Costs with Private Insurance (457 Working Visa)?

[sryn]

Hi!

I'm hoping that someone may be able to help me somewhat, as my husband and I moved to Melbourne recently due to his new job and I know absolutely no one here!

We are at a point in our lives where we'd love to try for a baby, but with the current economic times the only thing holding us back is our concerns about finances.

I do not qualify for Medicare (although my Swedish husband personally receives Reciprocal Medicare, it doesn't apply to me) and that's why I signed myself up for a Working Visa Health Insurance with excess through Medibank a few months ago.

I've never had a baby before so I'm not certain about what procedures are to be expected and how much of their associated costs can I expect to be able to claim through private insurance. :confused:

There have been many helpful posts here about other's costs, but most people seem to claim procedures like scans, blood tests, and obs appointments through Medicare.

Does that mean that I would have to pay out of pocket for those stages, and only costs associated with the birth are covered by private insurance?

I'd be so grateful for any insight! Thanks in advance! :goodvibes:

[Izy]

I highly recommend you call medibank to discuss your cover with them on Tuesday (monday public holiday). Check to see if the cover includes benefit for pregnancy related services and that you are not within waiting periods. Also check if they will cover the costs of pregnancy related services including birth in private AND public.

You're 100% right that most people claim on their scans and GP visits under medicare. In most cases your insurance would cover the medicare scheduled fee cost of outpatient services (anything that is treating you without a hospital admission is 'outpatient'). For any of these services your provider can nominate how much to charge, so even if your fund is paying 100% of the schedule you might have a bit extra to pay out of your own pocket.

To know how much out of pocket check if your fund pays 100% of the schedule, then ask your service provider how much they charge above the scheduled fee.

This will be the same process for GP, Obstetrician and scans.

As far as the birth of your baby is concerned you have three main options.
* public hospital
* private hospital
* home birth

How much cover you have with your insurance will probably sway your decision.

Home birth can't be claimed anywhere (usually, however there may be some basic benefit for midwife attendance that barely covers the cost of the midwifes fuel). So homebirth will cost roughly the same wether your insurance is onboard or not. To get an extimate on costs you need to speak to the midwife you'd like to hire (there is a directory of independant midwives in the directory section of the hub. click here to go to midwives (http://www.bubhub.com.au/servicesmidwives.php))

Public hospital- you can choose be cared for by an obstetrician, share care (Gp and midwives) or midwifery lead care. If your fund covers pregnancy you would normally be covered in full for this (with the possible exception of some aditional charges from OB if you go ob lead)

Private hospital- You HAVE to have an Obstetrician admitting you. Private Ob's often charge additional fees so you'd have to check with the obstetrician on their fee structure. The hospital it'self will probably be covered in full (much like private) if your insurance covers pregnancy and birth.

It will all depend on your cover and your choice of Dr's.

Good Luck and I hope this helped explain things a little.

[sryn]

Hi there Izy,

Thanks so much for such clarification, it most certainly helps me get a better understanding of the terminology and the health system here in Australia!

I've forwarded a slew of questions on to Medibank specific to my policy and I'll probably double-check them later with a phone/visit to them. So far I've chatted with two Medibank agents (who were young men) and they didn't seem absolutely confident in their answers, so I'm hoping to get something back in writing.

I'll update later about what I discover, hopefully that will be helpful to other people who are in the same boat as me.

Cheers!

[Izy]

happy to help :goodvibes:

Something you may also like to check, is if you will be able to acess medicare immediately for your baby when they are born.

This might be important if bubs needs to go into special care (or even needs to be admitted for something as simple as jaundice) because your current cover as a single person may not cover costs incurred under baby's name.

OOOHHH, and good news, your cover WILL pay towards pregnancy and birth you can see product details here (http://www.medibank.com.au/Visitors-Cover/About-Visitors-Cover/About-Working-Visa-Health-Insurance.aspx)

You do have a 12mth waiting period for the birth though as seen here (http://www.medibank.com.au/Visitors-Cover/Further-Information.aspx%22) scroll down to the table on waiting periods. But it looks as though they will pay for services before the 12mths if baby is DUE after the waiting periods are served. So maybe look at starting to try to conceive after you've had the cover 3-4 months in case you fall pregnant first cycle.

Definitely check for your baby though, cause I don't think the bub it'self would be covered unless you have your husband added with you- which you might like to do if you want him to be able to access private hospital care.

[Izy]

oh, but definitely check if the restricted services


Restricted services

Restricted services apply to Basic Visitors Cover.
A restricted service is any service listed in the Medicare Benefits Schedule and that is not listed as an included service or an excluded service under your cover. With Basic Visitors Cover, benefits for restricted services apply only to hospital accommodation charges (including intensive care charges) and are paid at the minimum benefit level set by the Federal Government for an eligible patient.
No benefits are payable for labour wards or operating theatre fees.
You will be responsible for all charges above any benefits we pay. apply to working visa cover as well as basic visitors cause I know I found that paragraph confusing as all heck and I'm in the industry :p

I think it's saying that on your cover the restrictions don't apply (through omission :S) But if the restrictions do apply you would receive minimum default benefit for labour ward and accomodation charges.

If this is the case than private hospital will cost ALOT MORE than public because they charge alot more, and the fund wouldn't pay the 'extra' that they normally do under their contract agreements.