How to Avoid the Health Fund Increases

Yes, it is that time of year again. Noticed an increase in adverts for health insurance providers lately? Every year on April 1st , private health insurers increase their fees. This year shows the lowest increase since 2002, but it’s still nearly triple the rate of inflation.

In addition, the latest dental fee survey carried out by the Australian Dental Association, showed that from 2018 – 2019 the average costs charged by dentists actually dropped by 1.9%. But our insurance costs are increasing and the average rebate paid is decreasing. So what’s going on and what can you do to make sure you get the most out of your private health insurance?


What to look out for this year

This year, the average increase in fees is going to be around 2.95%. In past years we have seen an average increase of between 3.5% and 5.5%. However, remember that this is just an average. One health fund is set to increase its fees by 5.58% (I was shocked to learn that this is actually my health fund!).

So, what should we do? Well first of all, don’t just accept the rise and carry on as normal. Although this seems tempting when you are already too busy and stressed to deal with it, it does pay to look around at other options.

The private health ombudsman advises you check your policy once every year to make sure that it’s meeting your health needs.


Do you actually need it?

I’m not an expert in health insurance, but this is the first question I ask myself. Here we’ll be dealing with extras cover only.

First thing to work out is what allied health services you actually use. Look back over past receipts or think about what you might be needing in the near future. Hoping this will be the year you finally run a marathon? Probably wise to keep the physio cover! Don’t wear glasses or contacts? You probably don’t need optical cover. Do you just get a check-up and clean once a year at the dentist? Maybe you don’t need dental cover.

If your health insurance extras covers for example, physio, dental and optical – grab your receipts from the past year and add up how much your total bills were. This is the total amount, before any health rebates, at each of these providers. Is this amount less that what you are spending in insurance? If so, you probably don’t need it unless you are foreseeing any changes coming in the next year.


Visiting your dentist regularly can help prevent
any unexpected emergency visits.


An example…

As an example, let’s say you paid $500 for the year for your extras cover, which is paying 50% up to a limit of $800 per year.

Imagine got 2 check-ups and cleans and one filling over the course of the year, which cost a total of $750. You’d have paid $375 (the 50% ‘gap’) plus your premium of $500, which means all up you’ve spent $875. This is more than the $750 you would have paid if you didn’t have any insurance.

This is just an example, but it’s definitely worth looking at your dental needs, what you’re paying and what’s covered to see if you have the right level of cover. Seeing your dentist regularly, they will be able to give you an idea of what kind of work you may require over the course of the year. Also, seeing them regularly means that you may be able to prevent problems before they arise, so there are not any surprise dental appointments that you didn’t budget for.


How does dental insurance work?

Different policies all do this differently. Some will give you an annual limit that will cover all dental whereas others will exclude certain procedures. Some will split procedures into general and major dental, but others might split this further into general, major, orthodontic and endodontic (root canals). Read your product information statement thoroughly. If you have absolutely no intention on getting braces, there’s no point having cover for orthodontics.

Each fund will have an annual limit. Some funds may allocate a limit for each type of provider, e.g. $500 for dental, $500 for physio. Others may not split it and give you say $800 a year to spend on any of the services covered by your policy.


Is your health insurance the right one for you,
or are you wasting your money?


What is a Member’s Choice or Preferred Provider dentist?

Some health funds have ‘Member’s Choice’ or ‘preferred provider’ dentist. This is purely a financial agreement between the dental provider and the health fund. The contracted dentist has agreed to provide a dental service at a fee agreed with the health fund. The health fund will then advertise ‘no out of pocket expenses’, but only if you see one of their dentists.

The dentist is providing the same service at at reduced fee, in return to receiving a higher volume of patients. The “preferred practitioners” are not actually preferred because of dental ability, nor are the practices held to a higher standard.

This is limiting the choice patients have over who their dentist is. Just because they signed up with a certain health fund doesn’t mean they should have to go to the dentist their health fund says. Continuity of care is so important. Finding a dentist that you like and trust should be your priority. Sticking with them over the years mean they get to know you, your history, your family. In addition they will become your trusted adviser and friend. Your health fund shouldn’t be penalising you for going to the dentist you like.


It’s important to see a dentist that you like
and trust.


Who can I turn to for impartial advice?

The government have a website that will give you comprehensive, independent private health insurance information.

Some of the comparison websites out there won’t compare all the funds. Funds pay to sign up with these companies. If you just use comparison websites, you’ll be missing out on all the options.

Another great source to try is the Fair Health Care Alliance, who have been backed by the Australian Dental Association. They will find out your insurance needs and do all the calculations and comparisons for your you.


In summary…

Want to get the most out of your health fund? Make sure you actually use it! Some funds give you unlimited check-ups per year (check your policy). There is no point in paying all that money to health funds who cover preventive treatment, when you don’t actually make the most of it.

Check-up overdue? Call our friendly team today on (07) 3211 1155 and let them take care of you.

If you would like to read further. 

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