- Coronavirus FAQ's
- How we're supporting you during coronavirus
- health.com.au with Kieser
- The value of private health insurance in a pandemic
- Adding or removing people from your account
- Authorising another person on your cover
- Cover review
- How do I check my limits?
- Pre-existing conditions
- Suspending your cover
- Updating your details
- What am I covered for?
- Waiting periods explained
- Private health insurance reforms
- Gap in cover
- Emergency Department Fees
- Going to Hospital
- Hospital Added Costs
- Insulin Pumps
- IVF & assisted reproductive services
- LHC exemptions
- Public vs. Private
- Restrictions & Exclusions
- Understanding out of pockets
- What is an excess?
- What is LHC?
- What is the MBS?
- Where does Medicare fit in?
- Transcranial Magnetic Stimulation (TMS) Pilot
Coverage for coronavirus
Does my health insurance policy cover coronavirus?
- health.com.au has introduced new support measures, which mean existing customers with hospital cover will be covered for all COVID-19 related hospital treatments as a private patient, as long as you have served your initial two-month waiting periods.
- This COVID-19 coverage will be provided initially until the end of June 2020. At that stage, we’ll review and consider any possible further extension, depending on how circumstances change between now and then.
What clinical category does coronavirus fall under?
- Testing for coronavirus comes under the new MBS item number 69485, for microbiology testing for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The treatment of coronavirus doesn’t have its own clinical category or MBS item number, but will likely fall under respiratory disorders under the Lung & Chest category.
- If you’re admitted into hospital to determine the root cause of the presenting illness, this is covered the same way as it would for any other medical admission, e.g. flu/pneumonia.
- If you are admitted to hospital as a result of a condition developed following contracting coronavirus, the condition will come under the applicable clinical category, e.g. Lung and Chest.
Will my health insurance policy cover GP visits and tests for coronavirus? (Private Health Insurance)
- We don’t cover outpatient appointments such as GP appointments, blood tests etc.
- These rules will continue to apply as normal, even for coronavirus.
Will my health insurance policy cover GP visits and tests for coronavirus? (Overseas Visitor Health Cover)
- For health.com.au OVHC customers on Essentials Workers Cover or Essentials Plus Workers Cover, we do pay benefits towards outpatient services.
- This includes cover for consultations with a GP (General Practitioner) or specialist outside of hospital.
If I buy hospital cover now, will I be covered for coronavirus?
- If you buy health insurance now to be covered for coronavirus, the standard two-month hospital waiting periods will apply before you are able to claim benefits.
- For customers who are new to private health insurance, the standard two-month hospital waiting periods will apply.
- The rules in relation to pre-existing conditions for hospital cover will not apply.
I have exclusions on my product that may not cover me for COVID-19. How will the hospital know that you will cover me?
- We’ve added wording to hospital eligibility checks to confirm coverage for all of our customers with hospital cover, so the hospitals are aware that you will be covered.
If I need to be quarantined for COVID-19, will I be covered?
- Quarantine at home (self-quarantine) isn’t something that would be covered by private health insurance.
Premium increase deferral
Why isn’t the premium increase deferral longer than six months, like HBF are doing?
- We’re a small fund. We’re doing our best to react to the current situation, which is highly complex and difficult to predict.
- The six-month deferral means that we can monitor the situation, and plan and adapt while we’re supporting our customers. The plan could change!
What if I’ve paid my premium in advance?
- For customers who have paid in advance via direct debit or credit card, these payments were for your pre-1 April rate, so the premium increase would not have been applied to these payments.
- If you’ve paid in advance and are now experiencing financial hardship, get in touch with our customer service team and we can partially refund your account. Please be aware that this will also affect your paid-to date, so you won’t then be paid as far in advance.
You told me my premium was decreasing. Is this being deferred as well?
- No, this won’t be affected by the deferral. Any premium decreases will still apply from 1 April 2020.
What happens after six months?
- By 1 October, health.com.au will reassess the deferral of premium increase, to determine if it should be extended.
- We’ll take into consideration the pandemic situation at that point in time, what our customers need and what we can provide for them.
- We’ll keep our customers aware of our position, and keep the lines of communication open to make sure they’re across all the support that’s available.
Will I have to back pay the difference once health.com.au implements the premium increases?
- No, you won’t be required to backpay the difference in premium amounts once the premium increases that were planned for 1 April 2020 come into effect on 1 October 2020 (or later).
Is the Government Private Health Insurance Rebate still changing on 1 April 2020?
- No. Changes to the Government Private Health Insurance Rebate have been deferred until April 2021.
Financial hardship policy changes
We’ve extended our financial hardship suspension policy during COVID-19 to give customers some premium breathing room.
- The maximum financial hardship suspension period allowed has now been increased from 6 months to 12 months.
- The 3 month minimum suspension period has been removed, so if you suspend and something comes up that you need to claim, you can reactivate on the spot.
- Customers on combined covers have the option to suspend just the Extras portion of their combined cover, so you can maintain hospital cover while still reducing your premium. We’ve had to make some system changes to set this up, so please get in touch if you were previously unable to use this option and we’ll get it sorted for you. Please note that this can only be used once per membership during a pandemic. If you choose to re-instate your extras, you will be unable to place them on suspension again.
- You don’t need to show any proof of hardship to take up any of these suspension options during coronavirus, however, you do need to have been a member with us for at least 6 months. Simply let us know how we can help and our customer service team will take it from there.
If I want to suspend my cover because of financial stress, can I still make a claim?
- As with any other type of suspension, you won’t be able to claim benefits while your cover is suspended.
I have a student dependant that has just come off my policy. What are the options for them if they can’t afford their own cover right now?
- Student dependants who now require their own cover but are unable to afford it at this time will be able to take out their own cover. health.com.au can then apply a hardship suspension straight away. A minimum of one-day premium payment is required.
- We’ll also waive the minimum suspension period, so they’re able to reactivate at any time.
When do the telehealth benefits apply for physio and psychology?
- Telehealth psychology consultation benefits apply from 1 April to 30 September 2020.
- Telehealth physiotherapy consultation benefits apply from 14 April to 30 September 2020.
How do I claim telehealth benefits for physiotherapy and psychology?
- You’ll need to pay for the service upfront, and then lodge your claim for benefits to be paid back into your nominated bank account. You can lodge your claim:
- Online – log in here or you can email your claim to us.
Why are telehealth benefits being introduced?
- As social distancing measures are in place, it’s important that our customers can continue to receive psychology and physiotherapy treatment during this time.
- Telehealth consultations are safe, effective and are the right thing to do to reduce infection rates in our community. They provide customers with continuity of care from the safety of their homes.
Are there any conditions for physiotherapy teleconsultations?
- health.com.au will provide coverage for teleconsultations provided by physiotherapists from Tuesday 14 April 2020 subject to the conditions listed below:
- The customer is undergoing an existing course of treatment and the customer has seen the physiotherapist over the past six months, or
- For new patients, the tele-physiotherapy service has been recommended by their general practitioner or relevant medical specialist, and the primary condition being treated is one of:
- Post orthopaedic surgery rehabilitation (e.g. Total hip or knee replacement).
- Chronic musculoskeletal condition (e.g. osteoarthritis)
- Cardiac rehabilitation
- Pulmonary rehabilitation, or pelvic floor muscle training,
- The service is delivered before 30 September 2020, and
- The service is undertaken in accordance with Australian Physiotherapy Association guidelines.
Are there any conditions for psychology teleconsultations?
- One on one Psychology consultations will be covered where:
- The patient is undergoing an existing course of treatment, and has seen the psychologist providing the teleconsultation over the past six months.
- For new patients, the telepsychology service has been recommended by their general practitioner.
- The service is delivered on or after 01 April 2020 and before 30 September 2020.
- The service is undertaken in accordance with Australian Psychological Society guidelines.
What if I have a pre-booked hospital admission or ongoing hospital treatment?
- The Federal Government has advised all non-urgent elective surgery will be suspended until further notice from midnight on 26 March due to the coronavirus.
- If you have a pre-booked hospital admission or ongoing hospital treatment, we’d recommend checking in with your doctor and hospital before your admission, to make sure you have the most up-to-date information.
Should I keep my cover?
We get it – it’s not great having to pay for something you can’t fully use at the moment. We are busily working away (from home of course) on ways to help our customers, so that we can come through the other side of these difficult times together. If you’re wondering if it’s worthwhile keeping your private health insurance right now, we’ve broken down some options and things to keep in mind based on the type of cover you currently have.
Hospital only cover
Private hospital cover is complicated, and there’s more to it than just elective surgery. If you are able to, maintaining your private hospital cover is always a good idea, even at a time like this. There may be an even greater backlog of elective surgeries when services eventually return to normal.
Lifetime Health Cover (LHC) loading allows you to drop private hospital cover for a maximum of 1,094 days in your lifetime without incurring a LHC loading penalty. If you decide to suspend your hospital policy instead of cancel, your LHC loading won’t be impacted.
However, there can be tax implications to dropping private hospital cover. If you earn more than $90,000 (single) or $180,000 (family, couple) cancelling your private health insurance hospital cover could mean paying extra tax. It really depends on your individual circumstances, so getting some independent financial advice is always a good idea. An alternative option is to either suspend your cover or temporarily change to a lower cover to reduce your premium.
If this is something that might affect you, it’s always a good idea to seek independent financial advice. You can also read up on Australian Government Surcharges & Incentives to get a better understanding.
If paying your premium is just not an option at the moment, we understand. That’s why we’ve extended our financial hardship policy to allow customers to suspend for up to 12 months if they need to. This means that you can avoid re-serving any relevant waiting periods when you reactivate. Waiting periods do vary, so if you have any questions about those just hit us up on chat. Please note that you won’t be able to make any claims while your policy is suspended.
Extras only cover
Extras limits are per calendar year and you have until Dec 31st to use your limits.
Please have a read of the section above on telehealth benefits for physiotherapy and psychology to see if this is a service you can use with your current level of Extras cover.
We know of some customers who are booking appointments a month or two ahead and reassessing closer to the date if they can still attend. This way, they have a booking locked in and can use their Extras again as soon as things return to normal.
Cancelling Extras cover now (not just suspending) means that you would need to go through the Waits process again (ie Major Dental has a 12 month waiting period) should you decide to sign up for Extras cover again in the future with us or any other private health insurer (unless they specifically waive your waits).
An option now available to health.com.au customers is to temporarily suspend their Extras cover. While this means you cannot claim any services during this time, you can take a break from payments without having to re-serve waits when your suspension period ends.
Both the Hospital only and Extras only information above will apply to customers on Combined covers.
An option available to Combined cover customers is to temporarily suspend the Extras portion of your cover in order to lower your premium. This option has the benefit of allowing you to maintain continuous private hospital cover and not have to re-serve your Extras waits when the suspension ends. We’ve had to make some system updates to allow us to do this - if you were previously unable to take advantage of this option we’ll be reaching out to you soon.
If you’re unsure, have a read of Private health insurance during coronavirus.
The most important message we can give is to get in touch if you’re unsure of the best option for you. Our Customer Service team is still available on live chat and email.
We’ll do our very best to help you where we can so we can get through this thing together.