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Health insurance can be a lifesaver

PRIVATE health insurance is very popular in Australia with some nine million people, nearly 50 per cent of the population, a member of one of the several official funds operating in the country. All of them, from the largest to the smallest are overseen and have to be approved by the Federal Government.

The funds operate in all States and Territories and allow members to access top quality health care at reduced rates and - probably most importantly - they save members from waiting for months or perhaps years for medical care and operations under the public health system.

Under the funds you can be admitted to the private wards of a public hospital or to one of the many private hospitals in the country.

The premiums charged by the funds depend on the State or Territory in which the member lives and the level of cover which the member chooses.

The top levels cover just about every medical procedure, including dental, pre-natal, optical, transplants, plastic and cosmetic surgery and elective surgery, such as hip and knee replacements, etc. These are called ancillary services.

To reduce your premiums you can chose to have fewer procedures covered or have a waiting period before some of these procedures are covered, or elect to pay the first so many hundred dollars of the costs.

Once you are in hospital outside the public health system you are liable for all costs, such as bed nights, surgery, operating theatre, surgeons, any doctor's visits, tablets, medicines - which mount up to thousands of dollars pretty quickly. However, if you are in a private health insurance the fund will pay most or all of these costs.

You can choose the hospital you attend and the surgeon of your choice but most often your local doctor will refer you to a hospital and suggest a surgeon, who then selects the other members of his team.

Like any insurance you could pay your premiums for years and not claim anything against the fund. Of course, the day you stop you'll most probably end up in hospital, facing huge bills.

Premiums differ from funds and between the State or Territory in which you live and also depending on how many members are covered and the type of cover you require.

Roughly premiums for the top cover are around $300-$350 per month, including the premium increase of just under 8 per cent last month. But the Federal Government gives a 30 per cent rebate off this rate and this increased, from April 1, to 35 per cent for 65-69 year-olds and to 40 per cent for 70 year-olds and above.

Being a private patient in a public hospital gives you a choice of doctor. Depending on your illness or condition and your needs, this may or may not be the same doctor you would have been allocated by the hospital as a public patient.

Being a private patient in a private hospital or day hospital facility gives you a choice of doctor and hospital, as well as access to hospital services at a time that may better suit your needs.

There are four possible categories of health insurance membership:

* Single Membership provides cover only for the one person named on the membership application.

* Couples Membership provides cover for the member and member's nominated partner.

* Family Membership provides cover for the member, the member's nominated partner and/or dependants.

* Single Parent Membership covers the member and the member's nominated dependants.

Not all health funds offer all four membership types as separate categories. Some funds have instead simplified these categories into single membership or family membership.

When you join a health fund or upgrade your existing level of hospital cover, you may have to wait some time before you can claim benefits for some services. This is called a waiting period. Waiting periods that apply to hospital cover include:

* 12 months for treatment related to a pre-existing condition;

* 12 months for obstetrics (pregnancy) services; and

* 2 months for all other hospital treatments except accidents.

Health funds can waive or reduce these waiting periods but they cannot be increased.