Private Health Insurance Report Card 2016

Richard Laycock 17 March 2016

Australian Medical Association report to help consumers understand what their health funds actually cover.

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The Australian Medical Association (AMA) has released its first annual report the Private Health Insurance Report Card 2016, which is giving consumers a glance at the costs private health funds will cover for 22 common hospital procedures.

The report is designed to highlight the real differences in the benefit amounts insurers pay for medical services. The data is a compilation of the procedure pricing available from the private health insurers’ websites. The NSW benefits lists for Bupa and AHSA was used.

The data used for the AHSA represents various funds including ACA, Australian Unity Health Limited, Budget Direct, Frank, Onemedifund, Peoplecare Health Insurance, Transport Health and Westfund. Though for the purpose of the report, the AHSA does not include HBF or GMHBA products.

With so many health insurance policies in the market, the AMA hopes that the report will allow consumers to know their policies better and discard policies on offer that provide public hospital only cover.

The report's timing coincides with the annual rise in health insurance premiums. The report will provide consumers looking to save money by switching policies with a deeper look into the policy features and insure that they're not getting sold a lemon of a policy.

Who were the best performers on the Private Health Insurance Report Card?

HBF was the best performer of all of the funds, providing consumers with the highest benefit in nine out of the 22 categories, ranking first for carpal tunnel release, cataract surgery, complicated delivery (of baby), craniotomy, cytotoxic chemotherapy, overnight investigation for sleep apnoea, tonsils or tonsils and adenoid, uncomplicated delivery (of baby) and vaginal hysterectomy.

Coming in a close second were the funds represented as AHSA (NSW), who ranked first in seven categories including basal cell carcinoma or squamous cell carcinoma removal from nose, eyelid, lip, ear, digit or genitalia, cholecystectomy, coronary artery bypass, femoral on inguinal hernia, haemorrhoidectomy, knee replacement and stent for coronary artery. Complete table at the end of the article.

Who did the best overall?

In analysing the funds as a whole, we ranked the funds out of eight to get an idea on which fund performed the best overall. As you'd expect after ranking first in the most categories, HBF came in on to with an average ranking score of 2.59 out of 8 across all categories. St.LukesHealth came in second scoring 2.68. St.LukesHealth ranked first on three occasions and never dipped below forth.

FundAverage rank
HBF2.59
St.LukesHealth2.68
BUPA (NSW)2.77
AHSA (NSW)3.18
Medibank/AHM5.09
NIB5.32
MDHF6.68
GMHBA6.73

Who were the worst performers?

The worst two performers overall were MDHF and GMHBA, who failed to rank higher forth, with GMHBA providing the lowest benefit in 19 out of the 22 categories.

Surprisingly neither Medibank or nib, who are two of the largest funds in Australia, ranked first for the highest payout. Additionally, neither fund provided above average benefits across the board.

According to a new report by the Australian Institute of Health and Welfare, hospital admissions increased on average 3.2% each year for public hospitals and 4.0% for private hospitals between 2010-11 and 2014-15. However, over the same period admissions for public patients only increased by an average of 2.7% each year, compared with 5.9% for admissions funded by private health insurance. With admissions funded by private health insurance on the rise it highlights the need to understand the costs before being treated.

Full list of funds and performance

ProcedureMBSHBFSt.LukesHealthAHSA*BUPA*Medibank#nibMDHFGMHBA
Appendicectomy$445.40$614.45$629.45$632.10$635.45$609.95$597.45$534.50$534.40
Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genitalia$221.35$335.85$311.85$366.10$315.80$303.15$296.90$265.65$265.65
Breast, benign lesion surgical biopsy of excision$260.05$355.20$367.25$356.40$380.55$355.30$348.80$312.10$312.10
Carpal Tunnel Release$276.80$459.05$426.80$440.20$453.75$404.90$417.55$332.20$332.20
Cataract Surgery$760.55$1,242.25$1,163.30$1,239.70$1,184.20$1,126.25$1,144.90$912.80$912.80
Cholecystectomy$739.35$1,019.80$1,045.10$1,091.90$1,054.85$1,012.45$993.60$887.25$887.25
Colonoscopy$334.35$456.45$461.95$435.00$470.25$442.50$429.80$401.22$401.22
Complicated Delivery (of baby)$1,629.35$2,649.15$2,307.90$1,855.90$2,406.65$2,198.50$2,280.10$1,955.20$1,955.25
Coronary Artery Bypass$2,200.00$3,665.20$3,404.40$3,783.30$3,294.85$3,265.15$3,064.80$2,640.00$2,640.00
Craniotomy$1,586.75$2,631.75$2,443.70$2,420.80$2,602.05$2,322.10$2,393.60$1,904.10$1,904.10
Cytotoxic Chemotherapy$97.95$127.55$119.60$107.80$118.05$115.30$111.00$117.55$117.55
Femoral on Inguinal Hernia$464.50$640.60$657.50$909.70$662.70$636.05$623.05$557.40$557.40
Haemorrhoidectomy$367.75$502.25$524.65$602.90$517.20$503.80$472.75$441.30$441.30
Hip Replacement$1,317.80$2,146.75$2,318.15$2,214.50$2,094.35$2,000.75$2,013.85$1,581.40$1,581.40
Knee Replacement$2,047.60$2,146.75$2,318.15$2,563.40$2,094.35$2,000.75$2,013.85$1,581.40$1,581.40
Overnight investigation for sleep apnoea$588.00$747.65$707.85$682.20$703.45$694.25$709.40$705.60$705.60
Tonsils or Tonsils and Adenoid$295.70$522.05$493.85$513.90$481.30$472.35$442.65$354.85354.85
Uncomplicated Delivery (of baby)$693.95$2,150.35$1,979.05$1,484.50$2,057.05$1,886.95$1,550.60$832.74$832.74
Vaginal Hysterectomy$674.70$1,252.85$1,024.65$1,066.20$1,076.80$986.20$1,012.05$809.65$809.65
Varicose Veins$109.80$149.95$169.05$164.80$164.45$160.70$148.35$131.80131.80
Vasectomy$229.85$317.20$365.95$343.80$353.15$348.95$349.30$275.85$275.85

*NSW, #AHM

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