If you’re starting to think about getting health insurance, you might have noticed that it can be a bit complicated and full of jargon. Which makes it a challenge to work out what cover might be right for you. Do you go basic or do you go with the full package? Perhaps the right cover for you is somewhere in between – but how do you decide? And how extra are Extras? Knowledge is your friend, so let’s demystify, clarify and get to know more about the health insurance essentials.
Going to hospital? Here’s why you might want to consider hospital cover before you do
Basically, health insurance comes in two common forms: Hospital cover and Extras cover. And quite often people go with a combination of the two. Most people see Hospital cover as the starting point for health insurance. You might be wondering why people choose health insurance (and, specifically, hospital cover) when we Aussies have trusty Medicare? Well, think about it as added peace of mind if you need go to Hospital or incur a medical expense (depending on your level of cover). Plus there are benefits like skipping public hospital waiting lists potentially for elective surgery and choosing your own doctor in a private hospital.
Health insurance comes in levels of cover
Just like most products you buy, health insurance comes with a lots of choice. To make this less overwhelming, the Australian Government has classified all Hospital products into 4 tiers; Basic, Bronze, Silver and Gold. Within these tiers are specific clinical categories (types of hospital treatments) which are standardised across insurers to give a level playing field and make it easier to compare. And for those who do appreciate extra choice, if you see the word ‘Plus’ in the product name, this means that the insurer has included additional coverage above the minimum requirements. Hooray, for not needing a PhD to compare the options!
Choosing the cover for you might come down to price and what you wish to be covered for. It’s really up to you. Of course, the level of cover will influence how much you pay, so let’s talk more about the dollar stuff: premiums and excess.
Premium as another word for price
Uh, why don’t they just call it ‘the price’? Insurance really is full of jargon, and the word ‘premium’ might be one of the jargoniest of all. But it’s actually simple: the premium is the price you pay for insurance cover. How is it worked out? It depends mostly on the cover itself. The Australian health insurance system is a ‘community rating system’, and it basically means that base premiums are worked out for the cover itself, and not based on an individual’s age, gender, health status or claims history. However, other factors, like income and how long you’ve had the same cover, can affect your premium. We’ll talk about that in a bit.
What is excess, exactly?
If the premium is the price you pay for insurance cover, then what is the excess? Well, it’s the price, too… but it’s the price you pay when you claim (that is, when you use your cover for a trip to hospital as a private patient). It’s basically a contribution that you need to pay towards the claimed cost of a hospital visit before you receive treatment – just like when you make a claim on your car or home insurance.
You select the amount of excess you need to pay when you sign up – the lower your excess, the higher your premium and vice versa.
Some things to note, before going to hospital. Your excess payment should be factored in as an upfront cost, and number of times you pay excess per calendar year can vary depending on your cover.
Extras, extras, read all about it
Extras cover is for other health services beyond a hospital visit, especially those not covered by Medicare. Depending on the level of cover you choose, extras coverage could include everything from dental to remedial massage to psychology to get your health on track, plus pre-natal and post-natal services. And just like Hospital cover comes in levels, Extras do too, from basic to comprehensive. You might consider going for extras that match your lifestyle and help bring you the health benefits that help you do your thing.
What about waiting periods?
Generally, when you sign up for a new health insurance policy or upgrade to a higher level of cover, there’s a period of time in which you have to wait before you can start claiming. This is called a ‘waiting period’. Generally, with hospital cover, waiting periods can be as little as one day for emergency ambulance cover and up to 12 months for pre-existing conditions, pregnancy and birth. And for Extras, the waiting period could be anything from two months to 36 months. You’ll find out what waiting periods apply to you in your policy booklet and product fact sheet.
What’s in and what’s out
Health insurance policies come with inclusions, exclusions and restrictions. Inclusions are the things that are fully or mostly covered by your Health Insurer – like hospital accommodation, ambulance, medicines and in-hospital treatment. Exclusions are conditions that aren’t covered, which could mean you’ll need to pay the full cost if you get treated for them as a private patient. And restrictions are services that you are covered for, but the cover is limited. This could mean you’re only partially covered and you might need to factor in additional out-of-pocket costs. It can get a little confusing, so it’s definitely worth a call to the experts. You can reach our ING Health Insurance team on 1800 111 831.
Let’s talk about the financy-bits, baby
Did we mention insurance was full of jargon? You betcha. There’s a lot. And some of the most jargon-y terms appear when money and tax jump into the health insurance mix. We won’t go deeply into them all but here are a couple to know about: the private health insurance rebate, Medicare levy surcharge and lifetime health cover loading.
So here is the twitter version of each explanation and a link to find out more:
- Private health insurance rebate – this is all about your income. The rebate is an amount the government might contribute to your health insurance premiums. The rebate is income tested, which means the less you earn, the more you might get back, and vice versa.
- Medicare levy surcharge – also income related. If you earn above $90k as a single and $180k as a couple, and don’t have private Hospital cover, you may need to pay additional tax at tax time. Be sure to check the ATO’s special definition of income for MLS purposes to understand whether the MLS might apply to you.
- Lifetime health cover loading – another government-y thing for those over 31. If you don’t have Hospital cover from the 1 July following your 31st birthday, you will be charged more once you do decide to take it out. Basically, the later you get insurance (the loading kicks in at the age of 31), the more you’ll pay (this is the loading part).
Thinking about getting private health insurance?
Find out more about the ins and outs of ING health insurance here.
ING Health Insurance is issued by nib health funds limited (ABN 83 000 124 381) (nib), a registered private health insurer, and is marketed by ING. ING is an authorised agent of nib and receives commission from nib. An ING Health Insurance policy issued does not represent a deposit with or liability of, and is not guaranteed or otherwise supported by, ING or its related bodies corporate.
ING Bank (Australia) Limited cannot advise on financial or tax matters. Any information provided to you is general in nature and does not take account of your individual circumstances. You should obtain your own independent financial advice.
To purchase ING Health Insurance Hospital Cover or to claim for Hospital or Medical Treatment, all those listed on the Policy must be Australian Citizens, Permanent Residents of Australia or entitled to full reciprocal rights under Medicare, registered for Medicare and listed on an active Medicare card. ING Health Insurance policies are subject to the ING customer eligibility and name screening assessment at inception and while holding the product. Please refer to the Customer Eligibility and Name Screening document.
This is general information only, and does not take into account your particular objectives, financial situation and needs and you should consider whether it is appropriate for you having regard to these factors before acting on it. Read the relevant Policy Booklet, Target Market Determination, Financial Services Guide and the ING Customer Eligibility and Name-Screening document available at ing.com.au and consider if an ING Health Insurance product is right for you before deciding to purchase or continue to hold the product.
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