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Couples Health Insurance

Name: Couples Health Insurance
Creator: Savvy
Published: 2023-02-27T12:59:49+10:30

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Written by , updated on December 19th, 2024

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There comes an exciting time in every relationship when finances are combined, and plans are made as a couple rather than as two singles. If you’re at this stage, you may be considering couples health insurance?

What is a couples health insurance policy?

A couples health insurance policy provides cover to two people rather than one. Each person receives the same level of cover and benefits from the policy, but there is only one premium paid. It’s generally designed for married or de facto couples, but in almost every other way works the same way as a singles health insurance policy.

There are three types of couples health insurance policies available:

Private hospital cover

An appropriate hospital cover policy allows the policyholders to be treated as private patients in either a private or public hospital. It may also give you more choice about which doctor treats you, and can help avoid public hospital waiting lists. Depending on the level of cover you take out, it can cover:

Hospital accommodation costs
Theatre fees and recovery ward costs
Private room costs, including meals
Fees charged by doctors, anaesthetists and surgeons
Drugs and pharmaceuticals provided to a patient whilst admitted
Tests and scans performed on a patient whilst admitted, such as blood tests, x-rays, CT and MRI scans
Palliative care
Ambulance cover (not included in all hospital cover, as some states offer their own ambulance cover)
Cost of any follow-up rehabilitation services required such as pain management or speech therapy

Such hospital cover is available in four tiers: basic, bronze, silver and gold. The minimum level of cover these tiers represent is legislated by the Australian Government, making it easy for the public to compare policies. The cost of a hospital policy will rise as the number of services and clinical categories covered increases. For example, a basic policy will only cover three clinical categories of treatment and is the cheapest health insurance option, whereas the highest level of cover available – gold tier – offers top coverage for all available categories in exchange for the steepest premium.

Extras cover

Extras cover (also known as ancillary or general cover) helps pay for treatments and services provided outside of a hospital setting, particularly those not covered by Medicare, such as:

Optical (glasses, contact lenses)
Dental treatment (both general and major dental)
Audiology services (hearing tests, hearing aids and devices)
Physiotherapy (for joint and muscle pain)
Chiropractic treatment (for back and neck pain)
Podiatry (for foot pain and injuries)
Remedial massage (massage therapy to aid a range of conditions)
Speech therapy (for speech and language difficulties)

Just like hospital cover, extras cover comes in different packages, depending on whether basic, cheap cover or a top-level policy which offers a high level of benefits is required. The policy offering a higher level of benefits will usually cost more, which is why it is a good idea to compare policies through Savvy frequently.

In addition, extras cover typically comes with benefit limits for each category of cover. For example, the policy may have a policy benefit limit of $5,000 per year for major dental. In a couples policy, these benefit limits are often shared between both parties at say $2,500 each.

Combined policies

A combined couples policy includes both hospital cover and extras cover in one bundle. It provides the same sort of cover as buying these two types of insurance separately.

What isn’t covered by couples health insurance?

There are several common exclusions which apply to many types of health insurance.

For hospital cover, these exclusions may possibly include:

Medical procedures not considered medically necessary
Assisted reproductive services (depending on the level of cover chosen)
Hip and knee replacements and other joint surgery (depending on the level of cover chosen)
Most x-rays, MRIs, CT scans and blood tests performed on outpatients

For extras cover, exclusions may include:

Laser eye surgery (depending on the level of cover chosen)
Some alternative medicines and therapies
Hypnotherapy (depending on the level of cover chosen)

How do I compare couples health insurance policies?

There are many elements to compare when looking at couples health insurance policies, regardless of whether you’re a young couple, middle-aged or seniors. These include:

Cost

Naturally, we all want to pay as little as possible for our health insurance. However, couples health insurance may not necessarily end up being any cheaper than buying two separate singles policies. In addition, the cheapest policy you may see isn’t always the one which will offer you the health coverage that you may need. Nonetheless, it’s always important to compare the cost of any policy that you’re considering to help you avoid overpaying for your insurance. The best couples health insurance policy will generally be one which offers the cover you’re looking for at the most affordable cost.

Coverage you’ll actually use

There’s little point in paying for health cover that you won’t need. Think about what your current health needs are now and what they may be in the next year or two, as well as the areas you would like coverage for just in case your needs change. For example, a silver plus policy may offer all the clinical categories of a silver policy, but with extra added benefits. However, if these added benefits aren’t useful to you, it may be that it isn’t the right policy for your needs. Consider what types of cover you’ll use before deciding on a level that is right for you.

What is available in your region

Rural customers may have less choice about the number of private hospital beds available in their region compared to city dwellers. This may influence whether you are able to have your own private room in hospital, for example. If you have preferred providers for extras services such as physio and dental services, it might pay to find out which health funds they are partnered with. Most private practices are part of one or multiple health networks, offering cheaper services to members of one particular health fund.

Inclusions and exclusions

Check what is included and excluded in the policies you’re comparing. What exactly is covered will be laid out in the health insurance information statement provided by the insurer. Make sure you are comparing like for like when looking at policies side by side.

Waiting periods

When first buying health insurance, it’s necessary to serve out waiting periods before you can claim on your policy. These waiting periods can be from two months up to 12 for hospital cover, while they can vary between extras policies as these don’t come with government restrictions. However, if you’re changing your type of policy, such as from a singles policy to a couples policy, it may not be necessary to re-serve waiting periods you’ve already sat out. Check with your insurer what waiting periods will apply and see if there are any special deals available which may waive them.

Excess and co-payment options

An excess is the amount you may have to pay if you do make a claim on your hospital policy. This can range from zero to $750 per person for a couples policy. The higher the excess you choose, the lower the cost of the insurance you’ll be offered. There may also be co-payments to take into consideration. These can apply to hospital admissions and can be a set amount per night, such as $100 per day of your hospital admission, capped at $700. Determine which insurers may require you to pay an excess or co-payment and whether either can be waived.

What factors will determine how much a couples health insurance policy costs?

The factors that will affect the cost of your health insurance policy include:

The type of insurance you choose to buy (hospital cover is generally more expensive than extras cover)
The level of cover you go for – with higher services and limits equating to more expensive premiums
The excess you choose (plus co-payment contributions)
Your age (and whether you qualify for an age discount, such as if you’re a young couple under 30)
How much you receive from the Australian Government through the private health insurance rebate scheme
If you have to pay the Medicare Levy Surcharge if you choose not to have cover
Whether you are also required to pay a Lifetime Health Cover loading

Types of health insurance

Hospital cover

This can help you pay for medical treatment if you need to be admitted to hospital. It can help cover the cost of your admission or accommodation and the fees charged by doctors, surgeons and anaesthetists. It can also cover other costs associated with a stay in a private hospital.

Extras cover

This helps cover the costs of health care treatments outside a hospital setting which aren’t covered by Medicare. This can include major and minor dental treatment, orthodontics, hearing aids, physiotherapy, glasses, contact lenses and podiatry (in most cases with annual limits).

Cover for singles

This is a standard health insurance policy designed for a single person, rather than being tailored to cater to the needs of a couple or family. It may include hospital cover plus extras, or either of these types of insurance on their own, depending on what you're after for your health cover.

Cover for families

A family health insurance policy is designed for a family unit including dependent children who may reach up to 31 years of age with some insurers. It offers private health insurance suitable for the whole family and may include shared limits for all members included in your policy.

Cover for seniors

A health insurance policy aimed at seniors is designed to appeal to people who are in the second half of their life. These are often specific Silver Plus policies that offer the same cover as other health insurance policies, with the exception that pregnancy and childbirth cover may not be included.

OVHC

Visitors who are in Australia on a temporary basis for travel, work or study may be able to take out Overseas Visitors Health Cover (OVHC). Many visas issued in Australia come with a requirement to take out this type of insurance, which covers visitors who may not be covered by Medicare.

Ambulance cover

Ambulance cover is generally available either packaged into your private health insurance or on its own as a separate policy or subscription. By having this protection, you could be covered for all eligible ambulance travel in Australia (subject to your insurer's terms and conditions).

Basic hospital cover

The cheapest and most barebones form of private hospital insurance, this can include cover for rehab, in-hospital psychiatric services and palliative care. Having this policy will enable you to avoid paying the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading.

Bronze hospital cover

Bronze hospital cover is a step up from basic insurance, including 18 further clinical categories such as ear, nose and throat, bone, joint and muscle, digestive system, joint reconstructions, gynaecology and chemotherapy, radiotherapy and immunotherapy for cancer.

Silver hospital cover

Silver hospital cover is the second-most expensive type of policy and offers the second-most clinical categories. On top of what's offered by basic and bronze cover, it also includes heart and vascular system, lung and chest, blood, hearing device implantation and dental surgery.

Gold hospital cover

The highest level of private hospital insurance available in Australia, gold policies can offer cover for pregnancy and birth, weight loss surgery, assisted reproductive services and insulin pumps on top of all the categories provided by silver, bronze and basic hospital insurance.

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Frequently asked questions about couples health insurance

If we have a couples health insurance policy, what happens if we split up?

If you do decide to separate as a couple, you will have to choose whether you continue to pay for your health insurance together or swap your policy for two separate singles policies. If you’ve paid your couples premium in advance, you may be able to get a refund for the unused portion of your cover. If you buy the same level of cover as a single, you may not have to re-serve waiting periods.

Do we both have to pay for our joint health insurance to qualify for the health insurance rebate?

Both parties covered by a couples policy will receive a private health insurance statement at tax time stating the number of days they were covered by health insurance for tax purposes. This will allow each eligible person to claim their health insurance rebate entitlement. Alternatively you can provide an estimate of your combined income to your health insurer and they'll apply your rebate as a reduction to your premium payments. Therefore, it doesn’t matter which bank account the premiums are paid from.

If we have a couples health insurance policy, can we add a baby to our policy?

This will depend on the terms and conditions of the couples policy you have purchased. Most insurers allow require you to switch to a family health insurance policy before the birth.

How does lifetime health cover loading work with a couples health insurance policy?

A couples policy provides the same benefits as if the couple had two separate singles policies. Each person will be deemed to have had adequate health insurance for tax purposes for the duration of the time they’ve held a couples policy. This policy will count towards your lifetime health loading just as any other form of health insurance would. However, if you do have to pay a health cover loading, that loading can be averaged out between the two parties. For example, if you have a loading of 10% and your partner has a 6% loading, the loading applied to the couples policy as a whole can be averaged to 8%.

Health insurance by age group

Babies

Kids

Young adults

Under 30s

Over 50s

Over 60s

Over 65s

Over 70s

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Read one of our helpful guides on a range of different ailments and potential hospital or extras treatments to help you find out if they're covered.

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