Coronavirus & Health Insurance in Australia

The coronavirus outbreak is a constantly evolving situation that means there are still a lot of unknowns about how the medical system will be impacted but we’ve tried to provide a bit of guide as to how private health insurance may assist during this uncertain time. 

Do I need private health insurance to be treated for coronavirus?

The coronavirus pandemic is considered a public health emergency and as such it is being managed through Australia’s public health system, including GPs and emergency departments. This means you do not need private health insurance to access testing or treatment for coronavirus.  If you are entitled to Medicare, then Medicare will cover the costs. 

If you do contract coronavirus, then having private health insurance doesn’t mean you’ll receive preferential treatment.  The level of care you receive will be decided by health professionals based on a range of factors including the severity of your symptoms and your age, not your insurance status. 

Normally patients with private health insurance can opt to be treated as a private patient in a public hospital to increase the likelihood of a private room. This is unlikely to be an option in relation to coronavirus as you will need to be in isolation.

How will coronavirus impact Australia’s health system?

While Australia is fortunate to have a fantastic public health system, it is already under increased pressure due to the coronavirus outbreak and is likely to be stretched even further over the coming months. While having private health insurance won’t help you in the event of you contracting coronavirus, there may be other advantages of having private health insurance.

How private health insurance funds are supporting members?

Most private health funds (including all on the iSelect panel) have delayed the scheduled April 1 premium rise for at least six months to help relieve the financial pressure on policy holders during this economically uncertain time.[1]

Numerous funds have also made changes to their hospital policies to ensure all members – regardless of their level of hospital cover – are covered for COVID-19 by adding lung and chest to all policies at no extra cost.[2] (Although this may depend on how long you have held your policy for to ensure you have served relevant waiting periods).

For those experiencing financial hardship due to coronavirus, some private health insurers are offering premium relief to their customers, such as policy suspension or waiving premiums for up to six months depending on how long you’ve held your policy for.  However, the options available to customers experiencing financial hardship will vary by fund and may depend on your policy type and how long you’ve been with the fund.

If you are under increased financial pressure and struggling to pay your health insurance, it’s important you contact your health fund directly sooner rather than later, instead of simply cancelling your cover. This is likely to help you avoid having to re-serve waiting periods already served if you look to re-join private health insurance down the track.

Coronavirus and ambulance cover

Unfortunately, it’s likely that some Australians who contract coronavirus will require emergency transport via ambulance.  Ambulance services are not covered by Medicare and depending on the state you live in, you may have to cover the costs unless you have either an ambulance membership or a private health policy that includes appropriate ambulance cover. 

Given the current coronavirus situation, it may be worth checking if your policy includes ambulance cover, and if so, what level of cover it includes.  Some policies include comprehensive ambulance cover, while others only cover emergency transport.   

Will my elective surgery be delayed due to coronavirus?

Possibly, although this will depend on the type of elective surgery and where you had planned to be treated. 

On 25 March 2020, all non-emergency elective surgery (most category 2 and all category 3) was temporarily suspended in both public and private hospitals due to the coronavirus pandemic, however category 1 elective surgery (including pregnancy and birth, as well as urgent heart and cancer procedures) was still continuing.[3]

However on 21 April 2020, the Federal Government announced that from 27 April 2020, all category 2 and some important category 3 procedures can recommence in both public and private hospitals.[4] Those elective procedures which recommenced from 27 April 2020 include IVF, screening program, breast reconstruction, joint replacements, cataracts and eye procedures, endoscopies, colonoscopies and all procedures for children under 18 years of age.

If your elective surgery can now go ahead, it will need to be rescheduled so you should contact your surgeon for more information.  Hospitals and surgeons will reschedule surgeries according to clinical need.[5] 

Keep in mind that given that most elective surgeries were suspended for almost a month, there is a likely to be a backlog of surgeries which could result in ongoing delays.[6] Although this may be frustrating, Australia needs to relieve the pressure on the public system and reserve critical medical resources for tackling the coronavirus outbreak.

Private health insurance could help you reduce long waiting periods in public system

As our public health system continues to grapple with the coronavirus outbreak, having private health insurance may be an advantage should you experience a health issue unrelated to coronavirus. 

One of the key advantages of private health cover is generally shorter waiting times for elective (or non-life-threatening surgery).  Normally, waiting times for elective surgery in the public system are around 4.5 times longer than in the private system.[7] However, on the resumption of elective surgery from 27 April 2020, it is expected that patients will be treated on the basis of clinical urgency, rather than whether they are a public or private patient.

Notwithstanding the above, when the coronavirus crisis subsides, there could still be a significant backlog of elective surgery and having private cover could help you have your elective surgery sooner than some of those patients relying on the public system.[8]

However, it’s important to keep in mind that health insurance policies include mandatory waiting periods.  This is the time you need to hold the policy for before you can make a claim.  For hospital admissions, this is generally two months unless it relates to a pre-existing condition (in which case it is 12 months). 

Greater peace of mind in a time of uncertainty

Another key benefit of private health insurance is ‘peace of mind’ and the knowledge you and your loved ones could have access to greater choice should you experience a health issue, including choice of doctor and hospital when admitted as a private patient, especially when there is increased pressure on Australia’s healthcare system.

Protecting yourself against coronavirus (COVID-19)

While having private health insurance won’t protect you against COVID-19, there are some things you can do to reduce your risk of contracting the virus.  The Department of Health emphasises the importance of maintaining good hygiene, including:

• covering your coughs and sneezes with your elbow or a tissue
• disposing of tissues properly
• washing your hands often with soap and water, including before and after eating and after going to the toilet
• using alcohol-based hand sanitisers
• avoid touching your mouth, eyes and nose
• cleaning and disinfecting surfaces
• if you are sick, avoiding contact with others
• staying more than 1.5 metres away from other people
• cleaning and sanitising frequently used objects such as mobiles, keys and wallets

More information:

DOH: https://www.health.gov.au/health-topics/novel-coronavirus-2019-ncov

WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

[1] Source: https://www.privatehealthcareaustralia.org.au/health-funds-postpone-1-april-premium-increase/

[2] As above.

[3] Source: https://www.pm.gov.au/media/elective-surgery

[4] Source: https://www.pm.gov.au/media/update-coronavirus-measures-210420

[5] Source: https://www.privatehealthcareaustralia.org.au/good-news-for-patients-as-elective-surgery-to-resume/

[6] Source: https://www.privatehealthcareaustralia.org.au/health-funds-postpone-1-april-premium-increase/

[7] Source: Ipsos Healthcare & Insurance Australia 2019

[8] Source: https://www.privatehealthcareaustralia.org.au/health-funds-postpone-1-april-premium-increase/