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6 questions to help you find the right health insurance

Make the process of finding health insurance a snap with these 6 questions

It's easy to feel slightly overwhelmed when starting the search for health insurance or reviewing your existing policy. Sorting through policy combinations, features, premiums and terms and conditions can be made easier by knowing what to focus on and the questions to consider when comparing cover.

This guide will run through 6 key questions to keep at front of mind when looking at cover to simplify the comparison process.

Know what you will be paying

1. What are the premiums, fees and excess?

These are the three main costs involved with health insurance policies. Premiums are your ongoing, regular payments while the excess is a flat sum you’ll have to pay when making a claim. Fees, meanwhile, can apply in different circumstances. Ask your insurer what the premiums, fees and excess will be for a policy.

  • Your insurer should typically describe premiums as annual or monthly costs. Find out whether premiums are the same across all payment plans and ask for a breakdown of loadings and discounts if possible.
  • Not all health insurance policies have an excess, and some may offer lower premiums for higher excesses, or higher premiums with lower excesses. Sometimes differing excesses might apply to different treatments. Ask questions about the excess until you’re clear on how it applies to a policy and how it may be affecting the cost of the premium.
  • Ask about all fees. Many health insurance funds will be able to provide a sheet that lists all fees that may apply. Group these into unavoidable fees and avoidable fees, and consider how much you will typically be spending on fees per month or year.

Sometimes a tempting policy with low premiums might have higher fees or a larger excess. By specifically asking about premiums, fees and the excess you can get a more thorough understanding of all the costs, and not just what’s mentioned in the brochure.

Understand the cover you have

2. What does this plan offer that Medicare doesn’t?

Medicare is public health cover available to Australian citizens and permanent residents. It is generally effective at covering essential and emergency hospital treatments at public facilities. Medicare is the alternative to private health insurance, so asking this question is a lot like asking “is private health insurance worth it?” In the answer, look for:

  • Which treatments are covered by that health insurance policy, but not covered by Medicare
  • What advantages the health insurance policy offers when undergoing essential treatments that are also covered by Medicare

3. Which hospitals can I access with this policy?

Health insurance policies require choosing between public and private hospital. Going public is typically cheaper, but going private can offer some advantages. When you choose private your insurer will usually have a list of specific “agreement” or “network” hospitals that you can use. Ask them which hospitals you can access with your policy to know:

  • Whether it is a public or private hospital policy. It should be fairly evident, but asking this question lets you get confirmation
  • Which private hospitals you can use. Some private hospital policies might not be suitable because there are simply no network hospitals in your area. You may wish to look for an insurer that has an agreement with your nearest or most-preferred private hospital

4. How are routine procedures covered?

It can be advisable to pay special attention to how a health insurance policy covers routine procedures and preventative examinations such as dental check-ups, mammograms and immunisations. This is because they are often not covered by health insurance, but are important and potentially expensive preventative measures.

  • Different insurers and even different policies from the same insurer may cover routine procedures very differently. Getting a thorough understanding of this may involve playing “spot the difference” with a lot of policies which can be very time consuming. Instead, try asking this question for an easier explanation of which policies do what.

5. Is ambulance cover included in the extras or the hospital part of the policy?

Ambulance rides, including flying doctors and helicopter medevacs, are not covered by Medicare except in QLD and TAS. If you are in one of these two states you can skip this question, but if you’re anywhere else you may want to ensure you have this important cover. Depending on the insurer, ambulance cover can be found in either the hospital or extras section of the policy. Ask about it specifically to confirm that you are covered and to help you better compare policies.

  • If you only want cheap, public hospital health cover and no extras then you probably want to avoid insurers who include ambulance cover under extras.
  • If you are prioritising extras cover and relying more on Medicare for public hospital cover, then it might be preferable to look for ambulance cover under extras rather than under hospital.

Know the policy terms and conditions

6. What are the limits, waiting periods and relevant exclusions?

The waiting periods refer to how long you need to wait after taking out a policy before you can make a claim, the limits are the maximum value of treatments you can claim per year and exclusions are conditions where the insurer may refuse a claim. These can have a significant impact on cost and benefits, and between the three of these you can get a reasonable understanding of some of the main terms and conditions to watch out for.

  • Sometimes each procedure will have its own waiting period, typically 2, 6 or 12 months. Being aware of these before getting cover can be particularly important for extras policies because getting the most value for money out of them often involves planning in advance.
  • Limits can also apply separately to different procedures. The limits are possibly the biggest constraint on the actual value of an extras policy and should be taken into consideration before taking out cover. If you know you will be making specific claims in the future, consider how the limits will affect these.
  • Your health insurance fund can refuse to pay claims if they fall under a relevant exclusion. Some of these will be general, such as a requirement that you obey the terms of the policy. However, others may be very specific and might only apply to you, such as an exclusion for diabetes-related surgery for diabetics.

If you’re not sure, just ask. Health insurance is a competitive area and you may be surprised at the level of customer service that is on offer. The same can even apply to health insurance deals and discounts. After you’ve asked insurers these questions, you might feel free to try asking for options to customise your cover, match competitor discounts or even for a better deal. Many will say no, but you may be surprised at how many say yes. This, too, can tell you a lot about the insurer and the nature of your cover.

Compare your health insurance options online or with help from an adviser

Picture: Shutterstock

Andrew Munro

Andrew writes for, comparing products, writing guides and looking for new ways to help people make smart decisions. He's a fan of insurance, business news and cryptocurrency.

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