Notice To Patients with Private Health Insurance – April 2018

BUPA Australia & HBF Announcement

The current publicity surrounding the announcements by both BUPA Australia and HBF regarding the (potential) exclusions from your policy for the following categories of surgery: Hip and knee replacements, cataracts, pregnancy and IVF treatment, obesity and “some” plastic surgery has caused an outcry from patients, doctors, hospitals and the minister for health.

Initially, BUPA announced this was for everyone, but this was subsequently revised to include all policyholders with levels of cover except their “top table cover” policies. HBF has followed suit.

In addition, BUPA further announced that your policy would only be covered if your surgery was performed in a hospital nominated by them. This means that if your surgeon does not work in one of BUPA’s nominated hospitals, then you would either need to find a different surgeon or have your surgery but not be covered by BUPA.

This is an unacceptable situation, and hopefully, these decisions will be reversed. However, it does appear that the Australian Private Health Insurers are attempting to reduce what they pay out for, while at the same time, increasing their premiums. Dr Goldman believes that this is inevitable.

Dr Goldman’s recommendations are:

  1. Make sure you have “top cover”. Whatever health insurance fund you are with, unless you have “top cover” you will not receive benefits or will receive reduced benefits. In other words, either you will not be able to claim at all, or if you can, the amount you will receive back from your health fund will be very reduced.
  2. Change from BUPA to another health fund. If you are a fully paid-up member of 1 fund, you will be able to change to the same level of cover with another fund WITHOUT a waiting period. YOU MUST CHECK THIS WITH THE NEW FUND. BUPA is, without doubt, the most frustrating and challenging health fund to deal with and always attempt to pay out the minimum.
  3. Assume that your surgery may not be claimable on you private health policy if you do not have top cover. In this situation, you will need to pay for the surgery, anaesthetic and hospital costs in full up front and then claim afterwards. If you do get anything back from your private health insurance as well, this is a bonus.

This information is Dr Goldman’s opinion and advice based on the recent publicity and trends within the private health industry as well as his practice’s dealing with private health funds over the years.

What You Need to Know About Health Insurance and Cosmetic Surgery

Cosmetic surgery is often associated with facial alterations, boob jobs and other elective and appearance-based procedures.

But what most people don’t know is that there is a huge range of cosmetic treatments and operations that can be considered completely medically necessary.

Medically necessary procedures can be covered by your private health insurance, so when the time comes to fund your cosmetic surgery, it’s really important to understand the distinction between necessary and elective procedures. Here’s how:

Figure out which one’s which

Much of the distinction between whether something is necessary or elective comes down to whether it’s deemed to be medically necessary by a professional.

Reconstructive plastic surgery is typically used to correct a range of abnormalities, whether they’re congenital or acquired, or to repair trauma damage that has occurred as the result of an accident.

At the end of the day, if a doctor or specialist formally recommends surgery, there is a high chance that it will be recognised by your health insurance provider – or at the least, Medicare – as something that warrants a rebate.

health insurance

Know what you can claim back

There are a few kinds of procedures that a comprehensive private health insurance policy should typically provide cover for (depending on the level of cover you opt for):

  • Surgeries for congenital abnormalities (conditions that exist at or before birth).
  • Reconstructive surgery following an extreme burn.
  • Surgeries for traumatic injuries.
  • The removal of cancers or tumours (or surgeries that follow the removal of cancers or tumours, such as a post-mastectomy reconstruction).
  • Procedures that repair scars or skin lacerations.

Get the best value from your health insurance

Don’t be so quick to exclude or restrict plastic surgery from your policy. While in the short term it may help you to save money on your premiums, you can never predict whether you might need surgery in the future.

It’s also a good idea to remember the distinction between reconstructive plastic surgery and elective cosmetic surgery when reviewing your policy. Some people find it easy to get confused and will accidentally remove reconstructive procedures from their cover.

If you’re looking into taking out a higher level of cover, compare health insurance policies for cosmetic surgery online to make sure you’re getting the best value for your money.

Know your options

There are three main private health insurance options for plastic and reconstructive surgery. You can:

  • Take out a comprehensive policy that covers reconstructive plastic surgery.
  • Choose a policy that offers restrictive cover for reconstructive plastic surgery in order to lower your premiums.
  • Choose a policy that excludes cover for reconstructive plastic surgery altogether.

What you choose is completely up to you. If you’re unsure of where to seek advice, have a look at the Ombudsman’s website.

Bessie Hassan

Written by Bessie Hassan

Bessie Hassan is’s resident Insurance Expert.