In this article, we will see how private health cover works. Australia is regarded as “the lucky country,” which is also true of our healthcare system. We can receive free medical care in public hospitals as public patients through Medicare and discounted prescription medications and GP visits.
Medicare, however, does not cover all of the expenses associated with maintaining your health. Private health insurance fills in these gaps left by Medicare by assisting you in financing your medical requirements.
At nib, we see ourselves as your health partner, assisting you in maintaining your best health and being there to help you when you need it as you navigate the frequently complex healthcare system. As a result, we have created a health cover explainer to aid you in choosing the best option for your current situation.
What exactly is health insurance, to begin with?
You can acquire private health insurance from a licensed health insurer like nib. Private health insurance comes in three primary flavors: Hospital cover, Extras cover, or a combination policy that includes both Hospital and Extras cover.
You might be able to: Use a private health insurance policy, depending on the amount of coverage you choose:
- Get a private hospital-like treatment
- Have more control over your care in a private hospital setting, including your lodging and the surgeon performing your procedure (subject to availability)
- Get a benefit for medical treatments not covered by Medicare, such as visits to the dentist, podiatrist, or physiotherapist
- Having access to emergency ambulance transportation
- If you require non-emergency surgery, avoid the public hospital waiting list.
What is covered by private health cover?
- Advantages of a hospital stay
If you live in Australia, Medicare and your hospital health insurance will help you pay for the costs of your care as a private patient. If you think you might need to visit the hospital in the future, it’s best to phone us at 13 16 42 and talk about your choices because nib has a team of health insurance experts on staff who can help you minimise or eliminate any out-of-pocket costs related to your hospital stay.
If you visit one of the hospitals covered by the nib Agreement (or any other public hospital as a private patient) and your chosen level of coverage includes your procedure, nib will provide benefits for:
- Your bed in the hospital, along with a private room if one is available
- theatre operating costs
- Fees for intensive care
- pay for labour wards
- Typical therapies and auxiliary therapies
- Related medical care for complications and related unplanned medical care
- Coverage for urgent ambulances
You can be in for the most expensive ride of your life if an ambulance is on its way to you in an emergency. You’re in for a surprise if you’re one of the 30% of Australians who believe Medicare will cover the expense.
If your State Government does not provide coverage for you, nib offers unlimited emergency ambulance coverage regardless of the Hospital or Extras Cover you select3. If you join nib, you will receive the assistance you require whenever and whenever frequently you require it.
- Emergency protection
All Australian citizens and the majority of permanent residents are entitled to free healthcare at public hospitals, including emergency care; however, if you require additional care after your first admission, there may be a wait time. Avoiding waiting lists at public hospitals may help you save time and money because waiting for treatment has the potential to negatively affect so many chapters of your life, including your ability to work.
If you seek medical attention from a doctor or go to the emergency room within 72 hours of the accident and are admitted to the hospital, you will get benefits under nib’s Accidental Injury Benefit in accordance with our Gold Hospital policy within 90 days of the accident. This covers being admitted to a private hospital or being treated privately in a public facility. Every level of nib Hospital cover4 offers it.
- Avoid the waiting queues at state hospitals
Wait periods for non-emergency care in the public system can be weeks or even months long without the proper coverage. Additionally, your treatment would be expensive if you decide to visit a private hospital without the proper insurance. If you buy hospital insurance, you can avoid the long lines you might have to wait in at a public hospital. Data from the Australian Institute of Health and Welfare revealed that in 2020–21, 7.6%5 of patients on the elective surgery wait list were waiting more than a year, with patients needing a septoplasty (surgical to repair a broken nose) having to wait an average of 330 days. You can pick when and where to have surgery with the proper amount of nib Hospital coverage, allowing you to return to work and play more quickly.
What exactly do Extras include?
To help you get the Extras protection that’s best for you and your family, nib offers a variety of options. In majority of our Extras policies, we provide benefits for the following core inclusions:
- Intensive care vehicle
- dental prevention
- dental in general
- serious dental
Does your need for private health cover reach a tipping point in your life?
Private health insurance provides peace of mind at any age, although you may have heard that it’s best to purchase a coverage before turning 31.
That’s because you’ll pay a 2% Lifetime Health Cover surcharge (LHC) on top of the regular premiums for each year you don’t have Hospital coverage up to 70% if you don’t get Hospital coverage by the first July after your 31st birthday. For 10 years of continuous hospital coverage, the loading is applicable.
This applies to any health fund, not only nib. Therefore, if you wait until you’re 40, your premium will be 20% higher than it would be for a person on the same plan who joined at 31.
You may also think about purchasing health insurance when you are young for other reasons besides that. Discounts of up to 10% are available to nib members between the ages of 18 and 29 on the cost of their hospital insurance. With this age-based discount, qualified members get a 2% discount for each year under 30 they have, up to a maximum discount of 10% for those of you between the ages of 18 and 25. best part? The discount is still available to you until you are 41; after that, it steadily decreases by 2% annually.
The Medicare Levy Surcharge (MLS) what it is, and how might it influence your choice?
In addition, you can be required to pay the Medicare Levy Surcharge if your taxable income exceeds $90,000 ($180,000 for families) and you don’t have the right form of private health insurance. In addition to the Medicare Levy that we all must pay, this is an additional tax of 1% to 1.5%.
If eligible, enrolling in any nib Hospital coverage and keeping it active for the entire financial year could help you avoid the Medicare Levy Surcharge and pay less tax. If you enroll in hospital insurance halfway through the fiscal year, you will not be charged a surcharge for the time you had adequate hospital insurance.