Difficult to Truly Compare Health Insurance Policies

[Lynda2475]

WCMO is how difficult it is to truly compare different health insurance provider policies.

With April 1 price hike about to kick in decided I should find a better priced plan especially since in the last few years I've needed to use more extras as I now need glasses and physio; and as one gets older different hospital coverage becomes a priority.

My current plan is getting pricey and whilst it offers an unbeatable 85% back with no restrictions on provider, some of the limits have not increased as much as newer policies.

It is so misleading that the headline 60-90% back on newer policies is only on their preferred providers not your own provider of choice. I do not want to stop seeing my quality dentist to go to some co-branded dental centre full of dental students or a provider they have screwed on price for a sub par experience. On some policies when you look at the rebate for non-preferred provides it is half the headline. the whole point of private health insurance is to give one greater choice than the public system.

Then for hospital there is no consistency in difference between top and next policy down across providers. The way they marry some services is crazy (worse than the married segment flight rules). For example on some providers if you un-tick pregnancy & assisted reproduction (something I dont need) that also removes coverage for cataracts (something I might need as I age).

You can also tell the polices are designed by men, because removing assisted reproduction doesnt remove male fertility coverage sexist much?

 

[SYD]

WCMO is how difficult it is to truly compare different health insurance provider policies.

With April 1 price hike about to kick in decided I should find a better priced plan especially since in the last few years I've needed to use more extras as I now need glasses and physio; and as one gets older different hospital coverage becomes a priority.

My current plan is getting pricey and whilst it offers an unbeatable 85% back with no restrictions on provider, some of the limits have not increased as much as newer policies.

It is so misleading that the headline 60-90% back on newer policies is only on their preferred providers not your own provider of choice. I do not want to stop seeing my quality dentist to go to some co-branded dental centre full of dental students or a provider they have screwed on price for a sub par experience. On some policies when you look at the rebate for non-preferred provides it is half the headline. the whole point of private health insurance is to give one greater choice than the public system.

Then for hospital there is no consistency in difference between top and next policy down across providers. The way they marry some services is crazy (worse than the married segment flight rules). For example on some providers if you un-tick pregnancy & assisted reproduction (something I dont need) that also removes coverage for cataracts (something I might need as I age).

You can also tell the polices are designed by men, because removing assisted reproduction doesnt remove male fertility coverage sexist much?

For Hospital - the Gold, Silver, Bronze and Poo tiers are supposed to have a minimum level of inclusions.

Hospital cover and product tiers

Hospital cover helps with the costs of treatment as a private patient in hospital. If you have private hospital cover, you can choose to be treated as a private patient in a public hospital, private hospital or day hospital facility.

www.health.gov.au

Extras are a whole other minefield…

 

[Lynda2475]

For Hospital - the Gold, Silver, Bronze and Poo tiers are supposed to have a minimum level of inclusions.

Key words being "supposed to" Im finding massive differences between the Gold tiers across providers. And why is a lower cost procedure like cataract surgery tied to expensive item like obstetrics in some gold hospital?

Some providers Gold Hospital is only the equivalent of others mid range Silver hospital cover.

Its a chore but I'm slowly eliminating the junk hospital and extras policies.

 

[Lynda2475]

Looking at https://www.health.gov.au/sites/def...basic-product-tiers-campaign-fact-sheet_1.pdf there needs to be something in between silver and gold, where you can get coverage for cataracts and kidney disease which have a huge impact of quality of life, but not non essential personal life-style choices like weight-loss surgery or pregnancy/child birth/assisted reproduction which quite rightly should be extra.

Noting that some providers Silver does include cataracts as going blind isn't practical for most.

Also the quote questions on almost all sites hide the gold policies if you say you dont want to "grow your family", so basically hiding the policies that provide the best coverage for non-obstetric coverage too.

I note that extras policies limiting preventative dental are a rort. People often only go for a check-up and clean once a year or less if their policy doesn't rebate anything for the 2nd 6 monthly visit of the year as is recommended. Everyone knows those with good dental health do better Healthwise overall than those who have lost their teeth.

WCMO even more is:

1. Providers who wont let you view their policies and pricing without giving them your name, email address and mobile number - one shouldn't have to divulge that to see what they sell.

2. PDS/Product sheets with a qualifier where the qualifier is not fully explained. Im looking at you HIF where you state the second dental clean or consult of the year is paid at a lower rate without saying how much lower.

 

[Pushka]

Looking at https://www.health.gov.au/sites/def...basic-product-tiers-campaign-fact-sheet_1.pdf there needs to be something in between silver and gold, where you can get coverage for cataracts and kidney disease which have a huge impact of quality of life, but not non essential personal life-style choices like weight-loss surgery or pregnancy/child birth/assisted reproduction which quite rightly should be extra.

Noting that some providers Silver does include cataracts as going blind isn't practical for most.

Also the quote questions on almost all sites hide the gold policies if you say you dont want to "grow your family", so basically hiding the policies that provide the best coverage for non-obstetric coverage too.

I note that extras policies limiting preventative dental are a rort. People often only go for a check-up and clean once a year or less if their policy doesn't rebate anything for the 2nd 6 monthly visit of the year as is recommended. Everyone knows those with good dental health do better Healthwise overall than those who have lost their teeth.

WCMO even more is:

1. Providers who wont let you view their policies and pricing without giving them your name, email address and mobile number - one shouldn't have to divulge that to see what they sell.

2. PDS/Product sheets with a qualifier where the qualifier is not fully explained. Im looking at you HIF where you state the second dental clean or consult of the year is paid at a lower rate without saying how much lower.

Just been down that path and posted this in the Qantas Health Insurance thread. So, WCMO is Qantas who for ongoing customers, their silver plus premium has gone up to $93 a week. For new policies? Same cover and excess etc and it's $72 . I tried to sign up for a new policy and got to the end, and they eventually 'recognised' me and said I couldn't proceed. Right. Off to BUPA and got their policy for same cover for $71 a week. Seriously, that's friggen $1000 difference. Thanks for your loyalty Qantas Health. I slammed the door on the way out. Cataracts were covered on both policies. I had mine done in September. Best move ever. No more glasses.

 

[Lynda2475]

Yes its a pain that with almost all insurers there are discounts/freebies for new customers and nothing for loyal ones. Doesn't incentivize one to stay at all.

Its backwards there should be a discount based on length of tenure, and newbies get current going rate.

Im compiling a huge spreadsheet right now; and need to find time on Monday to call current provider about newer corporate polcy for comparison.

My current policy gives $450/year for optical everyone else now seems to give $300. That barely covers single vision lenses let alone frames.

As my current policy is an NIB corporate one, I've never been eligible to apply for Qantas as its NIB behind the scenes.

 

[RooFlyer]

My current policy gives $450/year for optical everyone else now seems to give $300. That barely covers single vision lenses let alone frames.

They don't pay out the max on any one service do they? Isn't it the case that for say, a new frames costing $300, they might pay $150 for that item. The remaining $150 is available for another claim?

______________

I have a Medibank Private Gold Advanced Hospital and Blue Ribbon Extras policy - but I've had it for years. Occasionally they try to get me onto another policy, but this one's a keeper. Been expensive to have, but two unexpected eye surgeries a couple of years back paid for premiums for 12 years.

 

[SYD]

They don't pay out the max on any one service do they? Isn't it the case that for say, a new frames costing $300, they might pay $150 for that item. The remaining $150 is available for another claim?

Yes, most extras are usually X% of the total, then capped at the annual limits.

“Self insuring” for extras is worth exploring for the occasional claimant.

I have a Medibank Private Gold Advanced Hospital and Blue Ribbon Extras policy - but I've had it for years. Occasionally they try to get me onto another policy, but this one's a keeper. Been expensive to have, but two unexpected eye surgeries a couple of years back paid for premiums for 12 years.

and that’s the primary point of insurance!

With the exception of “Extras”, you normally don’t want to claim but when you do, you want decent coverage - whether that be TI, Home/Contents, Motor vehicle etc

 

[Lynda2475]

They don't pay out the max on any one service do they? Isn't it the case that for say, a new frames costing $300, they might pay $150 for that item. The remaining $150 is available for another claim?

My current policy pays 85% up to max of $450 for Optical. Since $450 is always less than 85% of the cost of glasses (frames + lenses) I've always get the whole $450 back.

But some of the new policies pay up to $300 as long as they are more than $300, so even if total cost was $301 (not that you can get glasses for such a low amount) you'd still get the $300 back. AHM does this on their top extras.

 

[Lynda2475]

and that’s the primary point of insurance!

for hospital yes.

But for extras I expect to get back a good deal of my premium outlay each year across dental check-ups, a pair of glasses, some remedial massages and physio if needed. If it was cheaper to just buy glasses, pay 100% of the dental check-ups and occasional replacement filling, physio etc then I wouldn't bother with extras cover.

Afterall the ATO only requires me to have hospital cover to avoid the extra medicare levy, but I want that hospital cover to be quality. Given family history Im highly likely to end up with a cataract at some point and knee surgery, so need coverage for that. Dad's coverage was excellent covering in-patient rehab.

 

[SYD]

With the exception of “Extras”, you normally don’t want to claim but when you do, you want decent coverage - whether that be TI, Home/Contents, Motor vehicle etc

for hospital yes.

But for extras I expect to get back a good deal of my premium outlay each year across dental check-ups, a pair of glasses, some remedial massages and physio if needed.

That’s why I singled out “Extras”.

Everyone should be interested in Dental, but unless you also have a need for Optical (many don’t), plus physio, chiro etc, Extras may not actually be worth the expense.

My insurer pays out 80% per claim (capped) - some years I get my monies worth, others probably not… It’s usually the unplanned dental that makes it worthwhile.

 

[Lynda2475]

Medibank extras cover is misleading, they say you get 90% back, but that is only if you use their providers and they dont disclose anywhere on the website what the reduced pay out is using your own dentist.

This is why I have been reluctant to come off my current plan which lets me use any legit dentist, not the ones brow beaten by a big corporate into a price they set which means disgruntled workers and sub-standard care.

 

[Lynda2475]

Off to BUPA and got their policy for same cover for $71 a week.

And hopefully also the 70-140k Woolies reward points which can be QFF points.

 

[Lynda2475]

Health Insurance: Compare Policies from 40+ Insurers | CHOICE if you click on each logo, choice tell you of the coverage for that provide is above, average or below average for your state.

Argg so AAMI, Suncorp and Qantas are all underwritten by NIB, so anyone switching from NIB is ineligible for the 6 weeks free or bonus points. A pain since the AAMI/SunCorp plans have betetr coverage and cheaper than NIB direct (although I have yet to check the corporate pricing).

 

[n7of9]

A number of years ago i switched to NIB because their dental centre was near my workplace, and they covered 100% of general dental up to a max per year. But i found they charged more per item so your max was used up faster. They also had no.personal service as you'd see any dentist who was next available, and almost all of them were short-term visitors from overseas. It felt like a visit to a puppy farm.

I'm also against any Luxottica brands (and their 1000% markup) for glasses and frames and have been going to Own Days for a handful of years, they are fantastic, and their frames are light and flexible.

 

[Lynda2475]

Yes I like to choose my doctor, hospital, dentist, optometrist, physio etc.

My dentist is independent, so is my optometrist.

Lucky my older NIB policy pays the same % or $ rebate regardless of which provider I attend. I am looking for something similar but without pregnancy cover. Medibank hasn't made the short list because of their deceptive advertising hiding rebate amounts for independent providers.

 

[n7of9]

.. looking for something similar but without pregnancy cover. Medibank hasn't made the short list...

Let us know who you end up with. I just renewed but only paid for 6 months because, though i had a cursory look at alternate policies, i didn't have time to properly research and I'm not convinced i want to stay with HIF long term. I usually find if you want to avoid obstetrics you're often stuck with Bronze hospital, and I'm becoming uncomfortable with that as i age mature ferment

 

[blackcat20]

WCMO is how difficult it is to truly compare different health insurance provider policies.

With April 1 price hike about to kick in decided I should find a better priced plan especially since in the last few years I've needed to use more extras as I now need glasses and physio; and as one gets older different hospital coverage becomes a priority.

My current plan is getting pricey and whilst it offers an unbeatable 85% back with no restrictions on provider, some of the limits have not increased as much as newer policies.

It is so misleading that the headline 60-90% back on newer policies is only on their preferred providers not your own provider of choice. I do not want to stop seeing my quality dentist to go to some co-branded dental centre full of dental students or a provider they have screwed on price for a sub par experience. On some policies when you look at the rebate for non-preferred provides it is half the headline. the whole point of private health insurance is to give one greater choice than the public system.

Then for hospital there is no consistency in difference between top and next policy down across providers. The way they marry some services is crazy (worse than the married segment flight rules). For example on some providers if you un-tick pregnancy & assisted reproduction (something I dont need) that also removes coverage for cataracts (something I might need as I age).

You can also tell the polices are designed by men, because removing assisted reproduction doesnt remove male fertility coverage sexist much?

We decided to keep top level hospital even though we aren't planning more kids as it's bundled with things like knee replacement, and there is a history of bad knees in my family.

 

[Pushka]

Yes I like to choose my doctor, hospital, dentist, optometrist, physio etc.

My dentist is independent, so is my optometrist.

Lucky my older NIB policy pays the same % or $ rebate regardless of which provider I attend. I am looking for something similar but without pregnancy cover. Medibank hasn't made the short list because of their deceptive advertising hiding rebate amounts for independent providers.

The consultant in BUPA said Medicare does funny stuff in their policies. WCMO. All providers should have to follow a basic platform of services. I thought that was the point of a couple of years ago re standardisation of policies? Seems like they play catch up with the Extras cover which we gave up as the appalling amounts they refunded.

Post automatically merged: Mar 17, 2024

Let us know who you end up with. I just renewed but only paid for 6 months because, though i had a cursory look at alternate policies, i didn't have time to properly research and I'm not convinced i want to stay with HIF long term. I usually find if you want to avoid obstetrics you're often stuck with Bronze hospital, and I'm becoming uncomfortable with that as i age mature ferment

Most offer Silver and Gold with no obstetrics but cover all the usuals like joint replacements and cataracts. BUPa tried to cut those out in 2018 which is when I left them and moved to Qantas (NIB). Look for the Plus

 

[RooFlyer]

Medibank extras cover is misleading, they say you get 90% back, but that is only if you use their providers and they dont disclose anywhere on the website what the reduced pay out is using your own dentist.

This is why I have been reluctant to come off my current plan which lets me use any legit dentist, not the ones brow beaten by a big corporate into a price they set which means disgruntled workers and sub-standard care.

I use a MP's 'Members Choice' dentist in Hobart and am perfectly happy with them - I have my particular dentist (same for 10 years now, before that someone else in the practice before they retired), not just any dentist in the practice. Your comment about disgruntled workers and sub-standard care is simply ridiculous and again, commenting about something you have no experience with.

Of my other similar providers such as optometrists etc, some are Members Choice, others not. You don't have to use the Medibank Private nominees.

If you want to check how much MP will rebate you for a particular service from a non Members Choice provider, why not just call them and ask? Might surprise you, and might end up being an attractive policy for you.

In respect to Hospital cover, the only private hospital in Hobart is their nominated one for cheaper out-of-pockets, so that works well.

And hopefully also the 70-140k Woolies reward points which can be QFF points.

Boy, if getting Woolies/QFF points is in any way on your mind re health cover, you are using the wrong metrics.