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List of approved fair health insurance companies

Fair Healthcare Alliance — Tue, 21 Jan 2020 01:40:38 +0000

Fairness within the health sector of Australia is fast becoming a focal point within the health practice landscape.
Recently, the ADA (Australian Dental Association) launched a petition to bring Parliament attention towards ending discriminatory rebates within the dental industry. More specifically, the ADA is talking about dental preferred-provider platforms.

What is a preferred provider?

The most expansive and numerous preferred provider platforms are hosted by Australia’s biggest health insurers. Medibank has the Member’s Choice network, BUPA has the Member’s First network, HCF has the More For You program (with specific names for each industry, for example: More for Teeth in dental), and HBF, AHM by Medibank, and NIB, all have specified preferred health providers in multiple locations.

Preferred provider platforms are networks of health practices and providers who offer higher returns for health services when claimed through a particular health fund. The benefit for the health insurer is that they can reduce and better control outgoing benefit claims for services such as dental, physiotherapy or chiropractic. The benefit for the participating practice comes from a marketing perspective: being an advertised preferred provider means new patients coming through the door. Finally, the benefit for the policy-holder is that they have a lower gap to pay when they claim for said health services.

It all sounds like a win-win-win on the surface but – like all things – something has to give. The true cost behind the scenes could be perceived as being more sinister. We’ve heard several stories of some practices building their entire patient-base and business model around big health funds preferred-provider platforms just to have their contract rejected when they changed business locations (or for other reasons). In one terrible move, potentially more than half of their patient base became at high-risk of moving to a competitor preferred-provider within proximity (sometimes, even, with assistance from the big health funds customer service team or online provider search tools).

Who wears the cost of these preferred provider platforms? Upon investigation, we found that the hosting health insurer dictates the frequency and fees of several item numbered services. It all comes down to cost control so that these big health funds can avoid significant prices hikes in April each year – it makes sense on paper. The cost of health insurance is a big issue of late and we understand the mathematics behind benefits paid as a percentage of contributions, however, skewing the market and penalizing independent health practice should not be a welcome practice in Australia.

Freedom to choose. Fairness by choice.

The biggest threat that preferred provider programs bring to our community is in relation to freedom and fairness. It threatens our freedom to choose who we attend for important health services and treatments without being penalized. It severely wounds independent health practice in Australia by shepherding insured Australians to practices in contract with certain health insurers, creating a biased and ultimately unfair landscape of choice. Remember, over 80% of insured Australians are with the top five largest health insurers, all of which host Australia most prominent preferred provider platforms.

This is a major issue of retention for independent health practitioners. Through no fault of their own, honest Australian businesses are losing patients to competitors who are in bed with particular health funds. To remain independent, these practices are being forced into a scenario where some patients incur huge out-of-pocket gaps for their treatment simply because they opt not to participate as a preferred provider (or perhaps were rejected participation). Poor rebates can negatively affect overall attendance and repeat business from customers, especially for preventative and ongoing health services. If the service costs the customer too much, they just don’t come back as often – it becomes a grudging service.

In this common scenario, the patient is being forced to choose between lucrative health fund rebates and their own right to choose who they attend for treatment. We’ve spoken to countless people who come to us for help because they’ve been attending their trusted health professional for years and more and don’t want to have to change just because their fund pays more somewhere else. It’s just bad news all round for independent health practice.

This issue of an uneven playing field isn’t just limited to claimable extras service such as dental. A patient can find themselves incurring significant out-of-pocket expenses associated with in-patient services and surgery too. BUPA made more than a few headlines in 2018 for trying to establish a restricted list of approved hospitals and doctors. Australians need to understand the true threat that this approach to cost-control can impose onto our freedom of choice.

The crux of our service is helping people compare health funds with private health insurance companies that use minimal or no preferred provider platforms. By minimal, we mean severely limited to a small handful of locations, most often hosted within or around the health insurers home town, and certainly not prominent in greater Australia.

Fair Health Care Alliance approves the following private health funds

Here is a list of health funds in Australia who we think fits our criteria for being fair and who encourage the non-discriminatory choice of provider for health services. Please note that some of these funds have very minimal preferred providers, which we have detailed below the table.

ACA	Hunter	Police Health
CUA	LaTrobe	Queensland Country Health
Doctors Health	Mildura	RT Health
Emergency Services	Onemedifund	St Lukes Health
GU Health	Navy Health	Teachers Health **
HIF	Nurses & Midwives **	Transport Health
Health Partners *	Peoplecare	TUH
Health.com.au	Phoenix	Unihealth **

* Health Partners qualify for this list outside of Adelaide only. Health Partners have several preferred providers in Adelaide and the Barossa Valley.

** Teachers Health Fund, Nurses & Midwives and Unihealth have five health centres total in Surry Hills NSW, Parramatta NSW, Hamilton NSW, Richmond VIC, and Adelaida SA.

Support these health funds – Get a quote

You can support the health funds listed above by considering them in your next health insurance comparison quote. By doing so, you are drawing a line in the sand and making a strong statement: that all Australians should have complete and total freedom in choosing their own health providers, and that they should receive fair rebates from their insurer despite who or where they choose to attend for treatment.

We are able to organize a formal comparison quote with some of these approved health funds. We do not work with all of them, although, we would certainly like to given the opportunity. We will help you compare any policies with health funds that might interest you side-by-side against the health fund you may be currently with.

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Health insurance WA: who are the best performing health funds?

Fair Healthcare Alliance — Tue, 14 Jan 2020 06:27:24 +0000

Western Australia is the biggest Australian state by land size with a measured area of 2.6 million square kilometers, and is home to almost just as many Australian residents and citizens. Despite the sheer size, almost all of the private hospitals in WA are in Perth, if not close to it.

Western Australia can also be tricky when it comes to what products and policies are prominent and well-recognized by local health providers. Many east coast health insurance funds have very little foothold way over in Perth, which certainly begs the question: who does the best health insurance in WA?

Of course, there is no such thing as a best health insurance fund and you should be careful heeding any advice that declares any one fund as being the “best”. This article does, however, seek to compare the key performance indicators that might demonstrate holistically the health insurance funds that stand above the rest in WA.

We will measure and compare the overall percentage of hospital related charges, the percentage of doctors gaps that were covered, and the benefits paid by funds compared to contributions paid into the fund by members. We will also take a look at which health funds hold the most market share in WA and who have most of their member-base in WA.

All the data used to share this information is taken from the most recent State of the Health Funds Report from the Commonwealth Ombudsman, which is updated each year on April 1st with data from the year prior. It’s important to understand that the following figures and comparisons will have changed slightly and will be updated when the new report comes out later this year.

The following tables only display the top 15 results. Please be aware that there are many more health insurers available in Western Australia. If you would like to compare health insurance in WA, get in touch with us for some advice.

compare health INSURANCE in WA

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Western Australia market share

Health Fund	Market Share in WA
HBF	53.1%
Medibank	20.2%
BUPA	11.5%
HIF	3.7%
HCF	3.3%
NIB	2.9%
GMHBA	0.9%
CBHS	0.8%
Defence Health	0.7%
Teachers Health	0.5%
Australian Unity	0.5%
GU Health Corporate	0.4%
Police	0.3%
Navy Health	0.2%
Health.com.au	0.2%

Total members held in WA

Health Fund	% total members in WA
HBF	89.4%
HIF	58.4%
Police Health	13.5%
GU Health Corporate	12.2%
Onemedifund	11.2%
Medibank	9.9%
CBHS Corporate	8.4%
Navy Health	7.2%
CBHS	7.1%
BUPA	5.8%
MO Health	5.8%
Health.com.au	5.4%
Emergency Services	5.2%
GMHBA	5.0%
NIB	4.5%

Important: This list is restricted to the top 15 results.

It’s no surprise that HBF (Hospital Benefit Fund) sits at the top of both tables. HBF have been Western Australia’s own health fund for more than 75 years, home-based in Perth. HBF hold just over half of the total Australian market share in WA with Medibank – Australia’s largest health insurer – only holding 20 percent in second place. Just under 90 percent of HBF members are based in WA proper, so it would appear that HBF are happy focusing their attention in their home state.

HIF (Health Insurance Fund of Australia) are another health insurance company based in Perth, WA. Originally established in 1954 as the Western Australian Government Railways Employees Hospital and Medical Benefits Fund Inc, HIF appears to have a much smaller market share (3.7%) in Western Australia. HIF sit in second place for % total members based in WA with just under sixty percent of their members calling WA home.

It makes sense that Australia’s bigger health insurance players sit at the top of market share in WA, with Medibank/AHM, BUPA, HCF, NIB and GMHBA, however, it would appear that Western Australia accounts for only 5-10% of their total membership base. These health insurance companies seem to be much more prominent in the east coast states where they are based (makes sense).

Health Fund performance in WA

Health Fund	Benefits as % contributions in WA	Hospital Related Charges covered in WA	% of Services with no gap in WA	% of Services with Known gap in WA
Nurses and Midwives	104.2%	90.8%	86.9%	95.4%
Defence Health	94.1%	93.1%	88.0%	96.3%
Peoplecare	91.8%	90.7%	87.4%	96.6%
CBHS	91.6%	92.8%	85.6%	95.5%
HIF	91.3%	92.2%	86.3%	97.1%
HCI	91.2%	95.2%	90.3%	99.4%
Police Health	91.1%	93.7%	81.7%	94.4%
Navy Health	91.0%	94.7%	88.3%	97.2%
HBF	90.2%	96.1%	87.9%	99.7%
St Lukes	89.7%	86.3%	79.7%	88.1%
HCF	89.0%	90.4%	86.7%	98.1%
QCH	88.9%	90.8%	85.5%	94.1%
Phoenix	88.5%	94.0%	86.7%	97.2%
Latrobe	88.5%	89.9%	67.5%	99.1%
Teachers Health	88.3%	91.6%	86.1%	95.9%
Health Partners	87.6%	89.9%	83.7%	92.2%
MDHF	87.3%	88.9%	76.7%	93.0%
Transport Health	87.2%	95.0%	90.6%	98.4%
GMHBA	87.0%	87.6%	70.8%	85.2%
Health.com.au	86.7%	84.5%	85.3%	96.1%
Reserve Bank	85.4%	97.1%	90.2%	98.5%
BUPA	85.0%	88.4%	85.0%	91.8%
TUH	84.9%	92.9%	89.2%	96.9%
RT Health Fund	83.8%	93.8%	87.3%	96.0%
CUA Health	83.5%	89.0%	88.7%	96.1%
Medibank	83.4%	90.4%	72.1%	87.7%
CDH	83.4%	71.7%	59.1%	100.0%
Doctors’ Health	82.9%	90.9%	90.8%	97.7%
NIB	82.7%	84.9%	81.8%	81.8%
ACA	82.2%	97.9%	92.9%	97.8%
Australian Unity	81.5%	88.8%	88.5%	95.7%
Westfund	80.3%	95.5%	88.0%	96.6%
Onemedifund	78.2%	94.5%	82.7%	94.2%
GU Health Corporate	78.1%	88.6%	83.4%	94.2%
CBHS Corporate	TBA	96.6%	89.7%	92.6%
Emergency Services	TBA	94.4%	81.5%	100.0%
MO Health	TBA	83.7%	75.8%	93.7%

Bigger isn’t always better.

An interesting outcome of reviewing this data is that some of the health insurers listed earlier as having the most market share in WA are not necessarily topping the charts for performance in the listed categories. We wrote an article about how the size of a health fund is not an indication for how they might perform.

Benefits as % contributions in WA

We have ranked the table above by benefits as a percent of contributions by members. This figure basically shows how much each health insurer pays back to their members in the way of benefits and payouts as a percentage of premiums contributed by members. Whether it’s in-patient or out-patient medical bills, doctors gaps, extras payouts or any health perk or benefit paid for by the fund, this figure demonstrates the overall value of the health fund in Western Australia.

It comes as no surprise that the results for benefits as a percentage of contributions is top-heavy with not-for-profit health funds, after all, there are no share-holders to consider and all profits go back into members, often in the form of benefits.

That being said, it does not necessarily demonstrate the value of any one policy with any health fund listed above. Each fund has a multitude of products and policies, each with it’s own inherent value rating. The ratings above are strictly universal and are being referenced as a point of overall health fund performance.

Hospital Related Charges covered in WA

These figures pertain to the amount that each health insurer paid on average of the total cost for in-patient treatments, where 100% is the total cost for the medical treatment. The Commonwealth Ombudsman describes it as:
“…charges for hospital accommodation, theatre costs, prostheses and specialist fees (not including the Medicare benefit) and associated benefits (after any excesses and co-payments are deducted). ” (Private Health Insurance Ombudsman State of the Health Funds Report 2018).
The industry average for hospital related charges covered in Western Australia is 93.8%.

% of Services with no gap or Known gap in WA

The number of in-patient health services where no gap was charged to the patient. The ‘gap’ is the out-of-pocket expense charged by the operating doctor and specialist, as well as the operating Anesthetist. The gap amount is the difference between the Medicare Benefit Schedule fee (what Medicare pays) for the procedure and the doctors’ fee (what the doctor/s are charging). Of course, the gap is payable by the member.

‘No Gap‘ means the procedure was performed and there was no gap fee charged to the patient. This is often the case if the doctor chose to participate in a gap-cover scheme with the patients health insurer. All that said, the figures above represent how many of the total private procedures performed in WA were with no gap.

‘Known gap‘ is similar to no gap, however the fee is not entirely waived. A known gap arrangement is where the doctors’ gap fee is reduced but not eliminated. The figures above under this column represent how many of the total private procedures done in Western Australia for the year were with a reduced gap or no gap.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

In conclusion, it’s hard to say to who is the best health fund in WA. There are numerous ways that we can measure a health fund in addition to what we have listed in the tables of this article. One important factor to consider is that all the night and day private hospitals in WA are centered around Perth. This makes health insurance tricky for any rural Western Australians who may not have easy access to Perth without a great or difficult journey.

There are some health funds who have greater benefits for Travel and Accommodation – an amount claimable by the member for costs association with long-distance travel for some medical services. Some funds are cheaper at insuring someone as a private patient in a public hospital, which is often beneficial to people who only have access to a public hospital.

Health insurance in WA is complex and multi-faceted. Different health funds are going to suit people of different health needs. Get in touch with us for some helpful health insurance advice. We can help you access some of the best health funds as per the performance tables listed above.

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List of private health insurance companies in Australia

Fair Healthcare Alliance — Wed, 08 Jan 2020 01:00:32 +0000

It’s not entirely easy to find a comprehensive list of private health insurance companies available to Australians. From the largest health funds with the most members down to the small, local health funds with a tiny piece of the market pie, this article seeks to offer clarity and comprehensive information about the market share, membership availability, and business structure of Australian health insurers.

Let’s first take a look at who-is-who and how each health insurance provider operates in Australia. Market share, Membership and Structure is explained in greater detail below the table.

Comprehensive list of health insurance providers in Australia

Data provided by the Private Health Insurance Ombudsman State of the Health Funds Report 2018. This report is the most recent available and is updated with data from the year prior on April 1st annually.

Insurer (abbr.)	Market Share	Membership	Structure
Medibank	26.90%	Open	For profit
BUPA	26.30%	Open	For profit
HCF	10.70%	Open	Not for profit
NIB	8.50%	Open	For profit
HBF	7.80%	Open	Not for profit
Australian Unity	2.90%	Open	For profit
GMHBA	2.40%	Open	Not for profit
Teachers Health	2.40%	Restricted	Not for profit
Defence Health	2.10%	Restricted	Not for profit
CBHS	1.50%	Restricted	Not for profit
HIF	0.80%	Open	Not for profit
Latrobe	0.70%	Open	Not for profit
Westfund	0.70%	Open	Not for profit
CUA Health	0.60%	Open	For profit
Health.com.au	0.60%	Open	For profit
Health Partners	0.60%	Open	Not for profit
TUH	0.60%	Restricted	Not for profit
Peoplecare	0.50%	Open	Not for profit
GU Health Corporate	Less than 0.5% *	Open (Corporate)	For profit
HCI	Less than 0.5%	Open	Not for profit
Phoenix	Less than 0.5%	Open	Not for profit
Transport Health	Less than 0.5%	Open	For profit
Nurses and Midwives	Less than 0.5%	Restricted	Not for profit
Reserve Bank	Less than 0.5%	Restricted	Not for profit
RT Health Fund	Less than 0.5%	Restricted	Not for profit
CBHS Corporate	Less than 0.5%	Open	Not for profit
CDH	Less than 0.5%	Open	Not for profit
MDHF	Less than 0.5%	Open	Not for profit
MO Health	Less than 0.5%	Open	For profit
Onemedifund	Less than 0.5%	Open	For profit
QCH	Less than 0.5%	Open (QLD,NT)	For profit
St Lukes	Less than 0.5%	Open	Not for profit
ACA	Less than 0.5%	Restricted	Not for profit
Doctors’ Health	Less than 0.5%	Restricted	For profit
Emergency Services	Less than 0.5%	Restricted	Not for profit
Navy Health	Less than 0.5%	Restricted	Not for profit
Police Health	Less than 0.5%	Restricted	Not for profit

* all of the health insurers listed as holding less than 0.5% market share are in no particular order and is completely randomized. As per this list, they are deemed as holding an equal market share of less than 0.5%.

Market Share

One of the most notable reveals of this list is that the memberships market share is incredibly top heavy. That is to say, most of the market share is dominated by few of the health insurers. Medibank and BUPA have a combined total market share of just under 54%. If we add HCF, NIB and HBF to the total, we can see that the top five health insurers in terms of size account for 80.2% of the entire market of insured Australians. We wrote an article suggesting that the size of a health fund does not necessarily mean it is higher performing.

This data is true for 2018 and will certainly have slightly changed since. We will update this table when the 2019 data is released in April 2020.

Membership

Although health insurance is non-discriminatory in Australia (pertaining to Community Rating as part of the Private Health Insurance Act 2007), a health insurer may not always be available to all citizens and residents who may wish to join. An Open health insurer means any Australian citizen or resident may join. An Open fund may offer different policies to residents of different Australian states or territories, or may not offer any policies at all in some states (see QCH – Queensland Country Health above has policies only available in Queensland and Northern Territory).

A Restricted health insurer means the health fund has limitations as to who may join. The restriction is most often limited by an occupational industry, the Defence services or Unions. Some examples are Defence Health memberships being restricted to people linked to service or employment in the Australian Army, Navy, Air Force or Department of Defence, or Teachers Health Fund memberships being restricted to people linked to specified teaching unions.

There are some very specific Restricted health funds such as ACA, who strictly provide health insurance products to employees of the Seventh-day Adventist Church (and their families). Another one is CBHS, or Commonwealth Bank Health Society – a health fund for current and former employees of specified CBA Group divisions (and their families). If you’d like to see if you are eligible for any Restricted health funds, contact us for advice and a quick answer on 1300 955 691.

Business Structure

Not-for-profit health insurance funds are becoming increasingly recognized and rightfully so. Not-for-profit means the health fund is owned by its members and that all of the surplus profits go back into members after the costs to operate the fund have been subtracted. It’s interesting to note that four of the top six largest health insurers operate for profit.

The difference between for-profit and not-for-profit may not necessarily mean that one fund is better than another. However, data does suggest that the Members Own health funds pay overall higher benefits as a percentage of premiums paid by members. The Members Own health funds do not include all of the not-for-profit health insurers. It could be said that the for-profit health insurers could afford to pay more back to members if they were not-for-profit and that’s just common sense.

We can get you access to some not-for-profit health funds. Contact us for a comparison quote.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

List of current and former Australian health fund brands

There is a key difference between the terms health insurance provider and health insurance brand. A provider may operate or underwrite one or more health insurance brands. A great example of this is that NIB – Australia’s fourth largest health insurance company – provides, or at some point provided, the health insurance policies for white-label brands Qantas Assure, AAMI, APIA, Suncorp and TAL.

AHM (Australian Health Management) are a very popular health insurance brand who have began operating for nearly 40 years. They are in the top 10 health funds in terms of size and fairly well known and advertised. They were bought wholly by Medibank in 2009 at which point they became AHM by Medibank.

The following list includes some health fund brands that have been completely absorbed and have changed names entirely to the operator. For example, HBA and MBF members were a very long time ago changed to BUPA members, however, they may still be holding old HBA and MBF policies that have simply been re-branded.

This list may have been subject to change:

Health Fund Brand	Operator
HBA	BUPA
MBF	BUPA
Mutual Community	BUPA
NRMA Health	BUPA
SGIC (SA)	BUPA
SGIO (WA)	BUPA
Hunter Health Insurance	CDH
Budget Direct	GMHBA
Druids	GMHBA
FIT	GMHBA
Frank	GMHBA
RACT	GMHBA
CY Health	HBF
GMF Health	HBF
Goldfields	HBF
Healthguard	HBF
IOR	HCF
Manchester Unity	HCF
Federation Health	Latrobe
Australian Country Health	Medibank
AHM	Medibank
Country Health	Medibank
Government Employees	Medibank
Illawarra Health Fund	Medibank
Kogan	Medibank
Mutual Health	Medibank
Grand United	NIB
AAMI	NIB
APIA	NIB
IOOF	NIB
Qantas Assure	NIB
Suncorp	NIB
Unihealth	Teachers Health
Union Health	TUH

There we have a comprehensive list of health insurance providers in Australia. so, Which one is right for you?

Remember, there is no such thing as the best private health insurance provider which we explained in this linked article. It’s about comparing health insurance companies and finding who matches your current state of health needs at the lowest price. Fair Health Care Alliance advisers are adept at assisting you with comparing apples with apples and helping you make a decision with clarity and care.

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Understanding the Private Health Insurance Act 2007

Fair Healthcare Alliance — Mon, 06 Jan 2020 03:50:21 +0000

The Private Health Insurance Act 2007 is an integral piece of legislation that governs how private health insurance operates in Australia. There a many facets to the act and there have been annual reforms since it’s introduction way back in 2007. In this article, we seek to outline the important elements of the act that protect the policy holders, particularly in relation to switching health funds.

It’s important to understand that all private health insurers in Australia must strictly adhere to the PHI Act and simply cannot operate outside of its jurisdiction by federal law.

Abstract

There is a means-tested rebate and a youth discount to help make health insurance more affordable.

Lifetime health cover loading incentivizes young Australians to take our hospital cover earlier in life.

Community Rating ensures all people are given access to products at the same rates regardless of medical history.

Portability means you don’t have to re-serve waiting periods when switching to a new policy.

If a health fund goes belly-up, it’s business as usual for members until the fund is sold to a more-stable insurer.

Chapter 2 of the Private health insurance Act 2007 – Incentives

Section 2-2 describes the Premiums reduction scheme which is more commonly known as the Government Rebate on health insurance. This section explains that the PHIIB (private health insurance incentive beneficiary) is entitled to a reduction in health insurance premiums if they were to meet certain criteria. The rebate is age-tested and means-tested, meaning that the rebate may increase or decrease based on the beneficiary’s age and/or income. The rebate has been subject to an adjustment factor since 2014 which has incrementally reduced the rebate discount by no more than 1% each year (5D, 5E).

Read more about the Government Rebate on private heath insurance at our article that explains the age and means testing in greater detail and how it might pertain to you.

Section 2-3 outline lifetime health cover loading. It’s interesting that LHC is listed under incentives rather than penalties, although we must appreciate the reasoning behind it. Lifetime health cover loading is the penalty which negatively impacts your private hospital cover cost if you are over 31 and haven’t held private hospital cover, or have had gaps in coverage for any time period longer than 1094 days. The penalty equation is written as (LHC Age – 30) x 2% x Policy Base Rate. This can be simplified as 2 percent penalty for every year over the age of 30.

Of course, Lifetime health cover loading is much more complicated than the snapshot above. Refer to our detailed article on LHC for more information.

Chapter 3 of the Private health insurance Act 2007 – Community Rating

Section 3-2 is about Community Rating, which is one of the most important facets pertaining to private health insurance. Community Rating ensures that a health insurer cannot discriminate the premiums of a policy based on pre-existing health conditions. All Australian citizens and residents are entitled to the same policies at the same price regardless of their medical history. This is in complete contrast to the Life Insurance and Personal Insurance industry which heavily penalizes the applicant based on their medical history or current bill of health, where in some cases the applicant can be outright denied insurance membership. It’s important not to bring the Life Insurance stigma into the realm of health insurance, as they are chalk and cheese.

Health Insurance is not entirely free from discrimination for pre-exisiting conditions. New members must serve a waiting period for any deemed pre-existing conditions that are covered on the policy. The pre-existing waiting period for private hospital cover is almost always 12 months, unless otherwise stated. Once the waiting period has been served the member is then covered for that pre-existing condition (unless it is listed as an exclusion on the policy) and the policy premiums remain the same. Note that served waiting periods carry across to new funds or policies (see section below on Portability).

Community Rating also disallows private health insurers from discounting their products unless otherwise allowed under the act (subsection 66-5(2)). Simplified, this means that a health fund can’t offer any discounts on policy premiums at the funds own discretion. This ensures a fair and competitive environment for all health funds, large and small. Without this element to Community Rating, surely the larger health funds would price out the smaller health funds who can’t afford the loss. That being said, health funds are still able to offer small incentives to join or retain members in the way of a period of free membership. The most common example of this is a free month of membership, or 6 weeks free, the cost of which is absorbed by the health fund from their allocated budget for member acquisition or retention.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

Division 78 of the private health insurance act 2007 – Portability

Portability requirements is possibly the single most important rule around comparing private health insurance and switching to a new policy of health fund. Portability means that an insured person doesn’t have to re-serve waiting periods when switching to a new product, even when it’s with an entirely new health insurance company. This means the member can safely switch onto a new product and remain covered for any services that were included on the policy they transferred from.

There can even be a small gap in cover where upon health funds will still recognize waiting periods served. Most funds will allow no more than a 30 day break in coverage, some even going up to 60 days. This means that you can be briefly uninsured between policies but can still benefit from portability. Sometimes, your previous health fund will allow you to back pay premiums to bring you up-to-date within allowed days for portability to be recognized but this is entirely discretionary.

Not understanding (or not trusting) the portability rule is one of the topmost reasons why many people are still hesitant to compare and switch health insurance. Understanding that this rule is part of federal law and it’s just not possible for a health fund to reject portability – it just doesn’t happen. Comparing and switching health insurance actually keeps the market competitive, healthy and up-to-date. We’ve seen that the poorest value health insurance within the market is most often the out-dated policies that people have remained on for years or decades.

As you can see, the market is actually designed for you to compare and switch health insurance as often as required by your changing health needs and personal budget.

Chapter 5 of the Private health insurance Act 2007 – enforcement

What good are all these rules if the Health Minister of Australia holds no power to enforce them? At any time, the Minster may administer and enforce all the obligations listed under the act. Upon request, the health fund must share key performance indicators, explain operations, respond to inquiries, produce documents and allow open-book investigations of books and records by the minister.

More importantly, the Minister may give orders or directions to the health fund that must be adhered to. This ensures that private health funds are operating fully to their obligations and that they are not partaking in any business practices that put their members at risk. This can go all the way down to reviewing the benefits and cost of a policy and directing the health funds to reduce the benefit or increase the price in order to lower risk and to ensure health funds can afford to pay all claims.

Usually, this makes it extremely unlikely that a private health insurance company operating in Australia will go belly up. In the unlikely event that this occurs, administration is closely carried out by the Private Health Insurance Administration Council (now APRA) and the fund in question is put to sale. A larger, more-stable health fund then purchasing the health fund and its member base. During this time of administration and sale, business is as usual for the members of the fund, claims are paid out and they remain fully covered as per their policy during the entire process.

This has only happened once in Australian health insurance history when newcomer health brand health.com.au went into liquidation and was then sold to GMHBA Limted in 2015. Health.com.au continues to operate to this day as a brand operating under the GHMBA Limited umbrella.

Please note

The Private Health Insurance Act 2007 goes through annual revisions and the content in this article is up to date as of the 6th of January 2020. As revisions are made, we will do our best to review the changes to the act and update and edit the information in this article, whereupon we will clearly display the date of revision. Any revisions to the Act can be found at https://www.legislation.gov.au.

If you would like some health insurance advice, please contact our very helpful health advisers on the form below.

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How the market is designed for you to compare health insurance

Fair Healthcare Alliance — Mon, 23 Dec 2019 05:02:55 +0000

For many Australians, the concept of comparing health insurance switching to a new health policy is perplexing and downright scary. There is a large chunk of the 13.5 million insured people who have been with the same health fund for ten years or more. This begs the question: is staying on the same policy and/or with the same private health insurer a smart investment?

The health insurance market is stimulated by a very important rule that is built into the Private Health Insurance Act 2007. The rule is called Portability, and it applies to all private health insurers in Australia. Portability states that when someone compares and switches to a new health insurance policy they don’t re-serve hospital and extras waiting periods for the things they are already covered for.

As a health insurance adviser for going on ten years, one of the most common scenarios we encounter when speaking to people is that they feel like that they pay too much for their policy and don’t get much back when they claim. There are a multitude of products in the market that qualify as being very poor value, and in most cases those products are the ones that have been around for a long time.

Closed health insurance products

Many people are on closed policies that are no longer available to buy. Health funds technically can’t kick you off a policy until you cancel it resulting in many insured people remaining on out-of-date health insurance products. The issue with a lot of these old products is that they inflate in price every April 1st but the benefits and rebates stay the same.

Many of these closed products were designed for an older market. Prices go up for health services over the years, as dental, physiotherapy, chiropractic, massage and any other claimable health service, and yet some of these closed health insurance policy payouts remain stagnant. As each year passes, the policy cost goes up, the cost for medical treatment goes up, and yet the benefits stay the same.

Health funds release new up-to-date products regularly

Every two to three years, most private health insurers release new products that have been designed to meet the needs of an ever changing market. These products have new names, new combinations of benefits and, most importantly, usually have higher benefits that match inflation of health costs.

It would make more sense for health funds to simply increase their extras rebates by the same amount the policy cost increases. For example, if the April 1st rate rise for the extras product is 4.3%, then the extras rebates should increase by 4.3% as well. This would keep polices in line and customers happy. It simply doesn’t work this way.

Instead, many funds simply leave members on out-dated policies until the customer indicates they are unhappy or may switch to health fund. A great exercise is to compare health insurance and apply to switch to a better policy and watch your old health fund contact you a beg you to stay after they receive the transfer request.

It’d be great if private health insurers contacted members pro-actively to advise of new policy launches with improved benefits but it rarely occurs. Retention teams at the larger health funds are known for being quite retro-active. It’s even been perceived that some health funds bank on their members staying on old policies because it helps manages costs, however, this is just an opinion.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

The Devil You Know Mentality

The ‘Devil you know’ mentality is one of the most detrimental approaches you can have concerning health insurance. This mentality can particularly be found among the senior audience of health insurance. We’ve heard this saying a multitude of times over the years as advisers.

Many people are afraid to switch from the private health fund that they have been with for a long time. It’s understandable that recognition offers comfort and security is important to a lot of people. However, how sure can one be that they are currently with the most reputable and best health fund available to them?

Many stigmas come from the life insurance/personal insurance market- where people are penalized or rejected health care if they have significant pre-existing health conditions- and rightfully so. It’s important not to confuse these two polar industries. Private Health Insurance has a rule called Community Rating, which ensures that all Australians are offered the same health insurance rates regardless of their pre-exisiting health conditions.

Coupled with the rule of Portability (explained at the beginning of this article), you can start to understand that the health insurance market is actually designed for people to compare health insurance often.

The market is stimulated by people who switch health insurance

When you compare your health insurance, you encourage health insurers to remain competitive. All health funds have measurable statistics, one of which is customer retention. Funds don’t like losing members. When you apply to switch to a new health insurance policy, there a number of very healthy benefits:

You initiate contact with your previous health funds retention team

You encourage your previous health fund to be more competitive.

You ensure you are always on an up-to-date health policy with benefits that match your changing needs

At Fair Health Care Alliance, we give transparent and straight-forward advice and can help you with a health fund comparison line-for-line against your current cover. Our co-operative of health funds are chosen for their fair rebates and great value and our advisers have over 20 years of collective experience in the Australian market.

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Is it time to cancel health insurance?

Fair Healthcare Alliance — Thu, 19 Dec 2019 06:23:05 +0000

why are Australians cancelling their health insurance?

Private health insurance is going through it’s biggest challenge yet. Prices continue to increase more than normal inflation and many people are left wondering if the cost justifies the value. Our new generation of youthful Australians are either cancelling our of health insurance or not taking it up in the first place mainly because it’s such a significant expense.

The risk here is that if young and healthy people don’t keep the private health insurance age demographic balanced, then the see-saw will tip. Too many senior Aussies with high-cost health requirements means health funds are forced to increase premiums. After all, joint replacements, open-heart surgery, dialysis, rehabilitation, major eye surgery… this is all the expensive stuff. It’s also all the more reason that middle-aged and senior Australians absolutely need private hospital cover.

Of course, health insurance can be a grudge-buy. Handing over hundreds of dollars per month and getting nothing tangible in return can leave the dopamine receptors in our brains firing blanks. It’s no surprise that more young people are dropping out of the health insurance game when they are conditioned to receiving instant gratification. Couple with the fact that young people are generally fit and healthy, how could private health insurance be of use when it’s never required?

There’s a saying in this industry that still rings true: you never need insurance until you do. The beauty of the Australian health landscape (public and private) is that the many props up the few, the young support the aged, and the healthy contribute more than they ought to so that the sickly don’t go bankrupt. We should be proud of this system. The alternative is to go the way of the American health system… let’s not.

Good Value Health Insurance

Building value into your health insurance is a complex yet rewarding outcome to pursue. Value is a broad term. Value in private health insurance means feeling that the rebates and returns are justified by the cost: you hand over premiums each month, you get something valuable for your spend. A lot of insured Australians don’t feel they get very good value, so we’ve decided to put together a plan to help change that before you go ahead and cancel your health insurance policy.

This is the most misunderstood aspect of health insurance. An annual limit is how much you have to spend on a particular extras category before you are capped. The Rebate is how much your fund actually pays out when you make a claim. For example, a policy might have a 0 annual limit per person for Physiotherapy, but may only payout a rebate per Physio visit when you actually make a claim.

Why should you continue to pay the lions share for such services? Especially considering how much you pay into your health fund. It’s no wonder so many people cancel health insurance as a result.

Many of the bigger health funds are known for dangling high annual limits in front of their customers, but being incredibly stingy on the actual rebates. Often a person won’t realise until they go to make a claim, which can be years after a policy is taken out. The point of claim is where a lot of people become upset with their health insurance. Being on a policy with higher rebates mean you hand over less money for the extras services you use most. Higher rebates = Better Value.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

Hospital Cover: Exclusions and Medical Gap Cover

Getting value out of your Private hospital cover policy is considerably more complex. It’s not as simple as how much your health fund pays for any given procedure. Value from hospital cover comes from what procedures are included or excluded, and how much money you hand over to your private doctor and anaesthetist in the way of their Medical Gap fee.

A key change that can reduce your health insurance premiums is to remove high-cost procedures that you likely won’t need (you might be surprised by the number of people over 50 that are still paying for Obstetrics, Pregnancy and IVF). Gold (Top) Hospital cover can also include Psychiatric services, Dialysis, Weight Loss procedures, and many other clinical categories that you may not need to be paying for.

One of the most common reasons people cancel health insurance is when they are hit with a bank-breaking private doctors gap bill after surgery.

Gap Cover can be an overwhelming topic, but it’s really quite simple. When we give health insurance advice to our customers over the phone, explaining Medical Gap Cover is one of the most rewarding ‘a-ha’ moments of the process. Probably the biggest complaint we hear from our customers is when they’ve finally gone an used their hospital cover for private surgery, and they’ve been hit with a bank-breaking doctors gap bill. It is of paramount importance that you understand gap cover terminology and how it works to help avoid this from happening to you.

Knowing your rights before you go in for surgery, and asking the right gap cover questions at the right time can be the difference between forking out thousands of dollars for a private procedure or not. Of course, being with a reputable private health fund that offers recognisable gap cover options to your doctor is just as important. An example of one of Australias most reputable Gap Cover programs is called Access Gap Cover by the AHSA.

Premiums: staying up-to-date

April 1st every year. Health insurance premiums increase again. Being on a silver or gold hospital cover, or holding a couple/family policy means paying over 0 per month for health insurance is becoming the norm. That’s just not good enough. Coming up with that kind of money can be difficult. More and more Australians are being forced to cancel their health insurance as a result.

We find that the most common reason people are on low-value health insurance policies is that they have remained on the same policy for more than five years. Policies go out of date, people.

The best way to reduce your premiums is to compare health insurance policies with the rest of the market. There are 40 health insurers and new policies are being released almost annually. Staying on top of your health insurance comparisons every 2-3 years is the single most effective way to keep your costs down and your benefits high. It also keeps the health funds on their toes as well, because they are forced to be more competitive when the market is kept healthy by health insurance switchers.

Should I cancel my health insurance?

Fair Healthcare Alliance can help you compare 23 health funds, many of which are not-for-profit. We can help you increase rebates, review hospital exclusions, learn about your Medical Gap Cover, and reduce your premiums. You should certainly undertake this exercise before you cancel health insurance.

It’s impossible to give health insurance advice without speaking to you on the phone, so we’re not going to give you a cheap and indirect online quote. We need to know what’s important to you and what isn’t, what you need and don’t need. Finally, we will help you compare your new policy to your old policy apples-with-apples.

Our customers give us 5-star reviews because we are transparent, honest, and care about you and your family’s need. We walk you through a health insurance comparison and explain everything along the way. Exclusions, excess, ambulance, participating hospitals… you get the picture. Contact us below and we can have a refined, tailored health insurance quote in your hand after a quick chat centred all around you.

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Who is the best health insurance fund?

Fair Healthcare Alliance — Wed, 04 Dec 2019 07:11:44 +0000

Ask anyone that works at a reception desk in the health industry what the most frequently asked question they get asked by patients is. At the top of the list should be “Who is the best health insurance?”.

It’s a very good question and we wish there was an easy answer. The fact of the matter is that it’s a redundant question with too many factors and variables to give a single, straight forward answer. We can certainly try and break it down though.

The best health insurance myth

Consider that there are over 40 private health insurance brands in Australia and that each fund has a unique set of policies that include, and exclude, different things. Fund A might include Pregnancy on their Top level of hospital cover but Fund B might exclude it. Fund C might have really high annual limits for Major Dental but poor dental payouts, and vice versa.

There are so many variables across hospital and extras, it’s almost impossible to spit out an accurate answer to the question of who is the best private health insurance fund without first getting to know who is asking the question.

The Barefoot Investor, Scott Pape, recommended South Australian-based health insurer Health Partners as the best health insurance fund for hospital cover. They are a great health insurer, we agree, but can they be said to be the best? Perhaps the cheapest health insurance as it stands now, but that is likely to change with time.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

An analysis of your health needs.

As an experienced team of health insurance advisers, we know all the right questions to ask in order to efficiently map out our customers’ health needs. We ask a series of questions that seek to pinpoint exactly what level of hospital cover suits your age and health requirements. We ask the same questions about extras needs and lifestyle. Example: do you go to the Physiotherapist? How often do you go? Do you know how much they charge per session? We ask this kind of questions for all the variables across private hospital and extras so that we might match a policy to your unique needs.

There are 38 different private hospital clinical categories and almost just as many different extras services that can be covered. With so many variables, it’s just not possible for any single health fund to cater to every different person’s health needs.

Different shapes and sizes.

Australians come in all different shapes and sizes, with personal and unique health requirements and lifestyle needs. Private health insurance policies also come in all different shapes and sizes too. You’re starting to see that our role as health insurance advisers is to help our customers best match to a policy based on our analysis of your current set of needs and claiming habits.

So who is the best health insurance in Australia?

The best private health insurance company is the one who has a policy that best matches you and your family’s current set of health needs. Health insurance changes like the wind with health funds launching a new suite of policies almost biennially. Considering that your health needs change almost as often, it’s essential that Australians compare health insurance every so often.

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Barefoot Investor health insurance

Fair Healthcare Alliance — Thu, 28 Nov 2019 04:04:59 +0000

Scott Pape recommended that Australians take out private hospital cover with Health Partners. Health Partners is a South Australian based private health insurer that operates as a not-for-profit. We have access to Health Partners and can get you a quote with them within minutes, alongside some other great health funds that may suit you better. We can help you compare your current policy to Health Partners and other funds side-by-side with detail and confidence.

The recommendation for Health Partners was for private hospital cover only on a Gold (Top) level of cover. Let’s start by saying that this is a great policy with a great health insurance fund. That being said, it may not be the best policy for your health needs.

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**Why did the Barefoot Investor recommend Health Partners health insurance?**

When it was written, Health Partners at that time offered one of the most competitive Gold (Top) levels of private hospital cover in the industry. This doesn’t mean that it is the best value policy for every Australian, and caution needs to be applied before signing up for a Gold Hospital cover with any health fund.

The following tables are a comparison of top Gold hospital and top Silver Plus hospital between Health Partners, BUPA and Medibank- Australia’s two largest health funds. Each comparison is made with a standard 0 excess and for a Couple/Family policy (excluding extended family cover for dependents over the age of 25 who are not studying full-time). We also limited the comparison to South Australia, Victoria, Queensland and New South Wales/ACT due to limited space available on the page. If you would like a quote for a 0, 0 or Nil excess, and/or in Western Australia, Northern Territory or Tasmania, please contact us directly.

It’s essential to understand that the following prices do not include the federal government rebate for health insurance, so for most readers the prices would be significantly cheaper. That being said, the price difference between funds are relative with or without the rebate. The following hospital cover prices are up-to-date as of 1st of January 2020 and are subject to change on April 1st 2020.

Important! The prices in the following tables do not include any LHC loading penalties or the health insurance rebate. Please contact us if you would like an accurate price tailored to your situation.

Level	SA	VIC	QLD	NSW	Exclusions
Silver Hospital Plus 0 Excess	8.99	7.97	7.97	6.62	Pregnancy, IVF
Gold Hospital 0 Excess	4.07	3.75	3.75	1.96	None

Level	SA	VIC	QLD	NSW	Exclusions
Silver Hospital Plus 0 Excess¹	0.00	0.60	5.20	1.90	Pregnancy/IVF Weight Loss
Gold Hospital 0 Excess²	7.60	9.60	3.90	0.10	None

Level	SA	VIC	QLD	NSW	Exclusions
Silver Hospital Plus 0 Excess³	7.60	2.70	8.10	3.20	Pregnancy/IVF Weight Loss Psych (R) Pain Management
Gold Hospital 0 Excess⁴	1.80	8.00	2.30	3.10	None

¹ Official BUPA policy name is Top Hospital No Pregnancy with 0 Excess – Silver Plus
² Official BUPA policy name is Top Hospital with Pregnancy 0 Excess – Gold
³ Official Medibank policy name is Silver Plus Security
⁴ Official Medibank policy name is Gold Complete Hospital

In the tables above, we can see that Health Partners is in fact the lower costing policy in all but one category. BUPA has a slightly lower costing Gold Hospital 0 excess in South Australia. For the Australian states we compared, Health Partners Silver Plus 0 excess hospital was not only lower costing (especially in Victoria and Queensland) but has fewer exclusions than BUPA (also excludes Weight Loss surgery) and Medibank (also excludes Weight Loss surgery, Pain Management and Psychiatric is restricted).

This certainly justifies the claim made by the Barefoot Investor that Health Partners is a great value health fund for hospital cover. Are they the best value compared to the other 37 odd health insurers in Australia? Some funds are more competitive in certain states, on certain levels of cover and with different combinations of exclusions and extras. It really is much too general and presumptuous to make a blanket statement about health insurance like the Barefoot Investor did.

Portability

Noun

Don’t re-serve waiting periods when you switch to a new health fund or policy *

“John was immediately covered for a hip replacement in private hospital because he had already served his waiting periods for joint replacements on his old policy”

* Read more about how portability works.

Why should I get health insurance advice before signing up to a policy recommended by the Barefoot Investor?

Every person has different health needs in relation to private hospital cover. There is no one-size-fits-all policy and there never will be. Gold hospital covers every single clinical category, including pregnancy. Many people don’t need pregnancy covered, so they may benefit more on a Silver Plus level of cover.

Let’s not exclude the fact that we have completely disregarded Basic, Bronze and Silver levels of hospital cover, policies that are designed for a younger demographic that don’t need pregnancy. The Barefoot Investor specifically recommended Health Partners Gold level of health insurance, but what about the readers who don’t need premium hospital cover? When comparing health funds, it’s really important to get a holistic view of your health requirements and looking at the bigger picture. With all things considered, it’s unlikely that Health Partners will always be your most competitive option with the best value to match your claims and peace-of-mind.

Also, health funds rarely remain in the top position for cost VS value for too many years running. As more and more people join up onto the policy, it increases how many claims are made, the risk and therefore puts compounding pressure on the fund to increase the premiums on that policy.

Should I join Health Partners based on the Barefoot Investor’s health insurance advice?

There’s no short answer to this. Health Partners is a great, non-profit health fund with great value hospital cover as it stands now. However, Health Partners extras benefits may not suit your health needs, especially if you reside outside of South Australia. As a transparent health insurance comparison service, we can get you access to a Health Partners quote alongside some other great Australian health funds too

There are over 40 health funds in Australia, all with different policies to match different health shapes and sizes. It’s a golden truth in this industry that there is no such thing as a “best health fund”.

Here is a link to another of our articles that explains that asking “Who is the best health insurance fund?” is the wrong question to ask.

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