FAQs Re Private Health Insurance in Australia
While Billy Explores is the expert in all things private health insurance comparison in Australia, the Australian government still has the final say in all things private health insurance, including overseeing private health insurance providers. We thought that we would take some of the Frequently Asked Questions from the Private Health Insurance government website, and replicate them here with some Billy Explores flair thrown in! The Australian government also recommends that Australian citizens do a regular private health insurance comparison as well.
See, Billy Explores knows that even the government wants to get a better deal on their private health insurance!
Medicare and Private Health Insurance
We’re just adding this in ourselves here, as the government doesn’t cover the difference between Medicare and Private Health Insurance. However, Billy has you covered, as we’ve already covered the difference between Medicare and private health insurance in great detail here. Of course, feel free to send any more questions you have regarding Medicare vs private health.
Covering Dependants To Age 31 And Covering Dependants With A Disability
The Government previously announced that it will increase the maximum age of dependants for private health insurance policies from 24 to 31 years and remove the age limit for dependants with a disability. These changes were passed by Parliament in June 2021. It is optional for insurers to implement these policy changes. Consumers can search this website for the new policies.
What is the definition of a dependent?
It will be up to individual insurers to define a dependent in their policies. However, the legislation outlines certain requirements for some aspects of the definition, including age ranges and partner status. While the legislation defines a dependent as a single person aged from 18 to 31 years, an insurer can choose to define and implement their own age range for dependants. For example, an insurer that currently has a maximum age for dependent as 24 years in their insurer rules, may increase the maximum age to 29 years rather than 31 years.
What is the definition of a dependant with a disability?
The legislation defines a person with a disability as a participant in the National Disability Insurance Scheme (NDIS) who is aged 18 years or over. They may have a partner. However, insurers will have some discretion to offer cover to people with a disability who are not participating in the NDIS.
For more information, see the Department of Health and Aged Care website.
Billy’s notes: you can still do a private health insurance comparison no matter the age of your dependents. This is also a good idea if you’re looking for private health insurance for sports injuries.
Medicare vs Private Health Premium Increases
Premium increases usually occur in April of each year. From 1 April 2022, private health insurance will increase by a weighted industry average of 2.7%. Not all products will change by the same percentage – some products may be offered with either a lower or a higher price change when compared to the industry or your insurer’s average. If your premium is increasing, your health insurer is required to notify you in writing with updated policy information and more information about the change.
Note that the Australian Government Rebate is adjusted each year in late January. Because of this, insurers are not able to provide definitive information on premium changes until February 2022. Your insurer will contact you if they are making any premium changes. You can also contact your insurer for advice about your premium.
Billy’s notes: premium increases should be a major driver for Aussies to do a private health insurance comparison. You can also compare extras cover health insurance.
Coronavirus (COVID-19) update
If you are experiencing financial hardship and finding it difficult to pay your premiums, please contact your insurer. Some insurers are offering premium waivers or membership suspensions for members affected by the pandemic.
For the latest information on COVID-19, please see www.health.gov.au. For information on the COVID-19 vaccine, please see the Department of Health and Aged Care website.
Billy’s’ notes: If you’re in isolation or have experienced Covid and didn’t have private health insurance, it would be a great idea to start comparing health insurance in Australia!
Medical Costs Finder
The Medical Costs Finder is an online tool that is an initiative of the Australian Federal Government. It lets you find out more about the cost of specialist medical services.
It covers common services in and out of hospital that patients want to know more about.
The tool’s results are based on the most recent publicly available Government data about what people have paid for medical services. Select the link below to find out more about this tool and to use the Medical Costs Finder.
Please note this link will take you away from the PrivateHealth.gov.au website: Medical Cost Finder
The Australian Government has announced the Medical Costs Finder tool will be enhanced as part of a suite of private health insurance reforms.
Billy’s notes: This is a great initiative to compare medical providers. Just be aware that sometimes gap fees will still need to be paid. Keep this in mind when you start comparing health insurance in Australia (and doing an extra insurance comparison of course).
Mental Health – waiting period exemption for higher benefits
If you are on a hospital policy which provides restricted benefits for psychiatric care, then to access higher benefits you usually upgrade and complete a two month waiting period.
However, from 1 April 2018, you can upgrade without having to serve this waiting period to access higher benefits for psychiatric care in a private hospital.
This exemption applies only once per lifetime and can only be accessed if you have already completed an initial two months of membership on any level of hospital cover.
For more information about accessing the exemption, please contact your health insurer.
Billy’s notes: another great question to ask when you’re looking to compare health insurance in Australia.
What Should I Look Out For When Reviewing My Private Health Insurance?
The Private Health Insurance Ombudsman recommends reviewing your policy at least once a year – your circumstances may change from time to time, so it’s important to review your health insurance policy regularly to make sure it still meets your health needs. For example, if you chose a hospital policy with restricted or excluded hospital services, you may want to increase your hospital cover as you reach certain life stages.
Billy’s notes: we’ve done a great article about that here. So make sure you know what you’re looking for before you compare health care providers and do a private health insurance comparison in Australia. As long as you know the differences between Medicare and Private Health Insurance you will be fine.
I’ve Just Turned 30; Do I Have To Purchase Private Health Insurance?
Private health insurance is optional – however if you don’t purchase hospital cover by the 1st of July following your 31st birthday, you will pay the Lifetime Health Cover loading on top of the premium of any hospital cover you later purchase.
Billy’s notes: Another handy article here for you about turning 30! Of course, why not use it to prompt you to do a health insurance comparison. If you don’t need hospital cover, just do an extras cover comparison.
I’ve Just Become A Permanent Resident; Can I Purchase Private Hospital Cover Without Lifetime Health Cover Loading?
Yes. If you are over 31, you have one year from the date you registered for your first interim (blue card) or full (green card) Medicare benefits to purchase private hospital cover without incurring a loading.
If you are under 31, you have until the 1 July following your 31st birthday to purchase private hospital cover without incurring a loading.
Please note that general treatment (extras) cover, overseas visitors’ cover, overseas student cover or international health cover does not qualify for Lifetime Health Cover purposes.
Billy’s notes: Perfect! We would love to help you compare health insurance in Australia and get the best value health insurance for your needs!
I’ve Just Received A Letter About Lifetime Health Cover. What Do I Need To Do?
Each year, the Department of Health and Aged Care posts letters to Australian citizens and permanent residents who recently turned 31 or registered for full Medicare benefits. The letters are sent to inform you about the Lifetime Health Cover (LHC) rules, which may affect whether you decide to purchase private hospital insurance.
Please note that general treatment (extras) cover, overseas visitors’ cover, overseas student cover or international health cover does not qualify for Lifetime Health Cover purposes.
Private health insurance is optional in Australia but you should be aware that if you want to join, the cost of hospital insurance will vary depending on your age:
If you have turned or will turn 31 during the 2021-22 financial year – You have until 30 June 2022 to purchase private hospital cover without incurring LHC ‘loading’. If you purchase hospital insurance from 1 July 2022 onwards, then you will incur a loading which increases the cost of insurance. The older you are at the time of purchase, the higher the cost. If this applies to you and you have already taken out eligible hospital cover, then you don’t need to take any further action.
If you are aged 31 or over, and you registered for interim or full Medicare benefits (usually a blue or green card) during the 2020-21 financial year – You have until the first anniversary of the date you registered for your Medicare card to purchase private hospital cover without incurring LHC ‘loading’. If you purchase hospital insurance after the anniversary date has lapsed, then you will incur a loading which increases the cost of insurance. The older you are at the time of purchase, the higher the cost. If you start private hospital cover within 1 year of Medicare registration, you will need to confirm your registration date by requesting a letter from Medicare – contact Medicare (Services Australia) or visit your local Medicare branch. Supply the letter to your health insurer on or after joining to have your loading reassessed.
Some exceptions may apply if you are overseas on your LHC deadline day.
I already have hospital insurance – do I need to take any action? If you already have hospital insurance and the correct LHC loading has been applied to your policy, then you don’t need to take any further action. If you are not sure if the correct LHC loading has been applied, or if you think there has been an error, contact your health insurer for more information.
If you are experiencing financial hardship due to COVID-19, please contact your insurer or potential insurer to discuss your options.
Billy’s note: Of course we are going to recommend our article for more handy information! Once you’re armed you can do a private health insurance comparison.
I’m Applying For A 482 or 485 Visa; Do I Need Private Health Insurance?
Yes. It is a condition of applying for a Visa Subclass 482 or 485 to make arrangements for a minimum level of health insurance.
Billy’s note: everyone should have private health insurance following a compare health insurance providers in Australia through Billy Explores.
I Am Visiting Australia From Overseas; Do I Need To Take Out Health Cover?
Even if it’s not a requirement under your visa, it is well worth considering taking out cover. If you need to visit a doctor or stay in hospital while you’re here, you could be responsible for the full cost of treatment, which can be very expensive.
If you are visiting from a country that has a reciprocal health care agreement with Australia you may be eligible to receive immediate necessary treatment in Australia’s public system Medicare, but should still consider taking out cover.
Some visas may require you to hold private insurance while you’re in Australia, such as the 482 visa, 485 visa, or the temporary student visa.
I am a student from overseas coming to study in Australia; do I need to take out health cover?
If you are coming to study in Australia on a temporary student visa it is a condition of your visa to take out appropriate health cover. Students from Sweden, Norway, or Belgium may have special arrangements.
Billy’s note: welcome to Australia! – enjoy your visit! Unfortunately this is the one area where we can’t help visitors to do a health insurance comparison.
What is the Private Health Insurance Rebate?
Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums. The rebate, known as the Australian Government Private Health Insurance Rebate, is aged-based and income tested. The rebate is available for people with Medicare eligibility. If you have a Lifetime Health Cover loading, the rebate does not apply to the LHC loading portion of your premium.
If you are eligible for the rebate, you can have the rebate automatically deducted off your premiums or claim it back at tax time.
Billy’s note: one of the differences between Medicare and Private Health Insurance. It’s almost enough to make you want to compare health insurance through Billy Explores.
Do I Have To Pay The Medicare Levy Surcharge?
The Medicare Levy Surcharge (MLS) is levied on payers of Australian tax who do not have private hospital cover and who earn above a certain income. Currently, the income threshold is $90,000 for singles and $180,000 for couples and families.
To be exempt from the surcharge, your hospital cover must be held with a registered health insurer and must cover some or all of the fees and charges for a stay in hospital. General treatment cover without hospital cover will not provide an exemption. See Medicare Levy Surcharge for further information.
Billy’s note: again, a difference between Medicare and Private Health Insurance. Now you definitely want to compare health insurance through Billy Explores.
Changes to Private Health Insurance
The Australian Government announced on 13 October 2017 a wide-ranging package of reforms to private health insurance.
Since 1 April 2019, health insurers can offer Age-based Discounts for people aged 18-29 years, increased maximum excess levels, and travel and accommodation benefits under hospital policies. Some natural therapies were removed from coverage.
Since 1 April 2020, all hospital policies fall under the tiers of Gold, Silver, Bronze, and Basic. All policy information is now presented in the Private Health Information Statements (PHIS) format. For more information, see: Product tiers and Clinical categories.
In 2021, private health insurance laws were amended to increase the maximum age of dependants for private health insurance policies from 24 to 31 years and remove the age limit for dependants with a disability.
Now That’s Done – Let’s Do A Private Health Insurance Comparison Through Billy Explores.
So, we have some FAQs from the Australian government, and you know a little bit more about Medicare vs Private Health Insurance and the differences between Medicare and Private Health Insurance. It’s time to see if you can get a better value health insurance policy for your needs and compare health insurance through Billy Explores. Even if you want to do an extras health insurance comparison only, you’re more than welcome to do that!
NB questions replicated from Private Health FAQs – Australian Government website.