A patient attended today for her first antenatal visit of her second pregnancy.

She wasn’t planning a second pregnancy just yet. So, to save money, she had dropped pregnancy care cover with her health fund. She said she was going to take it up again in the future when she was planning her second pregnancy. Now she is in the unenviable position of having to pay to be a private patient or having her baby through the public sector. Neither option is appealing to her. She has heard lots of bad reports of management of patients booked for confinement at her local public hospital.

The lesson in this is make sure you have appropriate health fund cover, if you want to be managed as a private patient. Many pregnancies (possibly 40%) are unplanned and so I suggest you should plan for this possibility.

Choose carefully when selecting a health fund and level of cover. I helped my daughter, Emily, to choose a health fund and appropriate policy recently. She had been covered with a policy designed for a young single person. Such a policy is now inappropriate as she will soon be marrying and will in the future want pregnancy cover.

Emily had been searching by Google.  There are some sites that ‘pop up’ at the top of the first page when Googling ‘compare health funds’. They look very appealing. Emily selected one site. Amongst the first questions the site questionnaire wanted answering was her personal information including contact details. Indeed you could not go further in the questionnaire without providing this and without agreeing to be contacted by staff from the company behind the web site.  She gave her personal details including her mobile phone number and immediately she had a call from an employee of the company behind the web site, who Emily described as very pleasant and who said she wanted to help Emily make the right selection of fund and policy for her.

Fortunately Emily spoke to me before making any decision. Emily told me what she had done and what was happening. I gave her information about this company that will not be told by the company’s staff and which is not available on their web site.

These sites have been set up by companies who act as ‘brokers’ or ‘middle men’ in the insurance industry.  They operate in other insurance areas also. There is no need for them and they do much more harm than good. They are a lot like ‘wolves in sheep’s clothing’ who pretend to be very helpful, pleasant and unbiased and acting in your best interests but who really have another agenda.

These companies go to the health funds and negotiate deals where they get a percentage of your monthly premium by getting you to take out a policy with that health fund through them. It could be 20% or even 35% of your health fund premium each month is going to this broker company. So the helpful person who is an employee of this broker company who phones you back when you give your phone number will most likely steer you in the direction of choosing the health fund that will give the broker the highest monthly income. They will be very unlikely to tell you about health funds with whom they don’t have contracts, and which may be more suitable for you. As well it is possible that you will be paying more for the same level of cover than if you dealt directly with the health fund you chose. If these brokers become more popular the consequence will be an unnecessary increase in premiums to cover their unnecessary broker fees.

But it is very difficult to compare health funds yourself. There are 37 different health funds registered under the Private Health Insurance Act 2007 in Australia. Each fund will have various policies. So what do you do?

  • The Australian Federal Government has come to the rescue with a very helpful web site at www.privatehealth.gov.au. This had been designed so you can easily compare the 37 health funds and their policies and work out which fund and which policy of that fund is the best for you. It is government web site so there are no broker fees and the government is not financially motivated to encourage you to join a particular fund. As well your can do it anonymously without providing personal details and you won’t get any call from a friendly but pushy salesperson of a private health fund comparison broker company.
  • Another option is a restricted health fund. But these are only available if you (or family member sometimes) are employed in a certain industry or work for a certain company. ;A restricted health fund will often give you a better policy at better pricing. But cross-reference their policies just to make sure.

Whether it a policy of a restricted health fund or a policy of a health fund that you found through the Federal Government website I suggest you give the fund a call before joining. This is to make sure about the ‘fine print’ with your selected policy.

And if you are looking for something ‘out of the ordinary’ and the fund employee to whom you speak agrees, e.g. wavering the waiting period as you are transferring from another fund, then get this in writing. I have had patients where they have been told something by an employee of a health fund but when they put in the claim the fund has denied this agreement or said the staff member who said it made a mistake. If it is in writing the fund can’t back down and your cover is assured.

Emily and I through www.privatehealth.gov.au found a health fund and policy that was most suitable for her. The fund she chose is based in Western Australia. We live in Sydney and so it is highly unlikely we have found this fund by ourselves.

So in conclusion don’t be influenced by the fancy appealing advertisements on television, on the radio and on the internet. If they want your personal contact details upfront become very wary. Remember the company behind the ad or web site is there to make money. Ask where does their money come from? The obvious answer is they make money from those people who join a health fund through them.

Also see Federal Government website www.privatehealth.gov.au.

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