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Private Health Insurance for Covid-19

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Anneke Van Aswegen Published/updated: May 4, 2020
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According to the Australian Government Department of Health, there have been 3,166 confirmed Coronavirus cases and 13 deaths in Australia, since 27 March 2020.

Because Medicare pays for the treatment of Covid-19 and many people are unable to earn an income during the pandemic, Australians are questioning whether to suspend private health insurance due to financial hardship or if coverage will still be useful in this time.

Australians who regularly claim benefits for treatments not covered by Medicare, for example, ambulance services, dental and home nursing, or want peace of mind that they’ll be covered for other medical procedures that might arise because of contracting the virus, may continue to benefit from private health insurance.

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Will health insurance cover the Coronavirus?

If you’re admitted as a private patient to a public or private hospital and have an active Hospital insurance policy that includes benefits for lung and chest treatments, you’ll be covered for the Coronavirus if you’ve served the standard two month waiting period. However, health funds have recently announced that all Hospital policies will now include full hospital coverage for Covid-19.

You might still want to confirm that your policy includes coverage for other services that might relate to the treatment of Covid-19, for example, kidney and bladder problems.

Take note: Any coronavirus treatments received outside of the hospital, which is paid for by Medicare will generally not be claimable from your private health fund.

How to check your level of cover and benefits

To make sure your private Hospital policy includes full coverage for lung and chest treatments and ambulance transport, request that your health fund send you an updated Private Health Information Statement (PHIS).

Use the PHIS to review your existing policy. It will generally include information regarding:

How to make a claim

When claiming for in-hospital treatments, your hospital will generally send the invoice directly to your insurer for payment. You can usually claim Extras online via your health fund’s web portal or email. Should you prefer to claim via email or post, please include copies of your invoices and completed claim form, which you can download from the insurer’s website.

Can you get private health insurance during the Covid-19 outbreak?

Yes, you can generally get a new or upgraded health insurance policy during the pandemic. However, you must be aware of the waiting periods, especially if you’ve tested positive for the Coronavirus. Applying for cover when you have Covid-19 will result in a general 12 month waiting period, as the virus will be deemed a pre-existing condition.

If you’re applying for a policy and do not have any Cobid-19 symptoms, a general two month waiting period will apply lung and chest treatments.

Switching health funds or upgrading cover

When switching health insurance companies, you generally do not have to re-serve waiting periods when taking out cover with the same or lower benefits and limits. However, should you upgrade or switch to a plan with new or higher benefits, you’ll generally have to serve waiting periods before you can claim on those benefits.

Get more information on how specific health funds are treating the Coronavirus

If you’re experiencing any Covid-19 symptoms, please phone the 24/7 National Coronavirus Helpline on 1800 020 080 and speak to a medical professional about your symptoms.

Frequently asked questions

  • What happens if you get infected with the Coronavirus before your waiting period ends?

    If you have not served your waiting periods for the treatments and services indicated on your Private Health Information Statement, no benefits will be payable. However, if you’re an Australian resident and admitted to a public hospital for Covid-19 treatment as a public patient, your treatments will be paid for by Medicare.
  • Will your health fund pay for Covid-19 testing?

    A test confirms the diagnosis of the Covid19 virus, this might be a blood test or swab test where cells from your nose or throat are collected, typically done at your GP clinic, a hospital or by a pathologist. The swab or blood is then sent to a laboratory for testing.

    Medicare pays for tests performed out of the hospital; thus, it will not be covered by your health fund. However, should testing be conducted when you’re admitted to hospital as a private patient, it will generally be paid for by your private health insurance if your Hospital cover includes it and you’ve served your waiting period.

  • Will health insurance premiums still increase on 1 April?

    As of 30 March 2020, 1 April premium increases, which was set to rise by an average of 2.92%, have been postponed by at least 6 months for member health funds, including Bupa, HCF, Medibank and NIB. The not-for-profit health insurer HBF has announced that they will waive the increase for 12 months.
  • What if you can’t afford your health cover premiums because of the Coronavirus?

    You can generally put your cover on hold for a period if you’re experiencing financial hardship and find it difficult to pay your premiums during the Covid-19 outbreak. Some health funds are also offering premium waiver and suspension options to members affected by the pandemic. Please contact your insurer to find out more about your options.

    Take note, while your policy is suspended, you generally won’t be able to claim on services and treatments.

  • Will your scheduled elective surgery still take place?

    All non-urgent elective surgeries will be suspended with only urgent operations to continue from 25 March 2020, as announced by the Prime Minister. If you have surgery booked, please contact your hospital to confirm your procedure has been cancelled and what the next steps will be.
  • Will private health insurance services still be open during the pandemic?

    Generally, all upcoming appointments, such as going to the dentist or physiotherapist, will likely be suspended until further notice. While call centres for specific services provided by your health fund might still be open, for example, eye care centres, branches will likely be closed across the country. However, access to emergency dental services will generally still be provided by health funds.
  • Will health insurance for overseas visitors cover the Coronavirus?

    If you have a valid visa health insurance policy that covers treatment for lunch and chest, and you’re admitted to a hospital as a private patient because of Covid-19, you’ll generally be covered. However, it’s best to contact your health fund to make sure.

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