PHI

Gap with your extras cover can arise due to

1. Limits to your Claimable Benefit
2. Set limits for each service type eg fixed amount for Physio
3. Fund rules - where each fund has it own way of calculating the benefit

As a general rule the more you pay the more benefits you will receive per service.

There is a gap with almost all extras health services, except  in some circumstances, if you go to a health provider nominated by your health fund and your extras cover meets the criteria for the no gap treatment as well as fund rules. Such cover does not come cheap.

To minimise GAP, health funds have preferred providers who are contracted on a fixed fee schedule. Despite such contractual agreements you may have a gap to pay irrespective of the years of membership with your extras insurer. Only some treatments are covered under the no gap arrangement. Even with the highest level of cover you could be faced with a GAP.

Data from APRA, shows the average gap across all health funds to be 46.84%. Which translates to increased costs to you as a member as the gap is payable by you over and above the fee you have already paid for the extras health insurance to be a member.

XHP

Often the two main reasons, extras health cover is taken out is for peace of mind and the other to reduce cost when needed.

At XHP that is just our aim is to make healthcare affordable, and have peace of mind of knowing that unused funds accumulate.

So unless you have spent all the balance in your account you will never have a GAP.

Simply put, you are in control of your health needs and health expenses. Assuming you are careful on how the funds are spent it is very likely you may have adequate funds in the account to cover the big ticket item that you did not foresee coming.

With preferred providers you will have the comfort of knowing the fee schedule is fixed in relation to the maximum fee that can be charged which would enable you to quickly make informed decisions.

Total Paid (10 year) = $18250

Cost of Dental Implant = $5000

Annual Limit = $1000 (maximum claimable)

Gap = $5000 -( $1000*2) (done over 2 years)

Total paid by Betty = $18250 + $3000(Gap)

With PHI, Betty has paid $21250 for the $5000 dental implant.

1.https://www.apra.gov.au/publications/private-health-insurance-membership-and-benefits- Part 9

Total Paid (10 year) = $18250

XHP Fee (10 year) = $1825

Account balance = $16425

Cost of Dental Implant = $ 5000

Even after paying in full for the treatment, Betty is left with a balance of $11425 in her account for future needs. What’s better is that she would not have to wait two years to have her treatment done.

With XHP, Betty has $11425 left after paying in full for the procedure and fees of her membership.