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There are around 35 providers of private health insurance in Australia and all offer different levels of cover and benefits. It is important that you compare the funds carefully and read the fine print to make sure that a policy truly meets your specific needs.

The internet is a valuable source of information about health insurance for IBD and can help you identify the most suitable providers. After doing some initial research, you should make a short list of potential providers and then discuss your needs with them directly (by telephone or in person) before deciding on a policy that is best for you. Remember, if you have IBD or another chronic illness that you fail to mention when arranging private health insurance, your policy could be deemed invalid when you need to make a claim.

On this page:

Can I get private health insurance with IBD?

A health fund cannot refuse to insure a person simply because of a chronic disease such as IBD. Australian law stipulates that health funds are not allowed to refuse membership to anyone on the grounds of health status, age or previous claims history. They can, however, impose waiting periods for those with pre-existing ailments.

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What is a pre-existing ailment?

According to the Department of Health and Ageing website:

‘The National Health Act 1953 specifies a pre-existing ailment as an ailment, illness or condition, the signs or symptoms of which, in the opinion of a medical practitioner appointed by the health fund, existed at any time during the six months prior to the member joining a hospital table or upgrading to a higher level of cover.’

The decision about whether or not your IBD condition is pre-existing is made by the health fund. The health fund will need at least a week to advise you of your status.

In view of these conditions, bear in mind that:

  • If you are taking out health insurance for the first time, you need to be aware of their assessment of your condition before you choose a fund, as this could have a bearing on your final decision. Be sure to discuss this issue with each of the potential providers on your short list.
  • If you already belong to a health fund and are planning to upgrade to a higher level of cover, you will also need to know their assessment of your status. Be sure to discuss this issue with your current provider before using health-care services such as visits to specialists, admission to hospital, etc.

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How long is the waiting period?

If you became ill prior to applying for private health insurance, you will need to serve a pre-existing ailment waiting period before you are covered for any treatment associated with your illness. This waiting period is usually 12 months, but you should check this timing with the various providers before making a decision about which fund to choose.

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Points to consider when taking out private health insurance

It is important to do the research and compare the benefits offered by the various health insurance providers before you decide on a policy that is right for you.

Some points to consider when taking out private health insurance for IBD:

  • The waiting period that applies before you can make a claim or qualify for a higher level of rebate for services, especially for a pre-existing illness.
  • Is a lower premium because of a lower rebate? A policy with a lower premium could mean that you will need to make a greater initial payment if you submit a claim, i.e., pay a higher excess. Also, your policy might provide reduced rebates or no rebate at all for certain medical conditions.
  • Preferred providers. Some policies restrict the choice of doctor or hospital. If your preferred health-care provider/s is not on the fund’s provider list, the fund might offer a lower rebate and/or charge you higher premiums.
  • The gap between treatment fees and the insurance rebate. Before you agree to any treatment, you should seek information from your doctor and/or hospital about any additional fees that will be charged. You should also ask about fees for any other doctors who will be involved in your care. As part of its informed financial consent campaign for doctors, the Australian Medical Association (AMA) has prepared a list of questions about costs that you can ask your doctor before you go to the hospital. See the AMA website at www.ama.com.au. Make sure that you also check your level of cover with your health fund.

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Where do I start?

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Australian Government Department of Health and Ageing

The Australian Government Department of Health and Ageing provides information about private health insurance for consumers, including advice about lifetime health cover and rebates and a list of frequently-asked questions about private health insurance. Visit their website at www.health.gov.au and search for ‘private health insurance’ to get relevant information.

T: 1800 020 103 (freecall)

www.health.gov.au

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iSelect

Another useful source that can help you to choose a suitable private health insurance policy is the iSelect website at www.iselect.com.au. Here you can compare the levels of cover and benefits offered by several major health funds in Australia based on your age, gender and individual health needs. To start the comparison, you need to work your way through a short series of questions via the ‘Start Comparing’ search engine located on the home page (it takes only minutes). You will then be presented with a number of options that best match your needs. This is a quick and easy method of identifying a short list of potential providers.

Note: The list of participating funds on the iSelect website does not include all health funds available in Australia. In addition, not all policies offered by the participating funds can be compared, but only those that the funds wish to offer through iSelect; this ‘Approved Product List’ can vary from time to time. Not all participating funds can be compared when recommending a policy.

T: 13 19 20 (9am to 6pm AEST time)

www.iselect.com.au

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Private Health Insurance Ombudsman (PHIO)

The PHIO manages a website at www.privatehealth.gov.au. Here you can search for and compare selected features for all private health insurance products offered in Australia. You will also find general information about private health insurance. The website allows you to:

  • Search the database to review your current policy or choose a new one
  • Print one-page statements (called SIS – Standard Information Statements) outlining the key features of any health insurance policy
  • Check to see if your local private hospital is covered by your insurer using the ‘Agreement Hospitals’ search.

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PrivateHealth.gov.au

If you are getting insurance for the first time, www.privatehealth.gov.au will help you ask pertinent questions—and get some answers—before deciding on the right insurance cover. These questions include:

  • Who is going to be covered by the insurance? Will it just be you? Will it be for you and a partner, or will you have dependants as well?
  • What is covered? You have to very carefully consider what type of medical cover you will need, especially in light of your IBD. Hospital cover will be a major consideration.
  • How does private cover work? You will most likely need hospital and general treatment, which you can buy separately or together, and this will affect what you can claim and how much you can claim.
  • What government incentives and surcharges will affect your insurance? For instance, the Private Health Insurance Rebate is a government subsidy that will cover part of your insurance.

T: 1300 737 299 (9am to 5pm Monday-Friday AEST time)

www.privatehealth.gov.au

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Where can I go for help if I have a problem with my private health?

The PHIO provides an independent service to help consumers with health insurance problems and enquiries. Any complaints must be about a health insurance arrangement. The Ombudsman’s office also deals with complaints from health funds, private hospitals, or medical practitioners, and publishes reports and consumer information about private health insurance. Visit their website at www.phio.org.au

If you have a problem with your health insurance arrangements, (e.g., you feel you have been treated unfairly or are unhappy with the service and information provided by your health fund), you should first discuss the issues directly with your health insurance provider. If you are unable to resolve your complaint, have not received a response from your fund, or need additional advice, you can contact the Ombudsman’s office directly at:

T: 1800 640 695 (complaints hotline; free call anywhere in Australia)

www.phio.org.au

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What are my rights as a consumer?

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Australian Prudential Regulation Authority (APRA)

APRA is responsible for the prudential supervision of private health insurers, a responsibility that was transferred from the Private Health Insurance Administration Council (PHIAC) on 1 July 2015.

Visit APRA’s web page on private health insurers and the private health insurance industry at http://www.apra.gov.au/phi/Pages/default.aspx to get information on prudential framework, register of private health insurers, and statistics relating to the industry.

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Consumers’ Health Forum of Australia

The Consumers’ Health Forum (CHF) is a national peak organisation providing a voice for all health consumers. The CHF’s strategic direction is set by its voting members. These voting members include consumer organisations representing a broad range of health consumers such as illness groups, disability groups and specific population groups such as youth, older people, and women.

www.chf.org.au

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How can I contact the registered health funds?

Contact details for health funds in Australia can be found in the Yellow Pages under the category ‘Health Insurance.’

The APRA website also contains information about all registered health funds in each state of Australia as well as all available contact details for each fund.

Crohn’s and Colitis Australia would like to thank {Source Name} for permission to use this article.  

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