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#1 cabbage88

Posted 11 November 2019 - 09:11 PM

Hi all
I know this has been asked before but I still can't really wrap my head around this.
Why do you have PHI of you do, or why not if you don't?
I've had extras only for years but could never afford more than that. I've had four kids through public and it was fabulous and I never paid anything. We've had broken bones and been to ED quite a few times.
I knew if we ever needed orthopaedic surgery we'd be in trouble, but there's so few instances where surgery is necessary but not urgent enough to do immediately in public, that I wasn't really worried as we don't play sport. Of course, hubby has busted his ankle and it needs surgery. Wait list we were told was 9 months but that was 5 months ago and we still haven't heard anything. He's in a lot of pain.
I also have my concerns that I'm going to need gynae surgery at some point in the future, and I think the wait list will be pretty long for public.
So we are over 30, been quoted 6.5k per annum for top cover (full extras and no excess). I realise it may be cheaper with no excess but we absolutely use extras- two in glasses, use the physio and massage and dental.
So, aside from the fact I don't have a spare 7k, I'm really struggling to understand in what situation PHI is needed for my age group? What circumstances? What am I missing? What is public not covering?
Obviously my hubbys current surgery needs are pretty dire, but unlucky, and it's still quicker and cheaper to wait on public (Same surgeon here too!). I'm not sure about for myself or my kids. Even their dental is currently free.
Share your understanding?

#2 Prancer is coming

Posted 11 November 2019 - 09:23 PM

I think if you are seriously injured, the public health system will sort you out.  But I think there are times you can have an injury or health issue that is not deemed urgent but will be very painful or limiting whilst you are on the public waiting list.  And I think it would be even worse having my children suffering.

So for me it is an insurance.  Hopefully I won’t need it, but if I do it will be worth it.  I am just in the process of changing providers and I am really doing the sums on extras.  I am not sure if extras cover is worth it for us, particularly the top level of cover.  If it is mainly dentist and optometrist you need, I reckon a lower cover could be adequate, but read the fine print.  If it is costing you an extra $50 a month to have physio included and you can only claim $300 back per annum, it is not worth it.

#3 Mooples

Posted 11 November 2019 - 09:28 PM

Dh and I both grew up always having top phi so it was just something we did when we moved out together. We wanted to have our babies in the private system so we’ve always made sure we kept it. Ds has had 2 sets of grommets, we are incredibly grateful we were able to do that immediately both times rather than being on a 12 month + waiting list in public. It is ridiculously expensive but we will keep it, I think it is also better tax wise for us to have it? I’m not sure on that side of things.

#4 DM. 2012

Posted 11 November 2019 - 09:40 PM

You can look into getting a lower level of extras.  Most of the lowest extras will at least include dental, optical and physio.

The current “silver” tier cover include what you need, it doesn’t exclude too many things.

#5 Dianalynch

Posted 11 November 2019 - 09:45 PM

We have it because we were sucked in by the whole tax/levy/you may need this etc

I’d rather we were all in the public system

#6 SeaPrincess

Posted 11 November 2019 - 09:55 PM

DH and I have both always had PHI. The times it’s been invaluable for us included ankle surgery for me, prolonged hospitalisation due to complications during my second pregnancy, the ability to travel interstate to the OB of my choice to deliver my third baby and back surgery for him. When he had his first back operation, the man in the room with him had been waiting for a long time, and had been in constant pain for months while on the wait list.

We have silver plus hospital with an excess, which saves a ton on annual premiums and you only pay the excess if you are admitted to hospital. The excess has nothing to do with extras.

#7 xxyzed

Posted 11 November 2019 - 10:36 PM

You can have separate levels for extras and hospital. We have in the past had the lowest hospital with the highest excess and the lowest extras cover. We initially got it as we were on a high income and the cheapest cover was cheaper than paying the Medicare levy surcharge. The main benefit is it gives you choice and you can decide whether to sit on the public waiting list or pay the large excess for the private hospital. You can then use it to see your specialist of choice and schedule surgery at a time that suits you rather than whenever it is your get to the top of the waiting list.

#8 rosie28

Posted 11 November 2019 - 10:38 PM

I guess using your examples, which happen to have also applied to our family, I needed some gyno surgery and had it 4 days after it was decided I should have it (not terribly urgent but I was able to choose when to have it done and I was wanting to start TTC so didn’t want to wait) and my husband needed shoulder surgery (again not urgent, the public wait list was over a year, but he was in pain) and he had it done the next week on a day that suited us. We’ve also used it for (almost) 3 births, a couple of other minor surgeries, and then we use the extras enough to make it worth it. I keep a spreadsheet on the extras. They also covered various bits of IVF, though not all of it.

Shop around, there’s quite a bit of price variance.

#9 MooGuru

Posted 12 November 2019 - 12:40 AM

I have always had it so continued.
Reasons I've maintained it: I wanted the local private hospital for birth. Lots of my friends had issues with births in public especially around being forced to leave earl whereas everyone I knew at this hospital were happy with it.
I get a med as an inpatient. Approval process took 6 months. People with same condition in public have said they have been waiting years.
Closest hospital is private with good rep. Horrid experience in closest public really puts me off using it.

#10 Chchgirl

Posted 12 November 2019 - 03:57 AM

Because I'm nearly 20 years older than I was in the 2000's when they were pushing for us to get it without the loading.

It wasn't so much the babies as I only had 2 (21 dd public and 18 dd private) but other things.  I haven't used it a lot but have used it for things not life threatening but worth not having to wait a long time in the public system.

In Nz I found it even more essential.

It's the one thing I made sure as a single parent i maintained.

I had no qualms swapping around companies and policies over the years for tge best price.

I'm not old in my early 50's but I'm assuming I'll need it more as I ger older.

#11 AdelTwins

Posted 12 November 2019 - 05:01 AM

 SeaPrincess, on 11 November 2019 - 09:55 PM, said:

We have silver plus hospital with an excess, which saves a ton on annual premiums and you only pay the excess if you are admitted to hospital. The excess has nothing to do with extras.

Just wanted to quote this as this can save you a lot of money. E.g. ask how much a $500 excess will reduce the monthly premiums.

Our health fund you only pay the excess if you are admitted to hospital. We only pay it a maximum of once per year so if DH and I both go to hospital then no excess for the second admission. Also we don’t have to pay the excess if our children are ever admitted to hospital.

Please double check the T&Cs for your own health fund.

#12 SummerStar

Posted 12 November 2019 - 05:21 AM

We have it because at the moment the extras we use cover what we pay. Mine is $200 a month for 6 people. Top level extras and lowest hospital to avoid the Medicare surcharge. We never use and don't plan to use private for hospital. Every procedure I've had done has been done public with little to no wait time so it doesn't seem necessary to have phi for hospital apart from dodging the surcharge.

Our extras though, by the time we have all had 1-2 dental check ups a year and 4 have had glasses plus the physio etc, we have been repaid more than I pay out a year. But our cover is the same cost for the family if there's 2 kids or 10. So right now there's 4 kids on the policy but they drop off after 24, once that happens the insurance won't be as worth it and I'll have to reassess.

Edited by SummerStar, 12 November 2019 - 05:54 AM.

#13 .Jerry.

Posted 12 November 2019 - 05:28 AM

Originally I had it because my family always had it growing up.  It was the thing to do.

I was glad I had it when I had DD.  I ended up hospitalised for 5 weeks prior to her birth.  Not sure I could have coped with that had I been in public:  shared room would have done me in.  My lovely private room and nice food helped make the time bearable.
The care DD received being born very prematurely was no different than public patients (same hospital) though.  Only difference was she had the same doctor each day, rather than a string of different doctors.

Private health did help DD have tonsil surgery within 2 weeks of deciding to get it done.  In public she would likely never have made the list, as hers wasn't for infections.

We could also speed up non essential hernia surgery for DP.

Though not really sure it is worth it.  But will keep it.

#14 nom_de_plume

Posted 12 November 2019 - 05:38 AM

I have never had it and probably never will.

We live in metropolitan Melbourne with good access to public hospitals. I am a huge supporter of Medicare. In fact DP and I both work in public health, and I have previously also worked in the private system.

We are high income earners and paid just over $2k of MLS last year. I can’t find hospital only PHI for less than $5k (we are over 31). So it doesn’t make sense for us to take it out for that reason.

For extras - we pay out of pocket. Optometrist has always been bulk billed. I’ve had 3 pairs of glasses in 17 years at a cost of less than $1k. Dentist I have an annual check up at a cost of about $120. I’m lucky I have good teeth. I’ve only ever had one filling and my wisdom teeth out. I paid to have that done privately and was $1.5k out of pocket. I’ve occasionally seen a physiotherapist or remedial massage therapist. The cost for this is around the $60-$80 mark. Admittedly, I now work in allied health so have access to treatment at a heavily reduced cost. Extras makes no sense for us. The only thing I would pay for (if we didn’t have it for free as an employment perk) is ambulance membership, which is less than $100 per year for a family.

The only surgery I’ve had was on my sinuses which was a 4 month wait. I saw a private surgeon who bumped me up the list, as I was originally on it, then had to come off it as I was pregnant. I also had my name down for 3 public hospitals and was prepared to go to whichever gave me the first appointment. I recently broke my hand and had surgery within a week through the public system. Other than that I have an annual colonoscopy through the public system, but it would cost $500 privately which I have done once in the past as I needed a particular appointment time/day.

I figure I am health literate and know how to navigate the public system, and have an emergency fund that we contribute to that I can draw on for around $15k if required. For everything else, I’m happy with the public system.

#15 ~LemonMyrtle~

Posted 12 November 2019 - 05:44 AM

We never had it growing up, my parents still don’t have it. We have it now because we actually save money by having it due to less tax paid at tax time (how messed up is that??) and we use the extras a bit (although it’s only good for glasses, get hardly anything back for speech or physio) is still take my kids to the public hospital if they broke an arm or something though.

As you say, it’s an insurance against that rare occurrence  where you are injured and the public wait list is long. Which is rare, but can also be painful and hazardous to your health. It’s up to you to decide if you want to insure against that. And this will depend on your finances.

As for your DH’s ankle. How far has he pushed it? My parents are very good at using the public system. First, ask the surgeon what other hospitals they work at, what is the wait list at those hospitals? Are there any other surgeons or hospitals with shorter wait lists? Sometimes it’s worth driving an hour or two to a regional hospital to get surgery quicker. Also, what is the surgery? Is it day surgery? Can you self fund it? Some surgeons have a discount for self funded patients, it will be expensive, but it might be less that $6500.  Do they know how much pain he is in? Is he the right category of urgency? Can he get put into a more urgent category? It’s a lot of leg work, but you can get things done publicly if you push hard enough.

Finally, $6.5k is a lot. Look at cheaper plans with a small excess. You will save a lot. And you may get the government rebate too, so it’s not $6.5k out of pocket.

#16 Cimbom

Posted 12 November 2019 - 05:54 AM

We don’t have it as it’s not worth it financially for us. We used to but I got rid of it after too many price increases that came along with more exclusions on top

#17 NeedSleepNow

Posted 12 November 2019 - 06:17 AM

We have always had PHI, but I’m the first to admit that I really don’t believe in it as a concept, and having it makes me feel uncomfortable. However, I guess as you have now unfortunately found out, the public system can really struggle to address life limiting (but not emergency) problems in a timely manner. 9-12 months + is a really long time to wait for your husband while he is in pain.
Reasons we have needed/used it
- Our DS needed a tonsillectomy, which was about an 18 + month wait publicly. Given how life changing it has been, I’m glad he didn’t have to suffer that long...which just makes me angry for the kids who are.
- Growing up my sister needed mental health admissions during her late adolescence/early adulthood. PHI is the only way to get the treatment she had. I work in the mental health system and the state of the public system here is disgraceful.
- I had a foot injury. The surgeon said early treatment would improve long term prognosis, but it couldn’t be done publicly. Because of the nature, he did it the next day in the private hospital.
- I did use it for my 2nd and 3rd children. I found the care from my female obstetrician head and shoulders above my MGP experience. She didn’t charge a management fee for my 3rd child, so that experience was pretty cheap!
- my first child needed surgery as an infant, which had to be done publicly. Our experience was amazing, but in the hours we were waiting we met multiple people who were there for surgery after waiting over a year (some 2), and for some they had already turned up and fasted multiple times, and their surgeries kept getting bumped.

Ideally PHI would be scrapped and the public health system funded properly, so people like your DH aren’t waiting long periods in significant pain. I think PHI is essentially a decision about if it’s worth it to ensure against those scenarios.

#18 Squeekums The Elf

Posted 12 November 2019 - 06:18 AM

dont have it never will
too expensive, id never use it honestly
I avoid the dr like the plague
in last 9 years ive been once for myself, dd 6 week check.....

dp wont get it as with all his pre existing conditions the premiums would be huge, if they even touched him

#19 SplashingRainbows

Posted 12 November 2019 - 06:23 AM

I’m with teachers health and don’t pay anywhere near that for top private and top extras.

I also suspect mid hospital would do you if you’re not wanting babies in private or needing heart/lung surgery.

Usually we have a big excess too to reduce the premium cost. We work out in front over the longer term as we certainly don’t need admissions each year.

I’d shop around for a members own health fund that you’re eligible to join, and get cover for only what is required at your stage of life.

What if your husbands one year wait turns into two? How much will you spend on doctors, medication and loss of work income while you’re waiting for him to be at the top of the list?

#20 -Emissary-

Posted 12 November 2019 - 07:20 AM

We now have it for tax purposes and the fact I’m now over 31. We have basic hospital and extras and pay about $260 a month for family (no government rebate). I work out that the surcharge would be roughly the same amount.

To be honest, if it wasn’t for the over 30 age loading, I would have dropped hospital cover and just paid the surcharge. If our incomes ever drop significantly, I’d probably drop our cover.

We use extras for dental and optical. It wasn’t that much more expensive to have both. It came in handy this year with DS needing a few fillings and we were not out of pocket.

Ambulance cover is also important to me. Prior to having family cover, I had a seperate cover for DS just for ambulance as he wasn’t covered by any health insurance policy.

#21 ~LemonMyrtle~

Posted 12 November 2019 - 07:34 AM

I have health insurance cover and ambulance cover. Because I don’t want to ever have to second guess a hospital transfer cause I’m unsure if private health will cover it. (They don’t pay if it’s in their opinion “unnecessary” or something like that) plus I’m helping to support a valuable service for not much cost.

#22 Chchgirl

Posted 12 November 2019 - 07:40 AM

I can understand people not having it die to the loading , we took it out before the deadline of this in 2000 and I was already 3w and my dh was 6 years older than me so it was worth it.

I have used it on and off over the years,  there are times I used public as well. Dh used public for chemo and palliative care.

In NZ I've taken it out again for my.move but they don't have loading there but it's worth it as I have to pay for scans, dr visits etc and can get them back in it. It's a bit cheaper for me and they don't have loading.

#23 newmumandexcited

Posted 12 November 2019 - 08:01 AM

I’ve got it and can barely afford it, and of course I don’t use it. But I’m not taking the risk for my three kids.

Edited by newmumandexcited, 12 November 2019 - 08:02 AM.

#24 Lunafreya

Posted 12 November 2019 - 08:13 AM

I don’t have it, and ex has ambulance only for him and DS. But we live in metro Sydney with good public hospitals and GPs. DS got great care at the public hospital when he had pneumonia. He was born at a public hospital which had a birth centre and the midwives visited us after at home. I’ve had great care in public hospitals and in the public system. My GP bulk bills and doesn’t hesitate to write a care plan if I need to see physio or something.

I really don’t see the need even for my child.

#25 71Cath

Posted 12 November 2019 - 08:13 AM

I've got it but I hate it.  I'm too scared to be without it, and I have so many pre existing conditions I can't shop around for a better deal.

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