My patients often ask me which health fund is best for extras cover… Quite simply, there is no answer to this questions, but what I am about to say may help you make that decision for yourself. I feel that most people consider joining health fund to actually save money. So presumably we expect to at least get our money back when in need, or possibly get more.

Choosing a Health Fund

It follows then that to qualify as a good health fund it has to give clients good return… at least in times of need.. Then it should be fairly straight forward to just calculate how much you are expected to pay for a given cover and how much you are likely to ever get back. A calculator is advisable. I have performed this exercise with a few major health funds and found that there was no way for me to be a winner: I never use optical (even though when I did wear glasses, I never wanted the ones offered on my health cover, so ended up paying big dollars anyway ))), I don’t use chiropractic services or physio (even if I did have an injury and required those services the yearly limits are so minute that the cover would be unlikely to help since rehab usually takes months and hundreds of dollars)… So out of all the services listed the most used seemed to be dental, and I found that most people join mainly for dental.

Personally I found health insurance brokers to be less than useful. None of them could actually tell me definitively what my rebate was going to be for dental as compared to premiums I was supposed to pay….But this was exactly the question I needed to clarify. They wanted to concentrate on my health “needs”. Surely they were able to recommend funds that “covered my needs” but they couldn’t spell out what they meant by “covered”. It was up to me to do the maths.When a health fund consultant tells you “all items are covered” what they forget to mention is that they are not 100% covered and ONLY to a certain limit per year… Which means: expect more expenses on top of your premium.

With some health funds you get “free” check ups and cleans (if you believe in anything free)….under the condition that you ONLY go to certain practitioners, you are not able to choose for yourself.. Same goes for heavily discounted treatments. And remember all this you are STILL paying for, just not at the time of service which may seem like you are paying less.

This is what it comes down to: people buy insurance for one reason only, and that is if something goes wrong and I am not able to finance the solution to my problem, my insurance will step in and take care of that.

Unfortunately it doesn’t work like that with extras cover.

Suppose one gets into a car accident and smashes all their front teeth. The health fund will ONLY pay for one, maybe two teeth if you have a very expensive cover, to be restored properly. You need to pay the difference… or walk around with only two front teeth ((. Because the amount that you can claim per year is restricted, usually around $1000 for best covers, what you actually NEED done in a given year is irrelevant to the health fund.

One more interesting point to ponder on: the ONLY non for profit health fund left in NSW is HCF… All others are in the mad race to pay dividends to their investors… Hmmmmm…

I guess my point is ….do your maths very carefully. This may be the only way to choose smartly.

And lastly, try to find a dentist you can trust so you can have your wants and needs assessed properly, fairly, in a transparent and honest way, without looking over your shoulder at the health fund requirements and demands. You never know, might just work out cheaper in the long run and better for your health.

Dr. Maria Avis