What to Consider When Reading Policy Documents and How to Compare Policy Costs

If you are one of the many people requiring a hip or knee replacement the public health system can take a long time. That is why over one point four million people in New Zealand rely on the opportunity to take private health insurance and avoid large crowds for elective procedures.

Still, private health insurance is not free and, unfortunately, some insurance providers can cost a family much more for the same coverage than others.

To assist you in making the right choice we compiled some top details from six different carriers to give you a basic health insurance plan that includes at least $300,000 of surgical procedures. Premiums were collected based on excess amounts of $0, $500, and $1000 for the following profiles:

• A 35-year-old
• A 55-year-old
• A 70-year-old
• A family of four

Why Get Health Insurance?

Health insurance: is it really necessary? Given policies that range from $157 per month for a 25-year-old female to $293 per month for a 55-year-old male, it is a question that can be asked. You may then say golly gee, I wish I had coverage for such procedures as hip replacement, non-urgent heart surgery, hysterectomy, and more. But if you are healthy in the long run you will be glad you never spent the extra dollars.
Rates often increase as you get older because better and costlier therapies are used, which were once considered innovative. For example, what you may require most of the time, when you are older and perhaps retired you find that the costs of health insurance are at their highest.
The public health system will eventually provide care if you get ill or you develop a chronic disease. But it is the “latter” part that makes health insurance attractive to many people as indicated in the following. Some feel that the possibility of getting the service as soon as they need it is worth the price and inconvenience of being a member of an HMO.

We’ve all heard that question before Do You Need Health Insurance?

Before deciding to take out health insurance, consider asking yourself the following questions:

• Can you create a fund for medical expenses strictly? As to the former if your answer is yes you would appear to be best off without health insurance or at least without comprehensive coverage so long as you may not need expensive options or procedures in your younger healthy years.
• Can you pay for a routine doctor’s visit? If so, such action suggests that getting an insurance policy that costs a lot in premiums for broader coverage might not be needed. Likewise, if you can make do with budget policies that will only fund GPs and primary health (including prescriptions), then you can pay cash basis without the need for insurance.
• Can you afford to pay surgery costs if you are not on a public hospital waiting list? For example, Southern Cross currently calculates the price of a knee replacement between $24,000 and $29,700. Details were made based on the affordability of certain expenses. You should also take into consideration how much more you might not earn, just in case of a sickness that makes you too weak to go to work.
• For this quiz, are you cool with some measure of risk with your money? There are those insurers who provide policies that allow the insurer to pay a certain proportion of the claims. The thought is that possessing skin in the game may reduce possible useless procedures or over-utilization of healthcare services. Instead, you could decide to settle for a larger excess to bring down the premiums.
• What percentages of patients that come to the hospital require major surgeries? Diet and exercise also act as an important modifiable risk factor in modifying the risks that make a person have to seek medical care. Some of the time, walking three blocks is more effective for a person’s future well-being than buying insurance.

Questions to Discuss With Your Health Insurance Agency

When shopping for a health insurance policy, make sure to ask the following essential questions:

• Is there a list of procedures or illnesses that are not considered as part of the policy?
• This is about whether or not there are treatment limits and if they are limits per a certain procedure, or limits according to the year.
• Just how friendly is the policy when it comes to scans and investigation processes?
• Could they claim the money for diagnostic procedures if you do not undergo treatment in the hospital?
• Which minor surgical procedures are authorized?
• Is there a prescription for the non-P-content drugs?
• Can patients avail of home-based nursing services after their surgery or operation?
• Can you be able to recover input for post-operative physiotherapy?
• Can you go abroad to receive treatment according to the policy?
• Do your children stay under any insurance from birth, up to what age?
• How long must a client wait before medical conditions they had before enrollment in the health plan are addressed?
• Is there an option for cost sharing and can you lower premiums by choosing a higher excess?

Things to do for a smooth claiming process

• Consult Your Regular Doctor First: If you have medical concerns, speak to your GP not to the screen. It’s easy to tag someone as a specialist these days online and unfortunately if they are not a Medical Council-registered doctor, more likely, the sufferer will lose time and money on a quack diagnosis.
• Check if You Need to Visit an Affiliated Provider: Other companies such as Southern Cross and Nib, only allow you to access specific clinics or providers to be fully reimbursed. That is why one should always look at the list of the associated healthcare providers.
• Request an Estimate and Apply for Pre-Approval: Do not be caught off guard, therefore, use your insurer’s pre-approval checklist. This guarantees that your claim will not be declined when it is least expected. Moreover, insurers might cover only ‘reasonable or customary’ fees, in which case you may find out if there is an upper limit to consultation or a proposed procedure.
• Review Your Policy Terms: Before moving any further, read the tiny prints in your policy document to see what is covered and what is not. That is on top of follow-up sessions and other related costs which may accrue to the patient.

Filing Complaints

Insurance carrying out medical insurance businesses must incorporate a financial dispute resolution mechanism. Every organization incorporated in our survey belongs to the Insurance and Financial Services Ombudsman scheme.

In case you fail to agree with your insurer in solving a certain matter, you can take the case to the ombudsmen. However it is necessary to understand that your complaint cannot be filed without meeting the threshold element that the complaint must be deadlocked.

The ombudsman can address complaints related to:

• Declined claims
• Legal policy and contractual policy maintenance
• Advice on financial issues, or financial services, offered by the insurer
• The payout amount offered

The ombudsman does not have powers of investigation in relation to complaints about premiums, excesses, or underwriting decisions, and cannot investigate claims where the amount is over $200,000 or $1 500 per week, unless the insurer has agreed to a review.