In-adequate cover for treatment required!

Every day in our surgery, we see patients who are increasingly becoming more and more frustrated with their health fund provider. Complicated policies lead to confusion, and often results in the patient paying costly monthly premiums and receiving a lack of return on the investment.

Health insurers increase their premiums every April, with up to an anticipated 4.49% increase expected this year across all providers. A substantial increase especially if your fund isn’t working for you. Whilst you are unable to avoid the price rise, it is advisable to review your policy annually to determine if the policy selected is still the right fit.

Who is the best? Are you getting the most from your fund? Is it worth having insurance? Hospital and/or Extras cover? All viable questions which often leads to the mind-boggling task of sifting through policies. Not exactly the most fun filled way to spend an evening. It’s easy to see why many patients take the first policy they come across that is the cheapest, or offers enticements (such as first month free).

The first mindset to overcome, there is no one insurer, or policy, that is ‘the best’ for everyone.

The ‘best’ policy is one that covers YOUR needs at a price you can afford.

Prepare a health fund shopping list

Make a list of what is important and the services you need. This will allow you to remain focused, avoid gimmicks, and purchase a policy that will WORK for you.

  1. Is “extras” cover necessary? How often do you anticipate seeing a dentist, or physiotherapist during the course of the year? If the answer is rarely, maybe a standalone hospital policy is the answer? Treatments for auxiliary services can then be paid for out-of-pocket on the day and when required. If only one or two auxiliary services will be utilised, consider a policy that allows flexibility to choose where you want your limit to apply.
  2. Are you sufficiently covered? Do you need major dental work or do you find a check-up and clean is the extent of your dental requirements? Most health insurers apply two separate limits for dental treatment, general dental (fillings, check-ups and cleans) and major dental (root canal treatment, crowns, dentures, dental implants). Understanding the difference between the two areas will save you money, and help avoid the shock of paying “out-of-pocket” for treatment you thought was covered.
  3. Are your limits, well limiting? There is no point having $2000 general dental coverage when you require $3000 major dental treatment – and you have a $200 limit! Compare the treatments you require with the health insurer’s annual limits. Remember, to fine tooth the policy to ensure there are no further restrictions based on treatment. For instance, your policy may have $1000 limit towards major dental, but a crown may have a $400 maximum limit applied.
  4. Most policies will have some treatment restrictions which means you aren’t covered for that service. If the main purpose for taking out insurance is to be covered for certain treatment, ensure that you are.
  5. Are your circumstances likely to change? A policy that has worked for you in the past may not be the best answer in the future. Always be aware of ‘waiting periods’ and ensure you change your policy with sufficient time to be covered.
  6. Consider the next level. Insurances are generally sold in packages and priced accordingly. Sometimes a premium may offer significantly more benefits or limits for a little extra per month.
  7. Rebates. How much are you prepared to pay out-of-pocket for treatment? Most funds will cover between 50 – 90% of treatment costs with the patient paying the remainder on the day of service.
  8. Become familiar with terminology. “Limits” and ‘rebates’ are the two terms that seems cause the most confusion. By understanding your policy, you are less likely to be caught out when you need it most.

If you find yourself questioning the validity of health insurance, the Australian Dental Association have launched a campaign Time2Switch. The site has the ability to compare policies and is stocked with articles that may help you navigate through the health fund selection criteria.

If you choose to take out health insurance for dental work, Greenvale Dental Group accepts all health funds and provided a valid health fund card is produced at the time of treatment, patients can claim o-the-spot with Hicaps.