Health funds provide a one-page fact sheet called the Standard Information Sheet (SIS) for each policy, which allows you to compare your cover. You can review the SIS for your fund and compare all policies at privatehealth.gov.au.
For extras cover, consider the services you use most, such as dental, and check the annual limit per person and per family. Sometimes the family limit is only twice the per-person limit, while with other policies it’s four times the per-person limit.
Next, look at the benefit limits for specific services. They’re usually a fixed amount. Benefit limits are usually listed as a dollar amount, but occasionally you may see a benefit limit listed as a percentage on the SIS. This means the fund will give you that percentage of the actual cost of the service (for example, 50% of your dental bills). However, if you see a benefit listed as a percentage in a fund’s marketing material it may mean something else, so always go by the SIS.
Beware of lifetime limits (some funds have them for orthodontics) and combined annual limits for a range of services, such as $400 for physiotherapy, natural therapies and chiropractic. This means that once you’ve claimed $400 for physiotherapy (for example), you won’t receive anything for the other therapies during that 12-month period.
- Top-cover hospital policies cover you for all conditions that Medicare covers.
- Basic- and medium-cover policies commonly restrict or exclude one or more conditions – this means you can’t jump elective surgery waiting lists and you may be treated the same as someone without insurance. Commonly restricted treatments are joint replacements, heart surgery, cataract eye surgery, dialysis, gastric banding, obstetrics and IVF, rehabilitation, psychiatric, non-cosmetic plastic surgery, palliative care and sterilisation.
By choosing an excess or co-payment, you can save on the premium. The highest excess you can choose without becoming liable for the MLS is $500 for singles or $1000 for couples and families, but there is no restriction on co-payments.
: Check whether you qualify to join a restricted membership fund – for example, for people working in the education or defence industry. They often offer good policies at a lower premium than open membership funds.