Gold Hospital

All that glitters isn't gold


18 February 2019

One of the most remarkable and systemic instances of consumer brainwashing in existence today has to be in the supply and demand for ‘pick and choose’ health insurance.

Driven by the concern of affordability, over the years many health insurers have dissected their policies every which way – eroding their value and making them a complicated mess of exclusions and restrictions, before selling them to consumers under the guise of ‘customisation’… and it’s worked.

The romanticised notion of ‘only paying for what you’ll use’ has been readily adopted by the unsuspecting masses. Which is somewhat well and good… until of course, it isn’t.

Like for instance, when after years (or decades!) of paying your premiums religiously, you’re not covered in your hour of need. Or when you wise up and crunch the numbers only to realise you’ve been paying for a policy with woeful rebates.

Not surprisingly the industry has seen a soaring number of complaints about exclusions and restrictions (the ‘lovechildren’ of pick and choose cover) forwarded to the Private Health Insurance Ombudsman – to the point where the Government has now stepped in to implement industry-wide Reforms, coming into effect this April. These include the introduction of a Gold, Silver, Bronze & Basic tiered hospital categorisation, to help people understand what is in or out of a restricted or excluded policy. 

While this new system of forced categorisation will go some way towards tidying up the proliferation of pick and choose cover variations, there is a long way to go. Some insurers will continue to prioritise sales and profits over the health of their members, while the minds of many consumers remain conditioned to look for customisation and the cheapest price, instead of value for money.

There are two main myths I see perpetuated by both the industry and the media that lead consumers down this garden path;

MYTH 1: It’s cheaper to choose cover that only includes what I think I’ll need…
FACT: Bupa’s ‘Gold Hospital’ and ‘Gold Hospital no Pregnancy’ cover cost the same.

MYTH 2: I can pretty accurately predict what my family and I will need cover for…
FACT: No, you can’t.

Forgive my bluntness. I suspect it’s come from the years I spent by hospital bedsides doing my rounds as a Nurse, and hearing time and time again from patients that they thought ‘it would never happen to them’… but it does happen, every day, to everyday people, and no one ever thought it would be them. So trust me when I say, if it happens to you or someone in your family, you can be darn sure you’ll wish you didn’t take a gamble on exclusions in your health cover.

You wouldn’t insure just half your house or half your car, so why insure half of your health?

This is a philosophy shared by those who see worst case scenarios every single day - those that work within the Police and Emergency Services community.

That’s why our two funds - Police Health and Emergency Services Health - exist just for us and our families, and why both funds have only ever offered one level of hospital coverage: ‘Gold’.

Holding gold cover with us means you don’t need a crystal ball to give you peace of mind – there are no restrictions or exclusions to worry about. And, when you compare apples with apples, it’s also exceptionally hard to find a better price or better value for money from another insurer.   

But here’s where it gets really interesting… in a market soon to be flooded with ‘Gold’ cover options due to the industry Reforms – consumers will need to be even more aware of the devil in the detail.

You see, meeting the Gold classification means, as a minimum, all 38 of the newly defined clinical categories for hospital treatment are covered without restriction. But since our cover has always gone above and beyond this ‘minimum’, and there’s no ‘Gold Plus’ classification for us to sit in, we’re confident of upholding our promise of ‘cover like no other’ in a number of ways;

  • We give our members their choice of hospital, doctor and any other service provider (provided they are registered and recognised) – because we understand that choosing who treats you and where is one of the main advantages of private health.
  • We don’t impose an excess  – because we know that this can become a barrier to treatment when other unexpected and uncontrollable out of pocket costs hit at the same time – such as gap payments for doctors and anaesthesiologists who charge over the MBS fee, and legally uninsurable out-patient consults with specialists. These unexpected costs often hit patients at the same time that they’re dealing with a loss of income, so removing any excess from the equation helps protect our members from the unforeseen - as we believe good insurance should.

We throw in a number of additional benefits not included in the new clinical categories as standard, such as:

  • 100% Ambulance cover for emergency transport, clinically required non-emergency transport, and treatment not requiring transport.
  • Hospital at home care for patients needing services such as wound management, intravenous therapy and post-natal care from participating hospitals.
  • Plus, the Reforms speak nothing of the all-important customer service standards that can really define the relationship you have with us. Our expert team come to work each day with the same goal – to support the health and wellbeing of our members.
  • We don’t have a pushy sales team, we focus on educating members and potential members about the ins and outs of health insurance so they can make their own informed choices. Brainwashing is our one exclusion!
  • It’s easy to make claims by swiping your HICAPS membership card at a provider or submitting a photo of your receipt in seconds via our mobile app.
  • You’ll speak to a real person from our head office in Adelaide if ever you need to call, and you won’t be caught waiting on a long phone queue to get through to us.
  • We’ve maintained a 98% member satisfaction rating or higher for over 13 years now for Police Health*. And while Emergency Services Health hasn’t been around long enough to have a member satisfaction rating – it’s run by the same friendly and knowledgeable staff, so it’s reasonable to think the same statistic holds true for both funds.
  • While I’d hate to be accused of peddling our own ‘propaganda’ – that’d be a little hypocritical given my opening statements about consumer brainwashing  – it’s important we assert our philosophies on providing just Gold cover because the tide of opinion out there pushing ‘pick and choose’ cover continues to swell. Helped of course by the extensive marketing budgets available to the big for-profit funds...

Without such budgets ourselves – we rely on two things to grow our membership: word of mouth from existing members, and our focus on ‘educating’ the community about the complex world of health insurance.

So if you or anyone you know is looking for honest and transparent information about our cover and our philosophies, give us a call. We’re here to help.


*hirmaa/MHFA member satisfaction research, 2007 through to 2019

About Scott Williams, CEO of Police Health & Emergency Services Health
As the son of a Cop, a Registered Nurse by background, and 20 years of experience overseeing the clinical and managerial administration of public and private hospitals both in Australia and abroad (including 4 years as the CEO of the North Eastern Community Hospital in Adelaide) – Scott is an ideal fit to lead Australia’s only private health funds exclusive to the Police and Emergency Services community respectively.