2 minute read
15 May 2020
- Telehealth appointments available where possible
- Additional hygiene practices adopted for face-to-face appointments
- Unique Rollover Benefit allows you to use unused Annual Maximums in following calendar year
There has been significant misreporting by the media and confusion in relation to how Extras can be accessed during the COVID-19 pandemic. While some services may be temporarily restricted due to social distancing guidelines, many providers remain operational with increased hygiene practices, and others have adapted to an online delivery model.
Our data to date indicates that while claims for physiotherapy consultations dipped following the announcement of restrictions in March, from mid-April numbers were increasing and by the end of April they were close to 2019 claiming averages - showing just how swiftly providers and patients alike have adapted to the new environment.
So, how can you safely attend an appointment?
Social distancing measures have significantly impacted the ability of some clinicians to provide face-to-face appointments. Where permissible, some services – including psychology, dietary, speech therapy, occupational therapy and some forms of physiotherapy – have introduced telehealth appointments (over video calls) to minimise the spread of COVID-19.
Telehealth appointments are only provided when it is both safe and clinically appropriate to do so, so please check with your practitioner directly to find out whether this is a service suitable for your circumstances. For information about eligibility for telehealth services, please call us 1300 703 703.
Safe face-to-face consults
Many clinics have adopted increased hygiene practices in order to continue providing face-to-face appointments where possible. These additional measures may include staggering appointments, increasing ventilation, wiping EFTPOS machines after each transaction, refusing cash payments, not sharing pens, and making hand sanitiser readily available.
You may have the choice to have either a face-to-face or telehealth appointment depending on your circumstances. Speak to your practitioner to find out more.
In March, dental treatments were strictly limited to emergency care, but those restrictions have now been relaxed to allow dentists to perform examinations, basic fillings & extractions, cleaning with hand instruments, and fitting braces or dentures.
While this is good news, it will be some time before it is business as usual at the dentist so it’s important to maintain good oral hygiene during this time. Brush your teeth and gums morning and night and reduce consumption of sugary foods and drinks.
One of the best advantages Emergency Services Health members have over members of other health funds is the ability to access our Rollover Benefit. This allows members to roll over any unused Annual Maximums from one calendar year to the next on most Extras services*. This means eligible members who find they aren’t able to claim their full Annual Maximum due to the impact of COVID-19, will retain access to those benefits in the next calendar year.
No one wants to live with pain or discomfort. If you need to access Extras services speak to your provider about whether a telehealth appointment is right for you, or whether you can attend a face-to-face appointment. If you have any questions about our Rollover Benefit or what services are eligible to receive benefits for telehealth consults please don’t hesitate to get in touch. We’re here to help.
*Subject to waiting periods and other conditions.
1.5 minute read
17 June 2020
- 25% of Australians on public hospital waiting list are now able to access non-urgent surgery as COVID-19 restrictions begin to lift
- Public hospital waiting times are now 4.5 times longer than private hospitals
- Surge predicted in demand for surgery in coming months
If you’re one of the thousands of Australians hoping to go under the knife soon, you may be waiting longer than you think, as the impact of COVID-19 hits elective surgery waiting lists nationwide. The backlog of patients is tipped to explode to 425,000, which will almost double the current waiting lists in most states.
Public and private beds during Covid-19
Private hospitals specialise in non-emergency care, with 7/10 cases of elective surgery taking place in a private hospital. At the start of the pandemic some state governments ‘purchased’ a number of beds from private hospitals for a set period of time, ensuring availability to help support the fight against COVID-19. These private beds will remain part of the public system until that period has passed, and patients will be prioritised based on how urgent their need is, rather than whether they are a public or private patient.
The procedures announced (on 27 April) to recommencing following are estimated to represent approximately 25% of the total public waiting list for surgery in Australia – this means up to 75% of elective surgeries are still suspended at time of writing.
Why does it matter if I wait longer for elective surgery?
“Many of the health conditions requiring elective surgery can be disabling, painful and life threatening,” explains Members Health Fund Alliance CEO, Matthew Koce. “Aside from the profound impact on quality of life, we know delays in elective surgery can have long term medical consequences”.
A long wait for medically necessary surgery can result in:
- further deterioration of your condition
- reliance on strong pain medications
- a significant impact on your mental health from living with pain and/or reduced mobility
- longer recovery and rehabilitation times, affecting your ability to get back to work doing what you love, helping the community
How long are hospital admission waiting times?
Before the pandemic there was already a distinct difference between actual public hospital waiting times and the publics perceived wait times. In a decades long study of healthcare in Australia conducted by IPSOS, the average public hospital wait time more than doubled in the last 20 years, reaching a record high of 109 days - which is more than 4.5 times longer than wait times in the private system. Interestingly, the public perception of wait times (prior to actually experiencing them) was far shorter.
So, given the huge disruption to non-urgent surgery in the wake of COVID-19, how long could you be waiting on a public hospital waiting list for your knee replacement, or ligament repair, or cataract removal surgery? And will the private system really be any better?
It is anticipated that Australia will experience a significant increase in demand for surgery in the months after the pandemic has passed. “We’re fully expecting in six to 12 months’ time there’s going to be massive pent-up demand for surgery,” says Dr Rachel David from Private Healthcare Australia.
This expected surge in demand will put increased pressure on the existing public waiting list. Waiting times will almost double in some states, with median wait times potentially increasing from four months to 18 months. Dr David explains that “the public sector is not going to be able to meet demand, so to get quick access to elective surgery, people are going to need their private health funds.”
“Health funds have been paying claims for elective surgery throughout the COVID-19 pandemic period and will continue paying claims for their members into the future,” says Mr Koce.
Now isn’t the time to ditch private health insurance. The public hospital waiting list is already under strain, with patients waiting an average of four months for admission. The impact of COVID-19 on wait times is anticipated to be significant and could see waiting times blow out to 18 months.
At Emergency Services Health, we’re here to protect our members from the unexpected. Your health is important, don’t run the risk of longer waiting lists. You’ve had our backs in the community during this pandemic, let us have yours in the months ahead.
1 minute read
30 May 2020
- Elective surgeries have recommenced on a clinical priority basis
- Real time system introduced to monitor intensive care capacity
- Resumption of surgery will be managed on a state-by-state basis
Each year over two million Australians are admitted to hospital for elective surgery, with two-thirds of these admissions in private hospitals, meaning a lot of Australians are eager to understand what the easing of COVID-19 elective surgery restrictions will mean for them.
Restrictions on some elective surgeries – including joint replacements, screening programs, IVF, post-operative reconstruction procedures, cataracts and eye procedures – have already been lifted with an aim of “restoring care in a safe and equitable way in this very challenging environment,” according to Deputy Chief Medical Officer, Dr Nick Coatsworth.
Priority will be given to low-risk and high-value procedures, patients with a low risk of post-operative complications, and under-18s. While cosmetic or other procedures not addressing significant medical conditions will not yet be considered.
As a frontline worker, it’s critical to safeguard your health to allow you to continue protecting the community. While you may not think you have any elective surgery on the horizon, something like a knee reconstruction from an injury or a wisdom tooth removal may come up unexpectedly and without private health insurance, at the best of times, you could be looking at a lengthy wait time in the public system or significant out-of-pocket expenses to be treated at a private hospital without cover. This rings true now more than ever before.
When will elective surgery start again?
Wait times for hospital admissions will vary state-to-state and will be affected by local hospital capacity, jurisdiction capacity, transport availability and any other relevant quarantine arrangements that are in place. The Royal Australasian College of Surgeons explains that “responsibility for the implementation and monitoring of the resumption of elective surgery will be under the control of each State and Territory’s Chief Medical Officer, who will also deal with specific complaints in both public and private hospitals, under the government’s national viability partnership agreement with private hospitals.”
At time of writing, individual states have not yet announced their strategies for recommencement of elective procedures, however private patients should anticipate hearing from their hospital within the next few weeks. If you are a Emergency Services Health member, speak to your doctor about when you might be admitted for surgery.
If surgery is required, it’s important that appropriate social distancing measures continue for any pre-operative appointments and management post-surgery – e.g. telehealth consultations where possible.
Intensive Care Capacity System
In order to support the resumption of elective surgery, the Australian government has introduced the Critical Health Resource Information System (CHRIS) to manage the evolving capacity of the healthcare system. This real time system monitors intensive care capacity (beds, ventilators, number of COVID-19/non-COVID-19 cases) across the public and private hospital network and will ensure that patients who require intensive care following elective surgery are accommodated.
A review of the measures is scheduled for May to determine whether additional services can recommence and volumes increased. However, restrictions may be reintroduced if cases of COVID-19 surge again.
Medicare Levy Surcharge (MLS) is a levy you should be aware of. Most Australian taxpayers are charged a 2% Medicare Levy. However, those who do not have appropriate private hospital cover may have to pay an additional levy called the Medicare Levy Surcharge (MLS).
A 1% MLS applies to couples or families without hospital cover who have a combined annual income greater than $180,000*, and singles earning more than $90,000*. This increases aligned to the income tiers as shown in your State Premiums & Benefits Guide. Family thresholds are increased by $1,500 for the second and subsequent dependent child.
Both partners must have hospital cover; otherwise both have to pay the levy. If you have dependent children they also need to be covered by a policy or you may have to pay the levy, even if you’re separated. If you’re unsure how this might affect you, we recommend you seek further advice from your tax advisor or the Australian Taxation Office.
For details on what income is included in the assessment please contact the ATO or refer to their website.
*Effective for 2019/20 and 2020/21 income years
Like all private health funds, Emergency Services Health has waiting periods for new members, including people transferring from another insurer when taking out a higher level of cover. Waiting periods also apply to current members upgrading their cover.
Waiting periods are designed to protect the interest of our members. Without them, it would be easy for people to join only at the times when they need cover and to receive benefits. This would lead to higher premiums for all fund members.
At Emergency Services Health the waiting periods are:
Hospital benefits of Gold Hospital and Gold Combined:
- 2 months membership for all benefits, excluding accidents
- 12 months membership for obstetric treatment
- 12 months membership for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care.
- 12 months membership for continuous positive air pressure (CPAP) machines, and goods and services under Non-surgically Implanted Prosthesis and Appliances and other aids and appliances.
Extras benefits for Rolling Extras and Gold Combined:
- 2 months membership for all benefits, excluding accidents
- 12 months membership for major dental (like crowns and dentures) and orthodontics, hearing aids, nebulisers, blood glucose & blood pressure monitors, blood coagulation monitor and for pre-existing conditions
- 12 month membership for Rollover Benefit (2 years Major Dental).
- 3 years membership for corrective laser eye surgery.
It is important to note that if you are transferring from another insurer, waiting periods only apply to the level of cover that is greater the previously held.
For instance if you previously had a top hospital cover with the previous insurer but with an excess, the waiting period only applies to the excess when joining Emergency Services Health.
A government leaflet containing further information is available by clicking here.
If a new member has a pre-existing condition before joining Emergency Services Health, they may need to serve a 12-month waiting period under the terms of our policy before benefits are payable for the particular condition. This does not apply for psychiatric care, rehabilitation or palliative care.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition existed at any time during the six months preceding the day on which you purchased your insurance or upgraded to a higher level of cover.
A medical practitioner appointed by Emergency Services Health (not your own doctor) is the only person authorised to decide that a condition is pre-existing. The practitioner must, however, consider any information regarding signs and symptoms provided by your own treating doctor or specialist.
A government fact sheet containing further information is available by clicking here.