Member Update May 2018

Welcome to the May edition of the Member Update.

In this edition there’s a message from the CEO, how private health insurance covers you, how you can cap the cost of your medical treatment, our MyBaby support program, and how our My Medical Expert service helped Defence Health member Alan. There is also a reminder of what to do if you have a DVA White Card and the importance of keeping your email up to date.

Thank you for being part of the family.

A message from the CEO

I realise that many members are making significant sacrifices to maintain their private health insurance. Everyone here is acutely aware of the challenges you face and we’re doing our utmost to contain costs and maintain value in your coverage, such as competitive negotiation of hospital contracts and tools such as Healthshare to help you and your GP find a medical specialist that accepts Access Gap.

We’re also focused on giving you as much in return for your premium as possible. Your fund pays significantly more than the industry average in benefits; 90.9% of members’ hospital related medical services are fully covered by us; and we operate with one of the lowest management expense ratios in the industry.

But affordability is the name of the game for the private health sector.

Although the Health Minister was recently touting the “lowest premium increase in 17 years,” the fact remains that health inflation is running at around 6% per annum, against a backdrop of stagnant wage growth.

What’s driving health inflation? In a nutshell: greater demand for health services and medical technology. More Australians are going to hospital due to chronic conditions – and because we’re living longer, we’re going to hospital more often in our lifetime.

Medical technology – while great for patient outcomes – also adds greater costs and contributes to premium increases.

Then there’s the costs that private health insurers have been calling on the government to reform. The wasted expenditure on treatment that is of little value to the patient; excessive charges by the medical device manufacturers compared to the public system; and opportunistic behaviour from some medical specialists.

I think the Health Minister understands the problem and where action is needed, but to be frank, because it lacks a clear majority, it is almost impossible for the government to bring about any meaningful reform. That is why the big-ticket items that impact on affordability are parked in committees.

The Labor Opposition Leader, Bill Shorten, also appreciates that affordability is the key issue for private health insurance. He recognises the big for-profit funds load their premiums up to include profits for shareholders. And he acknowledges the superior customer service focus and value proposition of not-for-profit funds like us.

But after drawing the distinction between for-profit and Members Own Funds, he says he will cap premiums at 2% for two years while the Productivity Commission conducts a review.

This approach is really no different, he just plans on using a larger committee to delay needed action.

A federal election is looming later this year or early next year. A government that continues to sit on its hands will be catastrophic for our delicately balanced health system. I urge you to demand the politicians seeking your vote commit to implementing meaningful reform to save our health system.

We’re all living longer and have the expectation of excellent health care. We need an affordable private health sector for that to occur.

Best wishes

Gerard Fogarty

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Private health insurance covers you

Insurance is designed to help you pick up the pieces when the unexpected occurs. You couldn’t afford to be without your car if it was smashed or stolen – so you insure it. Home owners insure against the damage or total loss of their most valuable asset. Sometimes we even insure our furry friends against the risk of costly vet bills.

Private health insurance is there for when something painful and unexpected happens to you. And it gets you fixed quickly.

Around two-thirds of all elective surgery in Australia is performed in private hospitals. That’s the non-emergency surgery that can be delayed for at least 24 hours.

But without private health insurance, you can wait almost a year just to see a specialist in the public system. And it’s not until after the specialist’s assessment that you go onto to the actual waiting list for public hospital treatment.

In 2016-17, the average wait for a knee replacement in a public hospital was 195 days *.

In 2018, public hospital waiting times are at their highest levels in two decades.

Who can afford to wait 195 days for a new knee? And what about the 6% of people who have to wait longer than a year?

If you’ve got a life to live, a game to play, or a job to get back to, you want to be treated quickly. And timely treatment, by the doctor and at the hospital of your choice, is what private health insurance delivers.

It’s not a bank account, but health insurance does give you peace of mind. Health funds generally – and not-for-profit funds especially – pay out the highest percentage of premium of all types of insurance.

The industry average is $0.86 (Defence Health averaged $0.97 last year) paid in benefits for each dollar of premium. This compares with $0.67 for property insurance and $0.64 for general insurance. When you need it, health insurance covers more than you might have realised.

* Australian Institute of Health and Welfare Elective Surgery Waiting Times 2016-17

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Cap the cost of medical treatment

Doctors and medical specialists may charge you more than the Medicare Benefits Schedule fee for the treatment you need. If they’re going to do that, they must inform you of the ‘gap’ you’ll have to pay – before you have the treatment.

We encourage all members to ask their doctors to use Access Gap for day-surgery or overnight hospital treatment. Access Gap caps the doctor’s charge so that you have no gap, or a small known gap for the treatment.

The doctor can choose to use Access Gap on a case-by-case basis. So it is important that you ask.

If your doctor doesn’t agree to use Access Gap, you have the right to find a doctor who will.

You, or your GP, can find an Access Gap doctor through the Healthshare directory on our website.

Healthshare gives you and your GP valuable information about specialists. It will highlight the doctors who’ve used Access Gap in the past and how often they use it.

Talking to your specialist about Access Gap is a conversation that you must have before going to hospital.

In 2016-17, almost 91% of Defence Health members had no gap to pay for their hospital related medical treatment. Ask your doctor to use Access Gap to cap your out-of-pocket medical charges.

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MyBaby support for your baby

There’s nothing more exciting than when a new baby is on the way. Our MyBaby Support Program is here to provide you with expert advice and practical support both during and after your pregnancy.

A major feature of the program is the Nourish mind, body, and baby portal. The subscriber only site is filled with quality content, ranging from fertility health, to exercise during pregnancy, labour and birth, breastfeeding and settling babies (and toddlers) to sleep.

You can view video tutorials, listen to podcasts, or access eBooks and articles at your convenience.
All the content is developed by qualified therapists, parent educators, midwives, psychologists and medical specialists.

Find out more in our MyBaby brochure and register at – whether you’re planning a baby, already pregnant, or have three kids under five, it’s our way of providing your family with extra care.

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My Medical Expert provides peace of mind for Alan

Don’t forget that all members with hospital cover have the opportunity to access expert medical advice or a second opinion, at no cost, through My Medical Expert.

Our member, Alan, was surprised when his annual medical check-up detected a heart murmur. The 53-year-old was referred to a cardiologist and it was recommended he have surgery to replace his aortic valve.

It was so out of the blue and because he didn’t have any symptoms, Alan wanted a second opinion before undergoing such major surgery.  My Medical Expert connected Alan with an international cardiologist who reviewed Alan’s medical history and all his test results.

The My Medical Expert specialist confirmed Alan’s original diagnosis and the need for surgery. Alan shared the report with his local doctors, who were very pleased with the collaborative feedback. Alan felt much more comfortable and confident in his decision to have the surgery and regain his cardiac health.

My Medical Expert provides expert advice or a second opinion on most medical conditions. Dental treatment, mental health conditions and emergencies are not included.

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White Cards and accepted conditions

If you have a White Card, all claims for treatment of accepted conditions must be sent to the Department of Veterans’ Affairs (DVA). And make sure we have a record of your accepted conditions in order to receive your ex-serving premium reduction (on eligible hospital or combined products). If you have any trouble finding a provider who will accept your DVA health card, you should contact the Department on 1800 555 254. If you need immediate or after-hours psychological assistance, contact the Veterans and Veterans Families Counselling Service

Update your email

Even Australia Post will tell you snail mail is slow and costly. The regular delivery time for mail can now take up to six days, depending on the destination. We’re getting our systems in shape to send more of our important communications to you by email.  So now is the time to make sure we have the best email address for contacting you or the family. Please check the email address we have recorded for you through your Online Member Services account. You can update it in ‘contact details’ under the ‘My membership’ tab. And don’t forget to tick ‘email’ as your contact preference for fast and efficient communication from us.

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