There are dozens of insurance companies in Australia that provide different types of medical insurance. How should you choose?
First of all, you should ask the insurance company to recommend a suitable insurance plan based on your visa status in Australia. For example, Chinese students studying in Australia with a student visa must purchase Australia Overseas Student Health Cover (OSHC). If you are traveling to Australia, visiting relatives, short-term work visits, or are not eligible for National Health Insurance Medicare, you should choose Australia Overseas Visitor Health Cover (OVHC). If you have become an Australian citizen or permanent immigrant, In addition to joining the National Health Insurance Medicare to get public medical care immediately, you can also purchase various forms of private medical insurance plans specifically designed for Australians.
Insurance companies generally provide basic, medium, and comprehensive hospital insurance plans for you to choose from. Basic medical insurance is similar to the public hospitalization insurance provided by the National Medical Insurance Medicare, and the insured can receive treatment in public hospitals. Intermediate medical insurance allows you to be hospitalized in public and private hospitals, as well as reimbursement for some auxiliary medical items. Comprehensive medical insurance includes hospital insurance for public and private hospitals and more comprehensive supplementary insurance medical items.
Generally speaking, if you choose an insurance plan with a higher deductible (excess) or a higher co-payment (co-payment), then your premium (premium) is lower.
In addition, the services of insurance companies are also very important. If the insurance company can provide bilingual services in Chinese and English, it will also greatly facilitate Chinese policyholders who speak Chinese as their mother tongue.
The cost of Australian private medical insurance
When considering private medical insurance, you should evaluate the cost of the insurance and choose the type of insurance that fits your budget. After you participate in private medical insurance, the expenses you need to bear mainly include the following situations:
1. One of the fixed expenses of participating in private medical insurance is premium. This is a fee that needs to be paid regularly (monthly).
2. After each use of medical services, you also need to pay part of the medical expenses in the form of deductible (excess) and co-payment (co-payment) according to the insurance contract.
3. The insurance contract stipulates different reimbursement rates for various medical items. The insurance company bears part of the medical expenses according to the reimbursement ratio, and you need to pay for the rest. For example, some insurance contracts stipulate that the insurance company can reimburse 85% of the outpatient fees of specialist doctors (such as cardiologists, obstetricians and gynecologists, etc.), then you must pay 15% of the outpatient fees at your own expense.
4. In addition, if the medical services you receive fall under the terms of the insurance company’s exclusions and restrictions, you must pay all or most of the medical expenses at your own expense.
5. Please note that as an Australian citizen or permanent resident, as long as you are eligible for National Health Insurance Medicare, even if you have purchased private medical insurance, you still need to pay Medicare tax in accordance with the tax law. Because after publicly funded patients participate in private medical insurance, Medicare still reimburses 75% of hospital expenses and 85% of outpatient medical expenses.
insurance(premium) What is it?
Insurance premium (premium) is the cost that you must pay regularly according to the insurance plan you choose. You can choose to pay every two weeks, every month, or every year.
In Australia, the premiums of private medical insurance companies are community-rated, calculated on a community basis. All insured persons, regardless of their age and health status, pay the same premium when they apply for the same medical insurance plan in the same area. Moreover, the insurance company must guarantee the policyholder's right to extend the insurance plan.
Therefore, when applying for private medical insurance, the insurance company cannot refuse your insurance application because the insured is in poor health and needs frequent medical treatment, or refuses to extend the insurance after the expiration of the insurance contract because of the large amount of medical expenses you reimburse. Moreover, you cannot increase the insurance premium you need to pay.
澳大利亚各州和地区的医疗保险费用各不相同，有些相差很大。一个家庭全年100％的医院保险（hospital cover）的平均费用为1600澳元，个人全年医院保险费为750～875澳元。一个家庭全年附加医疗保险（Extras cover）的平均费用为1150澳元，个人全年附加医疗保险平均保险费为575澳元左右。
The premium is related to the insurance plan you choose. Basic medical insurance has the lowest premium, but you can only be treated in a public hospital. Medium and comprehensive medical insurance allows you to choose private hospitals and get more supplementary medical services, and the insurance premiums you need to pay increase accordingly.
If the insurance plan you choose has a wide coverage and a large reimbursement ratio, the corresponding premium (premium) you need to pay is higher. Insurance plans with lower insurance premiums cover a smaller range of medical services, or require higher medical expenses at personal expense.
The premium of additional insurance (Extras cover) generally depends on the number of auxiliary medical services covered by the insurance plan and the reimbursement ratio. Additional insurance is divided into basic, medium and comprehensive insurance according to the insurance coverage. The reimbursement ratio for medical items with additional insurance also ranges from 50%, 75%, or 100%. Additional insurance also sets annual limits for each medical service item. Generally, the more insurance items and the higher the reimbursement ratio, the higher the insurance premium. vice versa.
When choosing additional insurance, first compare the service coverage of various insurance plans, whether it includes the medical services you need, such as whether you need optometry and glasses, or want to get acupuncture services. Second, compare the costs of various insurance plans, including insurance premiums, the reimbursement ratio of each medical item, and the prescribed annual reimbursement limit.
In addition, if you choose an insurance company’s contracted institutions, such as dental clinics, optometrists, to obtain services, the insurance company’s reimbursement ratio is higher. You can find out if there is an insurance company’s contracted medical institution in your area, so that you can use its services more conveniently and you can reimburse more expenses.
Other personal expenses: deductible (excess) and co-payment (co-payment)
To purchase private medical insurance, in addition to paying the premium on time (premium), individuals also need to pay deductible (excess) and co-payment (co-payment). When you choose an insurance plan, you should also take these costs into consideration to determine whether you can afford private medical insurance.
Some insurance plans require the insured to pay a certain amount of medical expenses at their own expense before the insurance company begins to reimburse the remaining expenses. This fee is called excess (excess). The deductible is the fee that each person needs to pay each year. Some insurance plans do not require policyholders to bear a deductible (nil excess), and other insurance plans require deductibles ranging from 100, 200 and 500 Australian dollars. That is, when you are reimbursing hospital expenses, you may need to pay 500 Australian dollars first, and then the insurance company will begin to reimburse you. Generally, the higher the deductible (excess) of a medical insurance plan, the lower the premium (premium). vice versa.
Some insurance plans require the insured to pay a fixed daily fee at their own expense during the hospital stay. This is called a co-payment. For example, if your insurance contract stipulates that your hospitalization co-payment is 50 Australian dollars per day, and you are hospitalized for 5 days, you need to pay 250 Australian dollars yourself, and the insurance company will reimburse the rest. Generally, insurance companies impose an upper limit on the copayment that an individual needs to pay. If you exceed this limit, you no longer have to pay the co-payment.
The medical expenses reimbursement standard of private medical insurance
The Australian government sets a standard price for reimbursement for each medical service included in the National Medical Insurance Medicare, which is called the National Medical Insurance Benefits Schedule (MBS). In private medical insurance contracts, the reimbursement standards for hospital cover expenses are usually calculated according to the reimbursement price set by MBS.
The medical service price set by MBS is only the standard used by Medicare or insurance company to calculate its reimbursement. In Australia, doctors and hospitals can exceed the MBS standard when charging medical expenses, and the excess expenses are borne by the patients at their own expense.
For example, according to the hospital insurance contract of private medical insurance, when you are hospitalized, Medicare will reimburse 75% of the doctor’s treatment costs according to the MBS standard, and your private medical insurance company will reimburse the remaining 25% of the doctor’s treatment costs (according to the MBS standard), and the ward Expenses, nursing expenses, operating room fees, and medicines and other expenses. If you are in hospital and the hospitals and doctors charge in accordance with the prices set by MBS, then you will not have to bear any expenses. If the fees charged by hospitals and doctors exceed the MBS standard price, the gap will be borne by you.
When you choose an insurance plan, you can consider adding a gap cover. In this way, when the amount actually collected by the hospital/doctor exceeds the amount of medical expenses that the insurance company can reimburse, you can use the difference insurance to reimburse you for all or part of the difference. Difference insurance can help you reduce or waive your out-of-pocket expenses.
If you have Medicare's public medical qualifications, even if you have purchased private medical insurance, you can still choose to receive treatment as a public patient in a public hospital when you need hospitalization. In this way, you can get treatment for free without worrying about personal medical expenses.
Insurance company’s contract medical institution
Insurance companies usually sign cooperation agreements with some hospitals and clinics to join the insurance company's medical network. When choosing an insurance plan, you need to understand the size of the insurance company's medical network, whether its contracted medical institution can give you many hospitals and doctors to choose from, and whether it is convenient for you to seek medical treatment.
If you visit an insurance company’s contracted medical unit, you can reimburse all or most of your medical expenses. If you choose to go to a medical institution that does not have a cooperation agreement with the insurance company, you will need to pay more.
What is the waiting period of medical insurance, existing diseases and other precautions
When participating in private medical insurance, you also need to note that private insurance generally stipulates that after participating in the insurance, the insured must wait for a period of time before reimbursing the medical expenses. In addition, you also need to pay attention to the reimbursement provisions of your insurance contract for diseases that existed before you participated in the insurance, and verify whether the medical service exclusions and restrictions stipulated in the contract conflict with your medical needs.
Different insurance companies have their own regulations for these situations. When choosing insurance, you should carefully read the relevant clauses of the insurance company and choose the insurance that is most conducive to your personal medical needs.
Waiting period for medical insurance
After you become a member of an insurance company, you generally need to go through a certain waiting period before you can apply for reimbursement of medical expenses. This is a preventive measure taken by insurance companies to prevent someone from abusing insurance rights. But if you are suddenly injured and need medical treatment, you do not have to go through the waiting period.
The Australian government stipulates that private medical insurance companies shall not exceed the maximum period when setting the waiting period:
－The waiting period for pre-existing conditions shall not exceed 12 months;
－The longest waiting period for the insured who is pregnant and giving birth shall not exceed 12 months. Under normal circumstances, you must take out insurance before you become pregnant to be able to reimburse the cost of obstetric services;
－The waiting period for psychiatric diseases, rehabilitation and hospice care treatment is no more than 2 months, even if these are previously existing diseases of the insured;
－The longest waiting period for other situations should not exceed 2 months
When you buy medical insurance, you need to know clearly which medical items your insurance plan stipulates waiting periods and the length of waiting time. Generally, private insurance companies stipulate that the insured must wait 12 months for pre-existing diseases before reimbursing the related medical expenses, and the insured must not be able to reimburse the expenses related to pregnancy and childbirth after participating in the insurance for 12 months.
What is a pre-existing disease (pre-existing conditions)?
Pre-existing conditions are symptoms or signs of illness that you have already had in the 6 months before you participated in the insurance. Even if the doctor does not clearly diagnose the disease, the insurance company can also recognize it as an existing disease.
Usually, the insurance company will appoint a professional medical staff to determine whether your condition is an existing condition. Because this is related to whether the insurance company agrees to reimburse your related medical expenses.
Even if you have suffered from a certain disease before applying for the insurance, the insurance company cannot refuse your insurance request. In addition, insurance companies cannot increase your insurance premiums because you have chronic or serious illnesses. However, insurance companies generally wait 12 months after you become a member before reimbursing medical expenses related to pre-existing diseases.
What is an exclusion clause (exclusion) and restriction (restriction)?
Some insurance plans use exclusions to stipulate that certain conditions or special treatments are not covered by the insurance plan, and you must pay the relevant expenses completely at your own expense. Some insurance plans restrict reimbursement for certain conditions or special treatments. This is called a restriction. For example, heart surgery, joint replacement surgery, kidney dialysis, assisted reproductive techniques such as test tube baby technology, and selective cosmetic surgery, etc., may be excluded or restricted by some insurance plans.
You need to carefully read the exclusion clauses and restrictions in the insurance agreement, and decide whether the insurance plan is suitable for you according to your medical needs. When you need to receive a certain kind of treatment, you need to carefully verify with the insurance company whether it belongs to the medical items excluded and restricted in the insurance contract.
Where to buy private medical insurance
The relatively large private medical insurance companies in Australia include Medibank Private, Health Insurance Fund, NIB, and Australian Unity. You can go directly to the website or office of the relevant medical insurance company to purchase insurance.
You can also use iSelect's medical insurance quotation system to obtain timely insurance product comparisons and quotations, and purchase directly through its website. iSelect is an insurance agency website. Unlike independent insurance companies, it can sell products from different insurance companies. The system of iselect can automatically compare dozens of insurance products from dozens of insurance companies that it cooperates with. You can easily compare the costs and service items of various insurances and select the cheapest and best cost-effective insurance.