As a not-for-profit and member-owned health fund, we’re committed to giving back claims savings we made due to COVID-19 restrictions. Members will receive their refunds in the same bank account that we pay their claim benefits to. Members don’t need to do anything to receive their refunds.
Choosing cover: 10 questions to ask yourself
To be covered or not to be covered, it’s the eternal age-old question. But then: which cover should you get? Hospital? Extras? Combo? There’s a lot to consider, so we’re here to make it easier (it’s what we love doing!). To help you in your decision making, we’ve put together some questions to guide you in your quest for cover.
1. Are you sporty?
Don’t worry, we’re not trying to guilt you for your couch potato ways. We ask because being very active in the sporting world often ups your chances of reconstructions of knees, shoulders, etc. Even if you’re not the next Tim Cahill or Cathy Freeman wannabe, accidents are more common than you think. If you’re sporty, it’s worth considering Hospital cover that includes joint reconstructions and Extras that includes physio for the post-op rehab.
2. Do you have young kids?
Although kids are generally pretty healthy, we all know it’s common for them to need braces as they get older (which are rather pricey!). What peeps often don’t know is there’s a 12-month wait for orthodontic work. Make sure that your cover not just includes orthodontics, but that you’ve taken it out in advance.
3. Would you want to have a baby soon?
If you answered yes (yay for you!), consider a policy that covers you for obstetrics. Why? It means you get an obstetrician of your choice, whereas if you go public you’ll get a midwife, and you won’t be choosing them. The midwife may also change depending on who’s available. Going private also means there’s a very high chance you’ll get your own room – and one you won’t be getting booted out of straight away. Going public means they’re generally trying to get you out the door the ASAP. Not so great if you’ve had a really rough 24-hour labour and you barely remembering your own name, let alone feel ready to go home.
Just remember: the baby must be born after you’ve served your 12-month waiting period. So, be prepared because we all know accidents do happen!
4. Are you just wanting to avoid extra tax?
The Government is pretty keen to get Aussies to take out private health cover to lessen the load on the public system, so they may hit you with the Medicare Levy Surcharge and Lifetime Health Cover Loading if you don’t have Hospital cover. If you’re not too bothered about having insurance, and you’re literally just wanting to save tax moolah, this is a totally different kettle of fish when deciding on your cover. If you fall into this boat, you can probably just get basic Hospital cover and say “I’m good, thanks” to Extras cover.
Also, if you’re earning decent money (which you generally are if you’re worried about the Medicare Levy Surcharge), maybe you’re one of the rare people who can just access emergency funds for dental, physio, etc. If you’re not, having Extras cover can take some of the shock away from any unexpected issues.
5. Do you have enough dosh if something were to go majorly wrong with your teeth?
If you’re someone who’s been saving away for a rainy day of epic dental drama, Extras cover might be worth skipping. Thing is, it’s a very unlikely story for most of us. And despite your champion efforts, you might still be worse off if you end up needing unexpected emergency dental work. People often massively underestimate the costs of major dental procedures – we’re talking easily hundreds if not thousands of dollars.
Making treatment easier to pay for straight away can also save your hard-earned cash in the long run. Ask any dentist and they’ll tell you the sooner you treat an issue, the more likely it’ll be cheaper, as most dental conditions go downhill over time. If you practice good oral hygiene, it’s less likely you’ll need major and expensive dental surgery, but regular check-ups are still super-duper important despite your passion for flossing.
6. Would Extras cover encourage you to look after your health?
One great thing about having private health insurance, particularly Extras cover, is that it encourages you to keep your health on track. If you have no gap* preventative dental and optical in your cover, you’re less likely to fall off the bandwagon with check-ups. This’ll save you on dental check-up fees, but more importantly it’ll save you accidentally missing something really serious. Plus, we lovingly send you reminders to go get those pearly whites or peepers checked.
You’re also just more likely to go get something sorted, like back pain, if you’re able to claim some of it back through your osteo or physio benefits. Or maybe it’ll mean you claim gym fees or yoga to help with a medical professional-verified condition, like anxiety or depression. If you’re reading this and nodding, then Extras cover is probably worth adding on.
*If you go to Peoplecare Eyes & Teeth clinic in Wollongong, this is you.
7. Where are you in the circle of life?
Are you young, fit and healthy? You might only need a basic level of Hospital cover.
Are you planning a family? You might want to consider stuff like obstetrics cover and Extras that includes orthodontics for the kids.
Are you mid age? Senior? You probably don’t want to get basic Hospital cover because it won’t cover you for any of the most common age-related illnesses like heart disease. Same goes with medical procedures like hip replacements (which typically means a year-long public waiting list – a very long time to be in pain).
These are important things to chat about with us, both when you join and as circumstances change throughout your life, so you know you’ve got the best cover to meet your personal needs.
8. How healthy are you and your ancestors?
When checking out various covers, be brutally honest with yourself about your health, now and in the future. What’s your current state of health? Do you like to move? Eat food rainbows every day? If you’re healthy, you might only need a basic level of Hospital cover. If you smoke like a chimney and eat dirty kebabs on the regular, you might need something more.
Another really important thing to think about is your family history of specific illnesses, especially hereditary or genetic ones like diabetes, heart disease, cancer and vision impairment.
Obviously, there’s no fail-proof crystal ball for health issues but understanding your health outlook gives a better idea of things worth getting cover for on a policy or things that should absolutely not be excluded. Not factoring in conditions you could end up with when choosing private health insurance can cost you more in the long run. A lot more.
9. What can you realistically afford?
It’s all well and good to say ‘yes’ to top Hospital and top Extras cover and all its advantages, but not everyone can afford it. Along with your health needs, you need to match your cover to your financial situation, too. If top Hospital and Extras cover isn’t realistic, perhaps some protection is better than no protection. Could you skip Extras? Or have a lower level of cover? There are also ways to reduce premiums, for example by paying a higher excess. Have a chat with us on the phone about your budget and possible ways around it – we’re here to help!
10. Are you comparing apples with apples?
When you’re choosing cover, don’t fall into the common trap of failing to see the finer details. You need to make sure you’re comparing apples with apples. Be sure to fully understand exactly what stuff is and isn’t covered, and how much moolah you’re able to claim for said stuff. Price and value are not the same thing – you might be paying less in premiums but getting fewer benefits or lower limits. Private health insurance is a major purchase so it’s important to choose a product that’s fit for purpose – and that it continues to meet your needs as your life changes.
More than anything, choosing cover is all about research, research, research and chat, chat, chatting it through on the phone to be sure. We promise we don’t bite! Just give us a buzz on 1800 880 704 because we’re always happy to lend a hand.