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Avoid The Health Insurance Gap Trap

Avoid The Health Insurance Gap Trap

Tags: Health Insurance
Last updated by Kayley Harris on

Since starting at the Fiftyup Club nearly 2 years ago, I have learnt so much, in particular how energy bills and private health insurance work. 

This knowledge has been invaluable in helping me negotiate a better electricity deal and bring down the cost of my health insurance.

Here are my 3 top tips now that health premiums are set to rise again by about $200 for  a family or couple.

1. Shop around

A lot of us think we can’t change funds but in many cases we are mistaken. It pays to ask.

To help you do that, the Club has teamed up with HCF and with a comparison service called HealthInsuranceComparison.com.au that targets older policyholders and says it saved 100 older customers an average of $375^ on their premium last year.

Since launching, thousands of Australians have already jumped on board. Over 20,000 Australians used HealthInsuranceComparison.com.au to compare health insurance in March last year, for example, citing saving money as their number one reason for using the site.

It’s worthwhile to remember that the government operates a free site with no strings attached, privatehealth.gov.au, if you want to see every policy on the market. But the government website won’t answer your questions over the phone, which is where commercial comparison sites have an advantage.

Here at the Club, we recommend you try a service such as HealthInsuranceComparison.com.au before you drop out of the system altogether.

Or you can always check out the Club’s member offer with HCF at this link.

2. Don’t just accept big Gap payments

By far the most useful and cost-saving bit of info I have discovered is to do with the so-called “gap” payments.

Did you know, you can choose your own doctor to perform hospital procedures? What’s even better is you can choose one who doesn’t charge those dreaded gap payments.

If your GP advises that you will need surgery and recommends a colleague, ask that specialist what out-of-pocket expenses you will be up for. If you’re not happy with the result, call your health fund and ask them to recommend specialists who don’t charge these gap fees.

Alternately there are websites such as healthshare.com.au where you can find a specialist in your suburb or town and find out if they have an agreement with your health fund not to charge these infuriating costs.

If you really do want to go with your GP’s recommendation, you may end up being penalised for being a private patient.

Increasingly, members are telling us they are opting to go into a public hospital as a public patient to avoid gap payments. After all, the bed you’re lying in and the nurse who cares for you are the same as for the public patient in the bed next to you.

Public hospitals are also asking patients to consider being admitted as a private patient so they get some money from your health fund rather than the zero they get from a public patient. If you’re asked this, make sure the hospital is prepared to cover any gap payments and grab it with both hands….it’s a win/win.

3. Ask about other benefits

There are many other benefits to belonging to a health fund, for example, HCF (my health fund) offers 100% back on some of the most common diagnostic and preventatve dental procedures.

With some policies you can claim for a range of health programs including weight management and gym classes and you can even get a free blood pressure, cholesterol and blood sugar check from your local HCF branch!

In addition, HCF has offered me:

  1. 25% discount on the Sydney Comedy Festival Showcase
  2. 20% off an ongoing subscription to HelloFresh and the first box is free!
  3. 15% off skincare and treatments in Jurlique stores

So as you can see there is so much more to your health fund that just that monthly premium you have to pay.

Make your health fund your health partner and the benefits will roll.

Originally posted on .

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Robert
Robert from QLD commented:

Just waiting to see what happens after 1st April 

martin
martin from QLD commented:

Rip off in health funds Be aware, be VERY aware, that if you require a medical appliance - for example a nebuliser for asthma and try to claim it from your fund under extras..... If you bought it online or from overseas (saving hundreds of dollars), even if it is the SAME make and model, they REFUSE to pay anything towards it! Citing some ridiculous internal BS that says it had to be purchased from a registered (read kick-back) supplier! This cannot be legal, forcing you to buy from their supplier and you (and the fund) actually pay a huge penalty. Cost of appliance in Australia $600-$700. Cost of exact same item via on-line or overseas $150 DELIVERED. Payment from health fund (if they paid for the online option) $100, if bought through their registered source, $200. Huh? I know only went to a Masters and not a PhD, but even a grade 5 child could see the fallacy with their maths! 

Dennis
Dennis from NSW commented:

Most Port Macquarie specialists, especially Anaesthetists all charge a gap. 

Daniel
Daniel from QLD commented:

Sorry Kayley I have no interest in all these added benefits, which I will never use. I'm also very tired of the great offers funds make for new customers what about looking after the long term customer. I sit and wish that one day I receive a letter from medibank private that tells me You have been a loyal customer for over 20 years and made very few claims so we will not be charging you for next month. maybe even a thank you.....I'll let you know when the pigs start flying. 

Alison
Alison from QLD commented:

We changed from Australian Unity mid hospital, to HCF mid hospital, on the advice of iselect......saving money for what I thought was identical cover. Did not realise until my son needed spinal surgery, that HCF does not cover that in a private hospital, but Australian Unity does. Be careful before you switch that the new fund offers you at the very least, what you already have. As for being treated in a public hospital, we were happy to do that, but the wait time is one year. As our son was in agony (herniated disc squashing the sciatic nerve), we opted to fund the procedure ourselves. An absolute rort to pay $300 a month to HCF, to not be covered for a non invasive, straight forward procedure, that we were previously covered for. Iselect and all those companies get a cut from switching you to someone else, so I don't think they have your best interests at heart. Do your own research and go to the government funded website. It might take a bit longer, but you won't be caught short. Very disappointed in iselect and HCF to say the least. 

margaret
margaret from NSW commented:

To me, discounts on something most have no intentions of attending, a discount on very expensive beauty treatments, and on a very, very, expensive way of feeding ones self, indicates just how out of touch HCF are, and how little chance there is that they could ever understand and thus address the need and concerns of the average Australian. 

Charles
Charles from NSW commented:

I have been with HCF for 54 years OK there was a 2 year gap when I had some Financial problems, but the Not For Profit (HCF) don't recognise those years. So recently I was flooded with glossy literature to announce that I was now a RUBY class of member what a lot of BS. If they really want to reward members that have been loyal they can if not eliminate the waiting period then maybe cut the time in half. I recently upgraded to a higher level and I have to wait for certain treatment for 24 months. They are punishing me for increasing my premium, what a lot of crooks. 

Michael
Michael from NSW commented:

I was with HCF for many years and was disappointed they didnt provide updates. I was on a plan that had been superseded by a cheaper version but i hadn't been informed, I changed to another fund and wouldn't go back to HCF 

Jacqueline
Jacqueline from SA commented:

I"m with HCF but like others don't want these extra offers, I can't get to the Sydney comedy, or want Hello fresh etc I just want a good value health insurance!!! 

Robert
Robert from NSW commented:

We started off with HCF many years ago, and stayed with them until they added gym fees and running shoes etc etc to the list of items they paid out on - with a hefty increase in premiums to suit. We switched to NIB and stayed with them until they too added lots of unnecessary items - with hefty increases in premiums as well. So we switched to Medibank Private, and stayed with them until their premiums went off the planet - their annual increases were regularly amongst the highest of all. For many years we couldn't find a fund which didn't include IVF and pregnancy items in their options ( we're now in the 65-75 age group ). Ultimately switched back to NIB a few years ago - their current offer is still OK, but we review our states of health, what we need and what's on offer every year. We are no longer loyal to any insurer of any description and are prepared to switch annually if necessary. And if we need to, we will become public patients if the gaps are unacceptable - I'm old enough to remember when there were NO gaps at all with private cover. IMHO it all started to unravel around the time of the introduction of Medicare. The medical practitioners and private health funds have been taking us all for a ride, aided and abetted by the government of the day. And as for non-related "gifts", cut them out and reduce the premiums accordingly. I rang one insurer and enquired what my premium would be if they deducted the full costs of freebies on offer - but that was beyond their level of comprehension. Shop around folks, it's the only way. 

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