Arming yourself with key questions to ask when comparing health insurance options for your family could make all the difference when it counts.
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Family healthcare expenses can really add up throughout the year, especially when the unexpected happens, whether it’s one of the kids getting injured from a sport after school or a member of the household who needs glasses.
A family health insurance policy with supplements and hospital coverage might be an option to consider as a financial safety net for your partner and children, for both serious and minor illnesses.
Below are some basics to help you make those important decisions when considering the right policy for your family.
A health insurance expert also details the main questions to ask your health insurance company when choosing family health coverage.
What is family health insurance?
Family health insurance policies can cover you, your partner and your children. The insurance covers medical appointments or care that is not covered by health insurance.
There are generally three different types of health insurance policies for families, each of which operates on different levels – gold, silver, bronze and basic coverage:
1. Family hospital coverage
This covers treatment as a private patient in a public or private hospital for:
• Treatment in hospital with the doctor of your choice
• Accommodation stay in a shared room
• Theater fees for surgery
2. Additional coverage only
This covers all or part of the costs of non-hospital health services such as visits to the dentist or optometrist.
The amount of coverage will vary from insurer to insurer, but more comprehensive policies will offer more services and higher benefits.
Supplements may include:
• Dental/orthodontic treatment
• Speech therapy
• Pharmaceutical prescriptions
3. Combined cover for hospitalization and extras
This policy allows you to combine different hospitalization and extras policies according to your family’s needs.
It is important for consumers to note when comparing health policies that you do not need to have your hospital coverage with the same health fund that you have your supplemental coverage if you manage to find a better offer by purchasing coverage options separately.
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What are the advantages of family health insurance?
Private health insurance allows patients to be treated in a private or public hospital, as a private patient. Often you can choose which doctor treats you and you are more likely to be able to find a treatment time that works for you.
Private Healthcare Australia CEO Dr Rachel David said private health insurance also covers services not covered by Medicare.
These can include services such as physiotherapy, dental care, optics and a number of other extras.
“Many people rely on private health insurance to access services they otherwise could not afford,” Dr. David said.
Two types of private health insurance coverage are available: hospital coverage and general care coverage (complementary or supplemental coverage).
Hospitalization insurance covers all or part of the costs of hospitalization as a private patient, including doctor’s fees and hospitalization.
General care coverage helps cover the cost of non-medical services such as physiotherapy, dental and optical care.
Who can be covered by family health insurance?
To be eligible for family health coverage, you must be a single or two-parent family with children generally under the age of 21 (or 25 if a full-time student dependent, although some funds have started to extend this age to 31 due to new regulations). This includes caregivers with children under 21 (or 25 if a student).
Children are covered up to a specified age, but some insurers will extend this coverage to full-time students.
Effective April 1, 2021, the federal government raised the maximum dependent age for private health insurance policies from 24 to 31 and removed the age limit for disabled dependents.
The updated policy will help ensure continuity of care for young Australians and encourage them to continue to purchase health insurance when they reach the age of 31 (the age at which loading of lifetime medical cover begins ).
A disabled dependent is legally defined as a person aged 18 or over and participating in the National Disability Insurance Scheme (NDIS). Insurers have some leeway to provide coverage to people who do not participate in the NDIS.
What are the key questions to ask when choosing family coverage?
nib Australian Residents’ Health Insurance chief executive Ed Close said it’s important to choose a policy that best suits the health and lifestyle needs of your family members, and to ask your your fund if these health needs will be covered.
“The most popular product among families is our combined hospitalization and extras coverage,” he said.
“This gives families the assurance that they are covered for unforeseen events that may require hospital treatment as well as daily checkups and health needs, such as dental and optical care.
“Before choosing a policy, you should consider your personal circumstances, such as your medical history and family lifestyle, and from there we can help tailor the policy to those needs.”
For a family with young children, he recommends purchasing hospital and ambulance coverage for unexpected accidents such as a broken arm, which may be more common in active young children.
“If your kids are a little older and like to play sports, you might want to add some extras to your policy, so they can attend those regular physiotherapy appointments to help maintain or prevent injury. “, did he declare.
Planning for the future is another thing to keep in mind. It might be worth considering upgrading to a hospital policy that includes pregnancy cover if you plan to start a family.
“It is important to note that you may have a waiting period for certain services, such as pregnancy and childbirth, so it is best that you find out before choosing your policy,” Mr Close said. .
Could you find additional coverage cheaper?
What is the cost of family health insurance?
According to the Private Health Insurance Ombudsman’s Policy Comparison, Gold Hospital and Extras policies could cost families up to around $800 a month before any refunds or loadings are factored in.
Can you benefit from a refund if you take out family health insurance?
Most Australians with private health insurance receive reimbursement from the government to cover the cost of their insurance premiums.
According to the Australian Taxation Office (ATO), reimbursement for private health insurance is income-tested, meaning that your eligibility depends on your combined income and that of your spouse – the higher your income, the less your right to reimbursement may be high.
The ATO has details on its website of the income thresholds that may apply to you and your family.
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