Health insurance is a critical component of our healthcare system, designed to provide us with a safety net for medical care.

However, for many Australians, navigating the complexities of health insurance policies can be as daunting as the ailments they're meant to protect us from.

With 14.7 million Australians enrolled in private health insurance, a staggering number of policyholders – 1.47 million, to be precise – are 'blissfully unaware' of the benefits they're missing out on.

Consumers who seek comprehensive coverage end up with plans that include a range of extras they neither use nor need.

Many Australians with private health insurance are missing out on unclaimed benefits. Credit: Shutterstock

This leads to wasted potential and contributes to insurers' financial gains rather than the policyholders.

The one-size-fits-all approach adopted by many insurance companies can make it difficult for consumers to discern what they need versus what they're paying for, leading to a disconnect between the policy's value and the actual benefits received.

This disconnect is further exacerbated by the gaps between what's covered by insurance and the unexpected out-of-pocket expenses that can arise.

Such gaps can obscure a policy's actual value and leave Australians feeling ripped off as they grapple with soaring out-of-pocket expenses.

It's a major gripe among consumers, who spend money on health insurance that offers limited value to their health needs.

The current system leaves many with coverage that doesn't address their health needs.

A data-driven approach is needed to consider an individual's health status, lifestyle, and personal goals, leading to better health outcomes and more effective use of insurance funds.

Imagine a future where health insurance is personalised, leveraging data and technology to track spending and assess how effectively people are progressing towards their health goals.

In this model, if data shows that someone frequently uses physiotherapy or speech therapy services, their plan would automatically adjust to offer more services.

Value-based health insurance represents a game-changing approach to how we think about and utilise our health coverage.

It's about making insurance work for the policyholder, focusing on the quality of care rather than the volume of services.

Insurers who are genuine about delivering quality health plans would gather detailed information about a person's medical history, current health conditions, lifestyle factors, and personal preferences to curate a customised plan that genuinely serves the individual.

This shift could end policyholders' paying for coverage they never use and don't need.

It's a win-win situation where consumers get the coverage they actually need, and insurers build trust and loyalty by providing real value.

In other news, many travel insurance policies don’t cover airline insolvencies, potentially leaving travellers with unexpected costs.

Exclusions in travel insurance policies often include lost or damaged smartphones, lost jewellery, and unattended items. Learn more about it here.

Key Takeaways

• Many Australians with private health insurance need to be made aware of how much of their entitled benefits remain unclaimed, resulting in lost money for consumers and increased profits for insurers.
• The current health insurance model includes coverage for various extras that many policyholders do not use or need, often leading to higher costs and a false sense of value.
• The article highlights the need for a shake-up in the health insurance industry, advocating for a shift from quantity-based services to quality-based outcomes that reflect individual needs.
• Personalised health insurance, driven by data and focused on quality care, is presented as a 'game-changing' solution, ensuring that policies are tailored to the policyholder's specific health status, lifestyle, and goals.

Have you reviewed your health insurance policy lately? Have you found benefits you weren't using or coverage that didn't match your needs? Share your experiences in the comments below.

 

[Liz]

Yes I received a quote for my new health insurance, it had gone up to $4,000 approximately so I had to drop Hospital Cover and keep extras. I have had cover for 50+ years but it is becoming far too expensive especially on a pension.

 

[mylittletibbies]

People on a pension can't possibly afford private health cover. They are lucky if they can afford to eat and keep a roof over their heads.
Still the government can afford to pay astronomical pensions and golden hand shakes to retiring politicians who are still way below retirement age
Take Mark McGowan for instance who was so tired and worn out had to retire, take all his benefits and then pull on four new jobs where he is paid millions and still receive all their full benefits.
Why are they so more entitled than the average person. Why is there not the same rules for everybody.
The system stinks!!

 

[Clancieblue]

I saw a specialist yesterday. His fee $275.00, I just received $140.00 rebate from Medicare. A hospital procedure will cost $25 for medication prior, + $500.00 gap in my private fund for the doctor and $500 for the hospital excess. $1,160.00 out of pocket after private insurance. The anesthetist will bill after procedure. Anyone relying on a pension would be spending a fortnight's pay on a small procedure. I don't know how people can continue if they have to do that. My friend told me she waited 11 months for a public hospital, and it cost her nothing.

 

[mylittletibbies]

I saw a specialist yesterday. His fee $275.00, I just received $140.00 rebate from Medicare. A hospital procedure will cost $25 for medication prior, + $500.00 gap in my private fund for the doctor and $500 for the hospital excess. $1,160.00 out of pocket after private insurance. The anesthetist will bill after procedure. Anyone relying on a pension would be spending a fortnight's pay on a small procedure. I don't know how people can continue if they have to do that. My friend told me she waited 11 months for a public hospital, and it cost her nothing.

Yep, my daughter has had oral cancer three times.
Public hospital care was instant, excellent care and after care for the last 14 years.
We would be bankrupt if we had relied on private health insurance.
Unfortunately that is the only problem, if it's not urgent then you have to wait.
I take my chances, private health care is just too expensive and then you have all the gap payments.

 

[novezar]

As with all insurance policies, in a lot cases, tongue in cheek, you get what you pay for.

 

[Macarj]

I review our health insurance every year and nobody can match HCF which is our fund

 

[novezar]

We are also with HCF. Minus a couple of bits & pieces not applicable to our needs.

 

[Gsr]

We have just dropped our private hospital cover after 50+ years. The cost has become too much of a burden for us, we need the money to put towards more necessary bills, like food. We still have extras cover as we both need a couple of major dental repairs, once we claim for them we will drop this cover as well. We both recently claimed for new glasses, so are using some of the money we pay for extras cover. in over 50 years I have been in hospital twice, for the birth of our babies which was in a public hospital but with my own choice of gynaecologist. Hubby has had a knee replacement over 15 years ago with out of pocket expenses of over $10,000, and a hip replacement 13 years ago with out of pocket expenses of over $5,000. The surgeon for the hip didn’t charge out of pocket even in the private hospital. He had a day procedure in a private hospital where we paid $750 excess and his out of pocket for dr and anaesthetist was over $2000. We can no longer afford these types of bills. These days most specialists working in public hospitals are the same ones who work in the private hospitals so apart from not having a private room and not getting lumped with huge out of pocket bills there is not much difference apart from longer waiting periods, however, if it is an emergency situation you get in straight away.