Hi, I'm looking to get Invisalign and thinking of getting private health just for the purpose of orthodontics.
An extras cover will cost me about $480 a year (no hospital) and I will be able to claim $1200 max after a 12 month waiting period at the start of the treatment. So that means I will be able to claim more than what I pay for (considering I only hold the insurance for 2 years).
Not sure if I'm missing something here? Has anyone had any similar experiences?
Thanks!
There are typically wait periods before you can make a claim for some items.
Catch may be that you can't make a claim for a 12 month period after sign up, so you might end up paying the first year and get nothing back.
Check with the insurer as some waive the wait period
There is a 12 months waiting period AND a yearly limit AND a lifetime limit for ortho. I have never seen a PHI that offers a generous limit in which you can recoup the insurance cost with using the ortho component alone. They are not that stupid. No point in paying for the extra only to claim for the ortho, you will end up paying more. Happy to be proven otherwise.
Our was like this. There was a yearly limit and a lifetime limit. If I'm not mistaken, at the time, it was at 750/year
I had St Lukes top extras and used it for orthodontics a few years ago. The premium was a very small percentage of what they gave back to me. Having said that, I don't think it's as good anymore. Your rebate (income) will also have implications on the 'value' of PHI.
If the fund decides that the procedure is due to pre existing conditions they will deny all related claims.
Are you able to explain a bit more please thanks
Basically means exactly what it says. IF they see you have a per-existing condition before signing up, it CAN (not always - but can) give them an out on paying up.
I have never heard of this happening with extras claims, only hospital
That doesn't make sense, I've needed glasses since I was 16 but I claim every 2 years just fine (didn't take out cover until just before I had to with the lifetime loading tax thing). Surely my eyes being dodgy and needing glasses is a pre existing condition? And for orthodontics your teeth don't go suddenly from being perfect to being wonky in a day. They would be wonky for a long time. So that would be pre existing too.
You are completely wrong on pre-existing conditions - they are covered after a 12month waiting period. I think you may be confusing exclusions with pre-existing conditions, and PHI with Life Insurance.
In PHI you can have policies that exclude services such as hip replacements. This means your policy will not cover for hip replacements ever. However, you can have a policy that does cover hip replacement, and you may be in need of one (pre-existing condition), and after a 12mth waiting period you will be covered for your hip replacement.
Also, note in OPs case the waiting period for major dental work (orthodontics) is 12mths with all funds - end of story. There is no additional waiting periods or pre-existing waiting period that applies, it is simply the waiting period for major dental work (12mths).
This is absolutely untrue. This is Australia, not America.
Please refer here:
Once a member has been on their hospital policy for a continuous period of 12 months, the pre-existing condition waiting period no longer applies and the member is entitled to the full benefits under their policy.
The exceptions to the 12 month waiting period for pre-existing conditions are psychiatric care, rehabilitation and palliative care. These services have a two month waiting period, even if pre-existing
…
Key Points for Pre-Existing Conditions
* The legal definition of pre-existing conditions only applies to hospital tables. Some insurers do apply similar rules to their general treatment (extras) cover;
https://www.ombudsman.gov.au/publications/brochures-and-fact…
Some PI also has a per year claim limit too. Our orthodontist kindly splits up the payments so you can claim over multiple years.
What insurance company OP?
You just need to read all the terms carefully with respect to the type of claim you wish to make. I would pay particular attention to whether Invisalign, specifically, is covered by that insurer.
Also, note that benefits can vary greatly, even across the top (most expensive) policies. Be sure that you are on a policy with the best benefits at the time you wish to claim.
My final piece of advice is to follow any discounts that might be available. However, these are usually limited to people taking out hospital and extras cover. If this applies to you (and it would seem that it does not), then you can keep churning across insurers without having to re-serve waiting periods.