Understanding health insurance coverage for specific health conditions
Private health insurance can empower you with greater choice when it comes to your medical care. It can provide peace of mind by helping you avoid public waitlists and by making out of hospital services, such as physiotherapy, more affordable.
However, it’s important to know what’s included on your insurance policy. In Australia, there are two types of health insurance – hospital cover for medically necessary inpatient surgeries and treatments, and extras cover for treatment outside of hospital, such as physiotherapy and remedial massage.
Different conditions and their related hospital treatments are organised into clinical categories. There are then set levels of hospital insurance which each include a specific set of categories, with higher levels of cover including a wider range.
Compare the Market’s Head of Health Insurance, Lana Hambilton, states it’s crucial to navigate these clinical categories carefully, as it isn’t always straightforward.
“Sometimes a health condition may require treatment from multiple different clinical categories. Diabetes is an example of this. Hospital policies can include ‘Diabetes Management’, but ‘Insulin Pumps’ aren’t included in this and are instead listed as their own separate category,” Hambilton says.
“It’s also worth considering whether you could benefit from a combined hospital and extras policy. This will enable you to claim a benefit on relevant treatment both in and out of the hospital. For example, some health funds will pay a benefit towards diabetes support programs, blood glucose monitors, or swimming lessons if approved by a health professional to manage diabetes.”
Having a policy that includes hospital and extras can also be beneficial for specific conditions and treatments, including cancer and pain, two of the most commonly Googled health conditions. With cancer, some extras policies in Australia include skin cancer screening, while hospital cover can pay a benefit towards inpatient cancer treatment like chemotherapy.
Likewise with pain, there are different hospital treatments that can be included (depending on the cause of the pain), while extras cover can pay benefits for relevant treatment like physiotherapy or remedial massage.
“It’s important to make sure you get the coverage you need when purchasing health insurance. Our health insurance experts help Australians navigate the private health insurance space every day. This way, people are equipped with the cover that matters to them,” says Hambilton.
“Australians wanting advice around what type of policy to get can call our experts for advice.”