting periods if I transfer from another health fund?
If you transfer from another health fund with comparable cover, you will continue to enjoy the same level of cover and you will not have to serve additional waiting periods as long as:
- You transfer from another Australian Health Benefits Fund.
- You transfer within one month of ceasing membership with your previous fund.
In some instances, your existing health fund may send your Interfund Transfer / Clearance Certificate to you (and not your new health fund). You will need to forward this certificate to your new health fund as confirmation of your Lifetime Health Cover and to ensure you receive continuity in your cover. (What is Lifetime Health Cover? Click here).
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7. Can I join two separate Health Funds?
Yes. Joining one health fund for hospital cover and another for extras can lead to better cover, lower rates or both, for your personal and/or family needs. Limiting your choice of hospital and extras to one health fund does not always deliver the best outcome.
If this applies to you, having one membership card for hospital cover and another for extras is a minor issue if it means you get better cover, lower rates or both.
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8. What are Agreement or Participating private hospitals?
The health funds have reached an agreement with most private hospitals about their charges, such as for accommodation and theatre fees. Private hospitals which have signed an agreement are known as Agreement or Participating private hospitals. Most health fund members are entitled to 100% cover for accommodation, theatre, critical care and labour ward charges in these hospitals.
At Health Link Consultants we can provide you with a list of these hospitals in each state for your selected fund. Using these hospitals can end or limit "out of pocket" expenses.
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9. What is a hospital excess?
An excess is an amount a member agrees to pay for a hospital stay before benefits are payable, in return for a lower premium. An optional excess is available with most health fund hospital products. The excess is payable only if you go into hospital. For example, you may elect to pay an up-front excess of $250 or $500 per calendar year. Or, you could pay a per-person, per-night excess of $50 to a maximum of $400 or $800 per calendar year. Taking an excess option helps to reduce the cost of the cover.
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10. What do ‘general treatment' or ‘extras benefits’ cover?
Many health care services outside of hospital can end up costing you a lot of money. E.g. general and major dental, optical, physiotherapy, pharmacy, chiropractic, naturopathy, home nursing, even funeral benefits. Most funds have multiple levels of cover for you to choose from. These general treatment services protect you against those unwanted and unexpected expenses, which are not covered under Medicare (previously called 'Ancillary Cover').
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11. What are pre-existing ailments or conditions?
A pre-existing ailment is an ailment or illness for which the signs or symptoms existed any time during the six months prior to when a member joined or upgraded to a higher level of cover, even though a diagnosis may not have been made. If there is any doubt as to whether an ailment is pre-existing, a fund may appoint a medical practitioner to examine information provided by your doctor, together with other relevant claim details.
Please note: procedures such as sterilisation, reversal of previous elective sterilisation and assisted reproductive services (e.g. IVF, GIFT) may be deemed to be pre-existing ailments.
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12. What is the Medical Gap?
While in hospital, medical services such as doctors’ fees are charged separately from hospital services such as accommodation. Medicare will pay 75% of the Medicare Benefits Schedule Fee for these medical services, and your health fund will pay the remaining 25% if you have hospital cover. If your doctor or specialist charges above this Schedule Fee, this cost is known as the Medical Gap.
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13. How can I avoid the cost of the Medical Gap?
Most funds have introduced initiatives to eliminate the Medical Gap. These include:
- No gap hospital agreements. With no gap hospital agreements, members can choose to be treated at participating hospitals by a participating doctor. This eliminates gap charges altogether and your medical bill is automatically paid by your health fund.
- Additional Medical Gap Cover is also available through Direct Billing Agreements which can fully cover Doctor’s payments. This enables the Health Fund to pay for your in-hospital medical services provided by your doctor directly on your behalf.
- “One off” arrangements. You should ask your doctor or specialist before having a hospital procedure if a gap cost will apply. In some cases, they can reach a “one off” with your health fund for no gap to apply, or a “known gap” (reduced cost) arrangement.
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14. When am I not covered?
You should be aware of the circumstances which will prevent payment of a claim:
- Lodgement of a claim 2 years or more after the date of service.
- Treatment received or goods purchased overseas (except prescriptive eyewear).
- Routine health checks for employment, life insurance, certificates of health, superannuation or provident schemes, health screening, admission to a friendly society, mass immunisation or situations where you or your dependants have the right to recover costs from a third party or authority, either by law or by statute, or from any insurance or employment benefit schemes.
- Benefits for any period during which you are in payment arrears of more than 2 months or your membership is suspended.
- Treatment of a pre-existing ailment.
- Where no specific health condition is being treated.
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15. What is Lifetime Health Cover (LHC)?
LHC is a Federal Government initiative created to reward people for taking out private hospital insurance early (by the age of 31) and keeping it so that their premiums stay low. From age 31, a person pays 2% more for health cover for each year they are without private cover (whether single or on behalf of a family or partner). You should contact Health Link Consultants if you are over the age of 31 and wish to join a health fund for the first time or have not held continous cover since 1st of July 2000, you should also obtain a Personal Recommendation.
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16. How does Lifetime Health Cover affect me?
If you did not take out hospital cover by July 1st 2000, and are now 31 years or older, you will pay a premium loading as a new member. If you did join a hospital cover prior to July 1st 2000 and maintained it until now, you will have secured a lower premium for life. This now locks in your 'certified age on entry' at 30 and ensures that you will not have to pay more than the base rate premium for as long as you maintain your hospital membership. Also, you can suspend your hospital cover for up to 3 years (less one day) and then rejoin, based upon your 'certified age on entry'.
The maximum loading a person will pay is 70% i.e. for people joining at age 65.
If you were born before 1 July 1934, you are exempt from LHC.
Once you have paid a LHC loading on your private health insurance for 10 continuous years, the loading is removed as long as you retain your hospital cover.
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17. What is the Federal Government rebate on premiums?
The ongoing Federal Government Rebate helps make private health insurance more affordable by subsidising your hospital and extras premium costs regardless of your income. You have the option to take this rebate as a discount on your premium, apply it as a tax offset in your annual tax return or a cash rebate from a Medicare office.
The subsidy is 30% for people aged below 65, 35% for 65-69 year olds, and 40% for 70 plus.
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18. What is the Medicare Levy Surcharge (MLS)?
The MLS is an extra taxation charge of 1% payable by families and couples earning more than $100,000 per annum or singles earning more than $50,000* per annum that do not have private hospital insurance.
The surcharge is levied as follows:
- Single people whose taxable income is $50,000* or more per year; e.g. an additional 1% on $50,000, pay an extra $500 tax.
- Families/couples with a taxable combined income of $100,000* or more per year; e.g. an additional 1% on $100,000, pay an extra $1000 tax .
If your income is as above or higher, to avoid paying the levy you need to take out at a minimum, hospital cover.
Examples are:
| Single NSW Resident |
| Single earning $70,000 pa X 1% additional Medicare Levy cost |
$700.00 |
| Single hospital cover – Public Hospital cover with $500 maximum claims excess |
$368.25 |
| Total saving by taking out private hospital insurance |
$331.75 |
| Family / Couple VIC Residents |
| Family / Couple on $140,000 p.a X 1% additional Medicare Levy cost |
$1,400.00 |
| Family / Couple - Public hospital cover with $1000 maximum claims excess |
$312.60 |
| Total saving by taking out private hospital insurance: |
$587.40 |
The above examples are based on premiums as at 1st April 2008.
* Note: These Income Thresholds subject to proposed increases of $100,000 for Singles and $150,000 for Families/Couples as per the 2008 Federal Budget.
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19. What Is Extended Health Cover?
Extended Health Cover is an option that applies in the following situation. If you, your partner or any children are diagnosed with any one of 40 serious medical conditions then the insured will receive a tax free lump sum payment in addition to the Hospital or Extras cover for treatment of the condition. Adding Medical Trauma benefits provides valuable financial protection at a time when you most need it.
Best of all, it’s so easy to apply and be covered. Call Health Link on 1800 808 026 for more information or a personal quote.
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20. If I have a dispute with my health fund, what should I do?
You should firstly attempt to resolve any dispute with the fund. If necessary, you can contact the Private Health Insurance Ombudsman - an independent body established to help resolve disputes and provide information. Contact the Ombudsman on 1800 640 695 or write to Suite 121, Level 12, St Martins Tower, Market Street, Sydney NSW 2000. You can also contact your health fund to receive a copy of the private hospital patients’ charter.
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