News10 Golden Rules of Private Health Insurance
10 Golden Rules of Private Health Insurance

10 Golden Rules of Private Health Insurance

While the real Golden Rule is treating others as one's self would wish to be treated. Here are the 10 Golden Rules of Private Health Insurance.

Read any and all letters or written information from your health fund

Your health fund will communicate to you changes in your cover., like the April 1 premium increase. It will send a letter (or email if you’ve opted for paperless communication), and tell you of any changes, if you need to make a decision relating to your policy, if there is a premium increase and a tax statement as well.

Let your health fund know about any changes in your circumstances that might affect your cover

This includes but is not limited to:

  • current contact details
  • change of address if you move
  • travelling overseas
  • changes to your family circumstances like a loved one passing away
  • change of bank details

Ask your doctor for an estimate of fees before receiving treatment

  • This will assist in preventing “sticker” shock when you get the hospital bill and it will let you you know exactly what you are paying for. Make sure to ask:
    What are the Medicare item numbers for the services
  • What will be the charge for each of these services
    Does the doctor participate in my health fund’s gap cover scheme
  • Will the doctor treat me under the gap cover scheme
    Will I incur any personal out-of-pocket costs
  • How much can I expect to have to pay
    Who are the other doctors treating me
  • How can I get an estimate of their fees
    Will the doctor provide me with a written estimate of any costs
    How will the doctor bill me
    When will I have to pay

Contact your fund before receiving treatment or entering hospital

While you might not be able to do this in case of an emergency, you should be able to call your fund before having any treatment or going into the hospital. When you give them a call, remember to ask:

  • What benefits it will pay
  • How much you’re like to have to pay
  • Ask them to confirm the above in writing
  • Ask them if they have an agreement with your chosen hospital

Know your limits

We’re talking about your personal limits, but the limits of your extras. Extras such as dental and optical services have limit to claims by some providers. Ask your fund for details about your benefits.

Promptly make claims

If you wait, you may have to pay the bill in full and then claim a refund. There are some services your hospital, doctor or general treatment provider can claim your health fund benefit and deduct it from your bill. Claiming sooner than later reduces the risk of losing receipts and you’ll get your refund sooner than later.

Make a note of any advice given

Don’t rely on your memory. If you speak to your fund by phone, write down notes with date, time, reference number provided and ask your health fund staff to provide you written confirmation.

Review your health insurance

Things can change in your life and with your health fund. Make sure you review your health fund each year.

Keep your premium payments up to date

If you have a policy that hasn’t been kept up to date, you risk the chance of losing any health coverage. While you can pay weekly, fortnightly, monthly, quarterly and so on. If you pay a year in advance, you know you’re set for 365 days and you can avoid the April 1 premium increase.

If you are switching health funds, make sure you understand  the new product

You can switch to a different health funds without serving waiting periods if you switch to the same level of cover and you’ve served the appropriate waiting period with your original cover, but always make sure you read all the documents you receive from the fund you choose to understand everything.


Any advice contained in this article is general in nature and does not take account of your particular objectives, personal circumstances or needs. If in doubt about your own situation you should seek appropriate advice.

Originally posted on .

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