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:
- 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.
- 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.
- 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.