What company has the best Private Health Insurance from a trans guy.

Question

Ive just started hormones (Primoteston), and looking at getting chest surgery in the future. Pretty much i need private health insurance to cover some medical expenses, but according to iSelect nothing would be covered by any private health insurance company because all this trans stuff is "not medically nessorsary" and all "elective surgery"

Just wondering if anyone knows what company to go with to get the most cover.

Answer 1

The biggest thing they do pay for is the cost of Private Hospital admission. Its worth it for this alone. The second thing that Health Companies pay for is 25% of the Medicare Schedule Benifit Fee (Medicare only pay 75%). The other thing some pay for is Private Prescriptions. Some policies will offer as part of Extras cover 65% of prescription costs. This is worked out by first deducting the PBS fee of $34.60 and then paying you 65% of that fee. This may not come to anything on Primo, but if you were to eventually switch to Reandron (which is around $140 per vial) it will give you some money back. Private Health Extras may also pay for pyshciatrist appointments if you get charged a gap.

NIB basics Plus with a $500 hospital excess costs around $33 a fortnight and does cover exactly what is mentioned above. Dr Megan Hassall in Sydney also does deal with this company a lot. Whether a company pays out also depends on which surgeon you chose and how they bill. Dr Batholomuesz in Queensland is notorious for billing as "Surgeon Fees" for which there is no rebates from Medicare or Private Health. Where as other surgeons will use the Medicare Codes such as "Bi-lateral sub/q masectomy" for which there is a Schedule Benefit Fee of over $1000 and which between private health and Medicare will be reimbursed in full. Without private health you would be responsible for the 25% of this figure.

Another thing to consider is with the Health Cover Lifetime loading thing, it well and truly works out in your benefit to have Private Health.

Answer 2

I went with HBA Top Hospital cover (now HBA is called BUPA) but to be honest I didn't do a lot of comparing between companies.

You might find this webpage useful:

http://www.ftmaustralia.org/transition/medical-affirmation/medical-transition/health-funds

It's a list of private health providers used by some of the members of FTM Australia.

Answer 3

I use Health Partners and they have been fantastic with all my cost. Keep in mind that you will be probably paying $1200 - $2000 per year for insurance so you probably want to make sure you will recover those cost in each year. I personally have recovered the cost ten times over but you need to work that out for yourself.

Hope this helps.