Abigail Koch Family Private Health Insurance Interview

Abigail Koch Family Private Health Insurance Interview

Starting a family? Beware of private health insurance waiting period pitfalls.

Aussies who are thinking of starting or growing their family are being urged to check their private health insurance cover at least a year ahead to avoid being caught short with potential waiting period traps.

Comparethemarket.com.au reveals a number of ways that parents could be caught out, given that there is a 12 month waiting period on pregnancy cover for hospital insurance. A mother could miss out on cover if she has an earlier-than-expected birth within the 12-month waiting period, or hasn't upgraded her health insurance policy to cover the delivery of her baby 12 or more months before the birth.

Abigail Koch, spokesperson at comparethemarket.com.au, says, 'Often, parents make the mistake of thinking they can take out pregnancy cover any time before the baby is due. The fact is, they need to get covered at least 12 months ahead of the birth. When the baby is born, the mother is the patient, so there is no need for the baby to be covered, unless there is additional treatment that the baby requires. This can include the baby being premature and needing a humidicrib."

For the baby's health needs to be covered (and not have to serve out any waiting periods), some insurers require the mother to upgrade the policy to family cover a couple of months prior to the birth. Other insurers may require the upgrade to take place 12 months prior to the birth.

'We encourage parents to call their insurance provider to ensure they are aware and are covered by the date of the delivery," Abigail says.

Comparethemarket.com.au points out the pregnancy waiting period traps all parents should be aware of:
There is a minimum 12-month waiting period for pregnancy and birth related coverage in private hospitals. Therefore, you'll need to be on a health cover that includes pregnancy at least three months before you start trying to fall pregnant.
The completion of the waiting period – or the cover start date – must fall before, or on, the hospital admission date for delivery.
You are not covered if you have a premature birth within the waiting period.
You may not be covered if you give birth even a day before the end of the waiting period, depending on your policy.
Some funds require you to switch from couples to family cover anywhere from 1-12 months before the birth.
Insurance policies that cover assisted reproductive services require 12-month waiting periods, such as IVF.

Abigail adds: 'A common misconception is that family policies are more expensive than couple policies, but this simply isn't true. Often, dependents are covered for free, and sometimes up until the age of 25 if they are studying full-time and are not married. Depending on what policy you have, your child usually needs to be added to the policy to ensure their health costs are covered.

'However, if you're a single parent, you may pay more for a single policy than a family policy, so it's important to shop around and find the best deal for you. The best way is to compare policies online against your health requirements through comparison services such as comparethemarket.com.au."

Interview with Abigail Koch, spokesperson for comparethemarket.com.au, is a household budgeting expert and useful source of information on how to find the best value insurance policies (health, home & contents, car, life and travel), home loans, energy plans and fuel.

Question: What are the main waiting period traps we need to look for with private health insurance cover?

Abigail Koch: Waiting periods vary between health funds, but the Federal Government sets maximum limits for certain hospital benefits. None of them, from pregnancy services to rehabilitation, last longer than a year, and some are as little as two months.

As for extras cover, the waiting periods are set entirely by the health funds, and will therefore differ from insurer to insurer. The Private Health Insurance Ombudsman does outline some typical waiting periods for general treatment that people should keep in mind:
- 2 months: Psychiatric care, rehabilitation, palliative care, general dental, physiotherapy
- 6 months: Optometry
- 12 months: Pre-existing conditions, pregnancy and birth-related services
- 1, 2 or 3 years: Orthodontics, and other high cost procedures

In terms of waiting period traps, consumers should keep a few of the following points in mind when taking out private health insurance:
1. When you switch funds, generally speaking, you don't need to re-serve waiting periods. However, if you are switching funds and haven't completed your original waiting period, you'll need to complete the remaining time with your new fund before you can claim.
2. Also, for new or higher benefits (for example, if your new policy includes a feature you weren't previously covered for), you'll still need to complete the waiting period before claiming for those benefits.
3. A two-year benefit limitation period for a feature like a hip replacement means you'll need to wait two extra years after the completion of the initial waiting period, before you can claim on that feature. (A Benefit Limitation Period is an additional waiting period which the customer will receive cover as a private patient in a public hospital for 2 years (generally a two year wait) after serving the standard waiting period where the customer has no access to that particular service).
As always, the above are generalisations: it's important that customers read the fund brochures for specific information on waiting periods for particular policies.

There are a number of waiting period traps mums-to-be need to look out for, in particular:
- There is a minimum 12-month waiting period for pregnancy and birth related coverage in private hospitals. Therefore, you'll need to be on a health cover that includes pregnancy at least three months before you start trying to fall pregnant.
- The completion of the waiting period – or the cover start date – must fall before, or on, the hospital admission date for delivery.
- You are not covered if you have a premature birth within the waiting period.
- You may not be covered if you give birth even a day before the end of the waiting period, depending on your policy.
- Some funds require you to switch from couples to family cover anywhere from 1-12 months before the birth.
- Insurance policies that cover assisted reproductive services require 12-month waiting periods, such as IVF.


Question: How does a growing family change our private health insurance cover?
Abigail Koch: It's pretty simple process. You can either call your current provider and upgrade the policy to family cover a couple of months prior to the birth, or indeed switch to a policy that better suits your growing family. You can compare policies online against your health requirements through comparison services such as comparethemarket.com.au. Often a family policy won't cost you any extra money either. Often, dependents are covered for free, and sometimes up until the age of 25 if they are studying full-time and are not married.


Question: What is your advice for couples planning to be pregnant in the near future?

Abigail Koch: Often, parents make the mistake of thinking they can take out pregnancy cover any time before the baby is due. The fact is, they need to get covered at least 12 months ahead of the birth; therefore, you'll need to be on a health cover that includes pregnancy at least three months before you start trying to fall pregnant.

For the baby's health needs to be covered (and not have to serve out any waiting periods), some insurers require the mother to upgrade the policy to family cover a couple of months prior to the birth. Other insurers may require the upgrade to take place 12 months prior to the birth.

Here at Comparethemarket.com.au, we encourage parents to call their insurance provider to ensure they are aware and are covered by the date of the delivery.


Question: What happens if families become pregnant prior to the twelve month waiting period?

Abigail Koch: A mother could miss out on cover if she has an earlier-than-expected birth within the 12-month waiting period, or hasn't upgraded her health insurance policy to cover the delivery of her baby 12 or more months before the birth.


Question: Can you talk us through the important of private health insurance before 30 years of age?

Abigail Koch: The Government's LHC loading was introduced to encourage Australians to take out private hospital cover earlier in life and penalise those who fail to do so. You could end up paying more for private health insurance over your lifetime if you don't take out hospital cover before 1 July following your 31st birthday. If you join after this time, you may be required to pay a 2% loading on top of your premium per year for every year you are aged over 30 and do not have private hospital cover, up to a maximum loading of 70%.

For example, if you take out private hospital cover at age 45 you may pay 30% more than someone who took it out at age 30.


Question: What should we be looking for in our private health insurance cover?
Abigail Koch: There are seven main things to keep an eye out for when selecting health insurance cover, these include:

1. Find coverage for services you will use, and nothing else!
Health insurance can be a comprehensive product that covers you for virtually every medical expense you may encounter. Or, it can be a simple product that covers you for a few different services that you will use regularly, and little else. Your circumstances may demand one over the other, but keep in mind that the latter option is significantly cheaper. In the first instance, ask your doctor for advice on what you need coverage for. Once you're ready to buy, learn more about saving on your health insurance.

2. Learn how much you can claim, and when.
The allure of health insurance for any Aussie customer will always be -free stuff!', but it's not that simple a product. In order to stop people from claiming on their policies immediately after signing up, and then cancelling before they pay any premiums, insurers impose waiting periods and annual limits (i.e. how much you can claim on any given benefit throughout the year). Take a good hard look at the policy brochure when/before you sign up, so that you don't overlook any of these restrictions. 3. Learn how health insurance can impact on the tax you pay

The Federal Government wants you to take out health insurance, because it eases the burden on the public healthcare system if you're being treated in a private hospital. Because of this, there are a range of incentives to make sure you sign up to private cover and some levies imposed on those who don't.

4. Think about what life stage you're at
Where you are in life will determine what kind of healthcare you'll need. Are you fresh out of high school and need your wisdom teeth out? Are you and your partner ready to have kids? These questions will help you figure out what kind of product to purchase.

5. Track down a cheap policy with a few tricks
Aussies love tracking down a good deal for themselves. But this can feel like an uphill battle when it comes to health insurance. However, there are a few things you can tweak when looking at your insurance options to keep the costs down.

6. Do you have ambulance cover baked into your policy?
Every Australian should at least have some cover for emergency transport, also known as ambulance cover. Emergency transport can be wildly expensive, and it pays to spend a tiny bit each year to ensure you don't get hit with any surprise costs. However, you don't need to take out cover if you live in certain states/territories. Additionally, ambulance cover is included when you take out health insurance in certain regions around Australia. It varies from state to state, and you can find out more by reading our article on ambulance cover.

7. Reassess your cover annually (or, when your situation changes)
Whether it's a industry wide premium rate rise, or you're income has gone up a few dollars since last year, re-evaluating your health insurance annually means you'll always be covered by the best policy for your circumstances. Additionally, there are hundreds of policies available in Australia. A newer, better health insurance policy could be out there waiting for you!


Question: When is the best time to change private health insurance companies?

Abigail Koch: Switching health funds is much easier than most people think. It is something worth considering when your health insurance policy no longer meets your needs, or you find another policy that offers better value.

Another reason many of us consider switching health insurers is because of a change of lifestyle. Entering a partnership, starting a family, or experiencing a change in your medical status are all good opportunities to seek a newer, better coverage to meet your changing needs.

There are many reasons to switch health insurers. Number one is obviously to save money and safeguard your health! Others are more basic. For example, your circumstances may have changed over the last year (maybe you're now considering kids), or you're trying to consolidate your bills with your partner (requiring a couples policy).


Question: What is Comparethemarket.com.au?

Abigail Koch: Comparethemarket.com.au is an online comparison service that allows consumers to quickly and easily compare and buy products from a wide range of providers including; car, travel, health, home & contents insurance, and personal finance products, utilities and petrol.


Question: How does Comparethemarket.com.au benefit Australians?

Abigail Koch: Comparethemarket.com.au helps Australians to find a product that best suits their needs and their back pocket and empower them to make buying decisions with greater trust, knowledge and savings.


Interview by Brooke Hunter