Health policies differ between insurancers so make sure you know what you are covered for. Photo / 123RF
Health policies differ between insurancers so make sure you know what you are covered for. Photo / 123RF
Opinion by Diana Clement
Diana Clement is a freelance journalist who has written a column for the Herald since 2004. Before that, she was personal finance editor for the Sunday Business (now The Business) newspaper in London.
Do you do the "should I, shouldn't I" dance around health insurance?
I've been there. I also chew the fat regularly out of lockdown with a friend who has the all-singing all-dancing version of Southern Cross health insurance. While most people have to beg their doctors to be even consideredfor a waiting list, my friend is in and out of the hospital at pace for whatever medical procedure is that she, her husband, or the kids need or want.
Health insurers and their various policies differ. But generally, they cover you for non-urgent medical treatment. That might include doctors' visits, specialist appointments and operations. If you have a car accident or end up with Covid-19 or any other acute situation, you'll still go to a public hospital.
The first question to ask, says Russell Hutchinson, industry consultant at Chatswood Consulting, is if you need medical cover in the first place. "We have a great health system," he says. On the other hand, we have health rationing in New Zealand.
Sometimes GPs don't refer you to a specialist. If you do get referred, you'll be rated on a clinical access priority score that determines if your case is "need" or "want", says associate professor Dr Tim Tenbensel of Auckland University's Faculty of Medical and Health Sciences. Rationing is a fact of life for all health systems in every country, says Tenbensel.
The Catch 22 of private health treatment, he says, is that the presence of private insurance helps to perpetuate explicit rationing in the public system.
"Private insurance is mainly about elective surgery. Effectively it facilitates queue-jumping for those that can afford it and therefore those that can afford it might probably want to [take out insurance]." But the existence of private healthcare encourages doctors to work privately, perpetuating the problem of limited access in the public system in the first place.
But if you can afford cover then you can skip the public queue. Hutchinson cites the example of his own knee injury. When the doctor realised he had health insurance, Hutchinson was booked for an MRI immediately. He may not have qualified for that at all on the public system. Likewise, another member of his family had a frozen shoulder and was treated within days, not the months it might take in the public system.
Everyone has their own story about private health insurance. When it comes to the "do I buy it" question, the three big ticks in the yes column for Hutchinson are:
1. Get diagnosed quickly.
2. Be treated quickly.
3. Get access expensive drugs prescribed by your specialist, but not available free through the public system.
Don't assume that all of these features are included in every health insurance policy. Cover varies. Some policies only cover surgery, not specialists' appointments and tests.
Even if your policy covers non-Pharmac drugs, for example, you may be subject to limits. Usually, these drugs come under what's called non-surgical benefit, but may have a sub-limit such as $100,000, which may not cover your needs, says Hutchinson. Or you might have a co-payment of as much as 50 per cent.
Insurance may help you get medicines that wouldn't be available to you otherwise. Photo / 123RF
"[Non-Pharmac cover] is great, but if the course of drugs cost $200,000 and you have a 50 per cent co-payment you have to pay $100,000," he says. That's not insignificant.
One question that comes up regularly about private health insurance is whether mental illness treatment is covered. Mental illness is common and they're simply illnesses, just like any other.
