Minimum level of cover needed to fund sleeve

Hi guys,

Im wondering if anyone would be able to help me. I have a friend who is going to take out PHI to fund her sleeve op, and I told her that I would ask some questions regarding the minimum level of cover needed.
Im no help to her since I have always had PHI and I have quite a high level of cover (mine includes maternity), which she wouldnt need.

If anyone is willing to tell me what health fund they are with and the level of cover they have which includes the sleeve we would be most appreciative.

Thanks

xx
Tamara

She needs HOSPITAL cover ONLY do not let them talk her into any extras. She can decide if she is willing to share a room or not. I am pretty sure all levels cover you for the sleeve, but a simple phone call to any insurer will tell you with no problems at all. It is a very common question they get asked. As in what is the minimun coverage I need to cover me for x surgery.
Another important thing to remember is that even if she is married that she ONLY has to take out single cover. this is a HUGE cost saving. She should be up for about $60 per month the last time I checked . There might have been a small rise since then, that was cover for a private room for somebody wanting to use Dr Amhand at SJOGM.

She then gets a care plan from her GP to cover her for most of the other bits for nothing.


applesauce

i'll let you know tomorrow in dteail and post later. cat stuck to me like glue cant type much. she is back home from vet and wont leave my side

Thanks Apple and Ricie. She's never had PHI before, and like I said before Im no help as I have always had it and I have ancillary cover also.

I'm with NIB and I have Bodyguard, but they don't sign people up to that anymore, they are trying to make everyone move. Just make sure that she has the medicare item number, and thehospital where the Dr. does the surgery when you call. some hospitals have agreements for no out of pockets, some don't its worth checking this if money is an issue. My cover has no out of pockets with the stay, pharmacy stuff but I had to pay the gap for the surgeon, anaethatist, and because I had an extra 9 day stay, I wasn't covered for all the blood tests they did when I was in for my allergic reaction, and had a $70 gap there.

Hi Tamara,

I'm probably not much help as I have fairly high cover. HCF Hospital savings and general extras plus but that is for my family of 5 and we use all the extras, all the time! Not that the extras are relevant for surgery. I was freaking out that for some reason HCF wouldn't cover but they are going to (yay) so no dramas there

rightio, cat has deceided to leave me alone.

firstly, you dont really need ancillary, however, if you end up needing phsyio (eg: bad chest post anethestic) or home nurse care for injections or wounds/drains if there is a complication then your hospital cover wont cover those, you'll have to pay for that yourself and it isn't cheap!

Anyway, first off your friend needs to decide what surgeon and hospital, then find out from the hospital which funds they have an agreement with to reduce out of pocket expenses.

If she is happy with a shared room then she can go for that option and then look at the tables of the health funds and remove things like joint replacement and cardiac surgeries and maternity.

If she has the minimum cover and all goes smooth, she will be okay. If however, she has complications, ends up in ICU or needs phsyio or home nurse services then she needs to be aware she will be out of pocket alot.

I'll bring my medibank private stuff tomorrow and show you how to work it out.

Hi Tam,

I am with Medibank private and pay around $55 a month for AdvantagePlus.

This is with Hospital and extras, im 26 and single and all my hospital stuff is covered - no exclusions. I have posted below the best medibank covers for the WLS with medibank - as with anything financial you are advised to seek independant advise from a representative of your propsective health fund.

AdvantagePlus – Hospital + Extras + Bonus
Comprehensive hospital and extras cover in one convenient package.

No restricted services
Cover for Alternative Therapies
No annual limit on general dental
Generous annual limits for things like physio and optical items
No excess for kids

Hospital
What is covered?
We'll pay benefits towards (less any applicable excess):

Private hospital accommodation
- Private room
- Same Day Admission
- Intensive care
- Theatre fees
Public hospital accommodation as a private patient
- Overnight accommodation in a shared or private room
- Same day admissions (shared room only)
Surgically Implanted Prostheses and other items on the Federal Government's Prostheses Schedule.
Your excess
This cover includes an excess of $200, which applies each time a member is admitted to hospital. You won’t pay more than $500 per single membership or $1,000 per couple/family membership each calendar year.


PremierPlus – Hospital + Extras + Bonus
Our top hospital and extras packaged cover. The best option if you want cover for a wide variety of extras or you have particular health concerns. No restricted services
No excess
Private Room Guarantee
No annual limit on general dental
Cover for an extensive range of extras services paying typically higher benefits than AdvantagePlus

Hospital
What's covered?
We'll pay benefits towards:

Private hospital accommodation
- Private room
- Same day admission
- Intensive care
- Theatre fees
Public hospital accommodation as a private patient
- Overnight accommodation in a shared or private room
- Same day admissions (shared room only)
Surgically implanted prostheses and other items on the Federal Government's Prostheses Schedule.
Private Room Guarantee
We recognise our PremierPlus members' desire for privacy when they are being treated or recuperating overnight at a Members' Choice hospital, that's why we offer a private room guarantee. If there isn't a private room available at a Members' Choice hospital you may be entitled to receive $50 a night up to a maximum of 5 nights per stay.

Blue Ribbon Hospital
Our top hospital cover providing protection for an extensive range of services. A great option if you have particular health concerns.

Comprehensive cover
No restricted or excluded services
Optional excess to help reduce your premium
Includes obstetrics-related services
No excess for kids

What's covered?
We'll pay benefits towards (less any applicable excess):

Private hospital accommodation
- Private room
- Same day admission
- Intensive care
- Theatre fees
Public hospital accommodation as a private patient
- Overnight accommodation in a shared or private room
- Same day admissions (shared room only)
Surgically implanted prostheses and other items on the Federal Government’s Prostheses Schedule
Medically necessary ambulance transport.
Your excess options
An excess is an amount that you agree to pay if admitted to hospital in exchange for lower premiums. It is paid per member per calendar year. Your excess options are:

No excess Level 1 Level 2 Level 3
Excess options $0 $150 $250 $500


Hope it helps

hi tamara,

mine is the twin saver HBF. it gives you intermediate hospital cover( covered for a shared room) is also has dentist(not orthodontist) chiro , glasses, and a few other things. im on a family cover and it costs about $140 a month....i think we pay a little more because we didnt take it out before we were 30, so we pay an excess.
my doctor was fully covered ( you pay the gap for your dr if they are not, same as the anesthestist (sp?) )so it only cost me a $100 hospital excess.

I just rang my PHF (hcf) to make sure that 30511 was covered in my level of cover, which it is,and she said she would send my a form to fill out that my gp, or surgeon has to fill out, and is wether my condition is pre-exisiting or not?? what now forms ? well i have been fat for 18years, but.....now im even fatter??? idiots....
Also if i get that form filled in and it is a pre-excisiting, does that cover me for complications with the op, she couldnt give me the answer to that? now im really confused....Im only wanting to know cause i may go ahead with op before my phi kicks in??

RR the Moth and I are covered with HCF - top cover and we didn't even ring to see if we were covered or not just presumed we would be really. They paid all the surgery and we just paid the gaps ie for my Surgery approx $6000.00, for the Moths surgery approx $3500.00 out of pocket expenses. We weren't asked about pre-existing conditions etc or to fill out any forms prior. So not sure what they are going on about with you. If you ring today you will probably get a different answer (lol).
Sorry couldn't help but I haven't heard that it is a pre-existing condition - heaps of us on here have been covered.
Good luck.
hugs
Jilly

redrooter99 wrote:

I just rang my PHF (hcf) to make sure that 30511 was covered in my level of cover, which it is,and she said she would send my a form to fill out that my gp, or surgeon has to fill out, and is wether my condition is pre-exisiting or not?? what now forms ? well i have been fat for 18years, but.....now im even fatter??? idiots....
Also if i get that form filled in and it is a pre-excisiting, does that cover me for complications with the op, she couldnt give me the answer to that? now im really confused....Im only wanting to know cause i may go ahead with op before my phi kicks in??

When my friend rang up she was told that she would need a dr to sign a form stating that she needed the surgery - is this along the lines of what your form is? Otherwise I'm not sure - sorry.

i havent got the form yet, so ill have to answer it later, but she said it was a form to state wether i have a pre exsiting condition? maybe its a new thing just to cover their ass. Tamara maybe you are right, she wasnt very helpful, and jilly bean yes i should ring again, and get someone else, its just i have to wait 2 1/2 weeks for telstra to put my phone on..OMG! (new house) and am trying not use my mobile much, thats all..And pre-exsisitng condition just means i have to wait out the 12months, isnt that what most of yous did??

thanks ill just wait for "the" form...lol

Yes RR sorry we did have to wait 12 months to kick in so that is what the forms will be for I guess. The surgeons nurse told us when I inquired about the surgery that if you took out PHI you would have to wait the 12 months but in the meantime while we were waiting we did all our pre-op appts and I had my surgery the month following the 12 month expiry.
Good luck and hope you get the right forms and most importantly the right answers.
hugs
Jilly

Yes it is pre-existing condition, as you have been overweight for more than 6 months prior to taking the insurance cover out. That means you do have to wait the required 12 months, or they may not cover anything. Crappy I know, but in the scheme of things, whats a few months anyway, things will dramatically improve after you have the op, and it will cost less that way, unless you plan to pay up front. My cover is with NIB and its not been for sale for a long time, but Im still on it because it offers more than their covers available now, and costs less than their basic one now too! They do keep trying to "tempt" me to move, but Ill wait til I have the plastic surgery, as this cover has more available on it.

You only have to fill in pre-existing forms when you have belonged to a health fund for less than 12 months.

Thats happened to me, I had to have day surgery after 6 months with PHI, its wasn't pre-existing, so my GP and surgeon filled out the forms and I was covered.

Hi RedRooter,
I too was asked if it was a pre-existing ailment - well being fat is pre-existing and no its not an ailment, i didnt catch fatness!

anywhoos - I was with Medibank on the top level of cover for the last yr. My Item number is also 30518 - partial gastrectomy.

My out of pocket is $2000 and hospital excess of $200

Yes Janette is correct... ... Pre-existing means that you have not had this "ailment" documented by your GP 6 months prior to you joining your private fund. We get them all the time at work.......

It is a hard one as STBT is right.... fat is not an ailment..... I really don't know how they would assess this one. the questions they will ask is... what date did your gp note these "symptoms" or "conditions", who were you referred to and when etc......

Let us know how you go!

I work for a PHI company, and the rule is DEFINITELY 12 months from the day you join to be covered for WLS. This is not negotiable. It is classed as a 'pre existing condition', but the only time you will have to fill in a PEA form is if you have any hospitalisation within your first 12 months of membership.
Also something to bear in mind, that some funds have 'benefit limitations', which means that you have to serve further waiting periods on top of the 12 mths. For example, you may have served your 12 mth WP, but some things such as WLS, psychiatric, rehabilitation etc have 'benefit limitations' where you are only covered at the default rate for a further period of time. This means that you will only be covered in a public hospital. Some benefit limitations are a further 12 mths on top of the initial 12 mths, some are longer, depends on the fund.