I'm new to the BH. My husband & I are looking to start a family & are looking for the best private health cover - one that covers everything including elective caesarians. Any suggestions would be greatly appreciated!
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03-06-2015 15:39 #1Junior Member
- Join Date
- Jun 2015
Looking for the best Private Health Cover
03-06-2015 17:05 #2
Hi and welcome!
I would recommend speaking to one of those comparison people like iselect about the best one to suit your needs. I would think most PHI would cover elective c/s.
I'm with defence health who are amazing! They've covered 3 elective c/s with no excess, over 10 surgeries again with no excess, many hospital stays, 2 insulin pumps worth $10k plus all the extras.
03-06-2015 17:19 #3
The government also has a comparison website for PHI which represents all companies (i-select only do a selected group of insurers). Im also dirty at i-select as they kept calling me after I used the website once.
I think most PHI will cover the cost of elective c-sections (as long as you select the pregnancy option). From my understanding, its more about your ob- whether their costs will include all situations during the hospital stay for birth. The ob I will be using (if I get a BFP that sticks around) charges a flat fee regardless of whether you have a VB or c-section (including elective c-section).
PHI won't cover all or even most of the cost of the obstetricians fee for delivery/birth, the rest of the fee you will have to cover. PHI covers the hospital side of it, which I hear runs at around $1000/day.
04-06-2015 11:42 #4Senior Member
- Join Date
- Feb 2015
When are you looking to start a family? Most insurers have a 12 month waiting period on Maternity cover.
04-06-2015 11:43 #5
04-06-2015 11:53 #6
Defence health is good and it's now open to people who aren't defence workers or know someone who is, we will be going with them
04-06-2015 12:13 #7
I am with Defence Health too and my 6 night stay in a private hospital with a c-section and a bub in special care for a month the only thing I was charged for was $22 for my discharging medications....
Most health places say that Defence Health give really good benefits. We have top hospital and extras cover...
04-06-2015 12:37 #8
12-06-2015 19:24 #9Junior Member
- Join Date
- Jun 2015
I've worked in the Private Health Insurance (PHI) industry for the last 12 yrs, I don't sell the products but do know the basics. I hope the below might be able to assist some people. (apologies in advance it's long winded) Best advice is to read the policy throughly and ask as many questions as you can, also always take a reference number down for your call so you have something to refer back to if the need arises.
I would go to the funds directly to review their policies, many have a little 'selector' tool you can use to 'recommend' products on their websites.
Most insurers have a waiting period of 12 months before you are covered for pregnancy. Generally if your baby is prem and arrives before the waiting period is up you will be covered as long as you can confirm your due date would be after the waiting period, so best to have cover for 3-4 months before you start to try just to be safe.
If you hold a single policy you will be covered for the delivery - the baby will stay on as your guest or boarder in the hospital but will not be admitted under their own name so will therefore be classified as an Out-Patient (where you are only covered by Medicare) however if the baby needs to be admitted on their own (NICU etc) you might not be covered for the services they need and when you do add them onto your policy they have the 12 month pre existing waiting period. A lot of funds will recommend you have 2 single policies (mainly with your partner on a lower level of cover so its cheaper) then advise you to join as a family when you find out your pregnant, your baby will then be covered from birth.
With regards to your excess or co-payment it would depend on your cover to how much this is and how often you pay it, most excesses are based on a calendar year period and are for the first 2 admissions in that year (on a family cover) regardless of who goes into hospital, some funds do have nil excess for children. Co-payments are X Amount per night for X nights in hospital, some have an excess and co-payment option.
When you go into hospital there are 2 types of fees, hospital and medical (drs)
Your hospital entails your accommodation, theatre and prosthesis fees - generally these are covered 100% by your fund less any excess or co-payment that applies - The hospitals always do whats called a 'Fund Check' where they call your insurer to confirm your coverage and check excess/co-pay etc.
Next is Medical - Drs, Anaesthetist, Pathology, Radiology etc. For Inpatient medical services (when admitted to hospital (ED isn't included) you are covered 100% of the Medicare Benefits Schedule (MBS) - this is covered 75% by Medicare and 25% by your Fund - anything the Dr charges above the MBS fee is your Out of Pocket expense - e.g. - Drs fee is $150 but MBS is only $100 - you will be covered for the $100 with $50 out of pocket - the Drs are meant to always give you an Informed Financial Consent. IF your Dr participates in whats known as the Gap Cover or Known Gap scheme, they have an agreement with your Fund where the fund will cover more of the Gap therefore reducing your out of pocket costs - e.g. Drs fee is $150, MBS for $100 still applies, then Fund pays additional $25 - leaving an out of pocket expense of $25.00. Unfortunately it is the Drs choice on whether they participate in this or note so always best to ask.
For any Out Patient services you are only covered for 85% of the MBS fee and nothing by your health fund (general Drs visits in their rooms etc)
Hope this helps and I haven't overwhelmed or confused any further
The Following User Says Thank You to larnij For This Useful Post:
13-06-2015 06:36 #10
^^ very good points.
My oby is no gap so we don't pay any extra for delivery. So if you want 100% cover pick a dr that is also no gap. I have heard horror stories about huge gaps.
Also keep in mind that most funds won't cover the pregnancy management fee so there's another out of pocket expense.
Most private will also insist on atleast 2 pead checks, one at birth and one for discharge ( with maybe some more in between) and as baby is an out patient these aren't counted towards phi cover
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