The Importance of Medical Insurance: A $169,000 medical claim case study

In the unpredictable journey of life, unforeseen medical emergencies can quickly become financial disasters. Private Medical/Health Insurance is invaluable to have when faced with the exorbitant costs associated with comprehensive healthcare and getting you back on your feet. Spratt Insurance Brokers recently processed a medical insurance claim that exemplifies the significance of having adequate coverage, providing a stark reminder of the potential financial devastation without it, one of the highest claims ever processed by our agency (specifics and personal details have been withheld). The claim in question involved a myriad of medical and surgical procedures, a hospital stay, recovery and scans each carrying a substantial price tag. The breakdown of the expenses serves as a testament to the diverse and expensive nature of the care you may need at any time that you may not be able to afford out of your own pocket:

• Firstly, a Magnetic Resonance Imaging (MRI) was performed, incurring a cost of $2,870. This diagnostic tool is crucial for detailed imaging and diagnostics, but its expense highlights the financial challenges patients may face without insurance coverage.
• A Computed Tomography (CT) scan came with a price tag of $850. These imaging techniques are essential for accurate diagnosis and treatment planning.
• The heart of the claim lay in the surgeon's fee, a whopping $58,650. Life-saving surgical interventions can be financially crippling without insurance, making it clear that comprehensive coverage is indispensable in times of medical crisis.
• Intensive Care Unit (ICU) expenses amounted to $2,405.01, underlining the fact that even brief stays in specialized units can lead to astronomical bills. The peace of mind offered by medical insurance becomes apparent as it shields individuals from such financial strain during critical periods of recovery.
• The anaesthetist fee, totaling $30,797, showcases the multifaceted costs associated with surgical procedures.
• Implants, costing $5,995.61, and hospitalization expenses, including room and medical supplies, amounted to a staggering $68,000.26.

Spratt Insurance Brokers, understanding the significance of robust coverage, ensured that the entire medical bill of $169,567.88 was paid in full. This example serves as a poignant reminder of the financial protection that medical insurance provides, alleviating the burden of healthcare expenses and allowing individuals to focus on recovery rather than financial distress. If you are interested in sourcing the best in medical insurance for yourself, your family or a group scheme, our professional adviser team would be happy to assist.

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The Insurance Advice We Give

With over 30 years of experience in the insurance field, our team specialises in problem-solving to ensure your financial independence remains intact during unexpected events and especially during challenging health situations.

In partnership with professionals and your own personal insight, along with trusted Solicitors and Accountants, we can create secure financial structures around your assets, ensuring your long-term plans are safeguarded.

When facing the uncertainties of disablement due to medical conditions, your reliance on earned income can be severely threatened. Maintaining your financial independence and funding amidst health challenges is paramount for your goals and your future. Here are the key factors we focus on to establish and regain control when faced with the disablement process:

1. Swift Access to Medical Support: Private medical insurance ensures immediate access to necessary medical advice, treatment, and technology without delay, providing peace of mind during critical times.
   
   
2. Control Your Debt Arrangements: We can help you be able to continue to service your loans in the early stages of disablement, reducing them significantly if your health continues to deteriorate and finally eliminating all debts in the event of your untimely impending or actual departure. This is where monthly mortgage repayment cover fits, along with lumpsums that pay out when a critical illness/condition is diagnosed, or if your disability becomes permanent.
   
   
3. Securing Artificial Income: Your ability to access a source of income becomes invaluable when earning your own living becomes impossible. This is where income protection fits, providing a stable source of income, enabling you to support dependents, completing retirement savings, and covering daily living expenses, ensuring your long-term projects stay on track.
   
   

Navigating the disablement process can be unpredictable, and it needs a more thorough set of appropriate structures and advice than many people think. By establishing proper structures, seeking expert advice, and selecting suitable insurance options, you regain control. Once control is regained, the Consolidation Stage begins as life continues, allowing your life to be addressed, resourced and funded as it continues.

The truth is that a holistic approach to the disablement process is necessary because, in our experience, the process is never predictable and never unfolds as you might expect. With our long term structured approach and comprehensive claims management we can ensure that your debt payments are met, solvency is established and ongoing needs are provided for. This can involve a complex claims process with multiple steps, which our service helps navigate for you. We take into account every facet of your needs from the lens of experienced industry professionals and help provide you with what you actually need at claim time, with no mistaken assumptions.

We specialise in a personalized approach, tailored to your unique situation. Let's meet to assess your current situation, evaluate existing resources, and discuss tailored solutions. We can and will also review Allied Professional Advice, existing structures like wills, trusts and guardianships, ensuring you and your dependents are well-prepared for the future.

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Insurance Claims: The Importance of having a Will.

Throughout our 30 years of experience in the Insurance marketplace, there are a few key things that we always advise our clients to look into regarding their insurance. One of the most important of those things is having a will in place that is complete and current.

If you have insurance cover on your life for instance, without a current will in place specifying your wishes your crucial claims money could be delayed or misdirected in ways you did not intend. Your Life Insurance policy will pay out at the time of your death and you can use your will to specifically detail how the Life insurance payout should be used.

Fortunately, these days getting a will in place and certified is not a labour intensive or expensive process, and it is a crucial step to take. It is equally as important to ensure that if you do have a will, that you make sure it is current and check it each year at the same time as your Insurance Policy Review. Make sure that your specified dependants that your estate will be distributed to is exactly who you wish for it to be, and make any necessary changes so that in the event that a life insurance or critical illness claim needs to be made, the intended recipients can get the claims payout with as little stress or delay as possible.

The Public Trust of New Zealand offers services that will allow you to create your will online for as little as $69. This is a small price to pay when compared to the possibilities of your entire life claim being delayed by unnecessary days, weeks or more. For more information on the process and to visit the Public Trust’s Will Service you can click here, or contact any of our team for any help that you may you need.

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Insurance Claims Statistics and Facts

Below are a collection of facts and statistics around claims and policies which may help you navigating the tricky waters of insurance:

1. 16% of Life Insurance claims are paid out early for Terminal Illness.

Some may be unaware that your life insurance can be paid out before the policy holder's death in the event that they are diagnosed with terminal illness. This happens in 16% of life insurance claims and can assist the family in making important financial decisions and quickly ease the monetary burden during this difficult time.

2. Life Cover Claim Reasons:

26% Heart Related (Cardiac Arrest, heart disease etc)
26% Cancer
12% Pneumonia
6% Stroke
2% Self Inflicted
1% Diabetes
1% Accident
11% Other
15% Unknown Causes

3. 50% of Trauma/Critical Illness Claims are due to Cancer

Heart related illness in this category accounts for 16% of claims, whilst Angioplasties and Strokes account for 5% each. Trauma cover is a separate form of cover which pays out a sum assured upon your diagnosis with a critical condition.

4. Muscular and Limb Injuries account for 47% of Income Protection Claims from one leading insurer.

5. The average age where Income Protection policies are cancelled is 46.

An extremely unfortunate fact, in light of the fact that...

6. The average age that Income Protection policies are claimed on is 47.

As we get older, we get more susceptible to injury and illness. Think carefully before making any big decisions about your insurance because being left without an income and a family depending on you can be a crippling financial burden.

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Hospital Stay Insurance Benefit - How it Works

Hospital. That smell, those beds, that food. Trust me, as a regular visitor to one, I know the drill. It sure isn't my favourite place in the world to visit. But if I was to get re-imbursed for it, that sure might make it a heck of a lot more tolerable. That's what we're talking about today, a benefit on your insurance that could result in just that.

If you have an Income Protection policy you likely already have this benefit (although it always pays to read the policy wording and check, because different providers and policies can vary). Basically, what it means is that if you suffer an illness or accident that necessitates a stay in hospital, you can claim on your hospital benefit. The benefit is designed to protect you whilst you're in hospital, aren't earning an income and possibly can't manage the bills such as your mortgage/car payments/rent etc.

The costs of a hospital stay on your life can be mitigated with Income Protection.

For instance, let's say Mike has a policy with a hospital stay benefit and suffers an illness which lands him in hospital for two weeks. The way the payout is usually calculated is that you will receive 1/30th of your agreed upon monthly income protection payout for each day you are in the hospital. Mike's monthly sum assured is $5,000. 1/30th of $5,000 is $166. That means Mike will receive $166 for each day of his hospital stay. Since Mike stayed two weeks, he is eligible for a total payout of $2,333.

We're trying to draw a bit of attention to this benefit, because recently we have had clients unaware of the fact that they were eligible for a claim on hospital benefit until we told them. So take a close look at your policy wordings and if you've had a hospital stay in the past, you might be eligible for some financial help.

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Insurance Advice: Avoiding Non-Disclosure

When it comes time to secure your insurance, most of us are familiar with all the forms we're asked to fill out and tests we're expected to undertake. These processes are on the part of the insurer, who is attempting to determine 'level of risk' that you represent to them as a business. Basically, if you are in tip top physical health at a young age and you're applying for life cover, you don't pose much of risk for an insurer to pay out a huge amount in the near future. Thus, your premiums will be lower and your policy will have less exclusions and no loading.

On the other hand, if you have gone through significant health issues in your life or are of a more advanced age, you are more of a risk to the insurer and thus premiums will be higher, exclusions may apply as well as some loading.

This process requires complete honesty on the part of the person applying for insurance, because unfortunately, insurance is a business and purposefully or unintentionally misleading the insurers on your health status or past conditions you have had can sometimes be deemed a violation of your contract, resulting in the insurer refusing to pay your claim or paying a reduced amount.  If it comes out during your application for a claim that any of these conditions were present and not disclosed to the insurer, you risk losing your payout entirely.

When it comes to informing your insurer of your health conditions and history, silence definitely is not the best policy.

So when you're filling out those forms, how do you know what to disclose and what not to? Surely you don't need to mention the leg cramps you had when you was 18? Well, the safest thing to do is simply declare everything you can think of. Not the fact that you had a cold or got the flu, but ailments, conditions, injuries, allergies that you have suffered throughout your life. If you have any doubt whether to include it, include it! At the very least get in contact with our team and ask, and we can tell you with our insurance knowledge whether or not this is something you need to declare or not.

Never assume something is irrelevant. The insurer may have a differing opinion and it could cost you a great deal. If in doubt, ask us, or contact your insurer directly. We have seen non-disclosure ruin claims and leave people in financial ruin. The good news is, with vigilance and honesty, you don't have to worry about it happening to you.

Important Health Insurance Facts from Southern Cross

Last week at the Spratt Financial offices, we received our annual presentation from higher ups at Southern Cross, New Zealand's biggest health insurance providers. Some of the facts mentioned were really interesting so we decided to share!

• A lack of medical insurance is according to statistics the biggest contributor to mortgagee sales in the country. Mortgagee sales for those who don't know, refers to the bank or lender selling a home from underneath the owners when they are unable to make mortgage payments. Unexpected medical, surgical or health costs when someone doesn't have insurance is the main contributor to people losing their homes and that was the most shocking fact of all to us.
• The majority of claims to Southern Cross come from those aged 65. 
• If you drink less than 2 glasses of alcohol per day, are a non smoker and exercise 3 times per week you can receive a 10% discount on your health insurance premiums. 
• The cost of the most common procedures used to treat the following disorders are as follows (based on Southern cross' 2012 claims data):
  - Heart Disease: $38,000 - $57,000
  - Skin Cancer: $800 - $3,900 for removal of lesions.
  - Osteoarthritis: $19,000 - $25,000
  - Prostrate Cancer: $15,000 - $21,000
  - Digestive Problems: $400 - $1,800 for Gastroscopy.
  - Breast Cancer: $7,000 - $12,000 for unilateral Mastectomy.
  - Cataracts: $3,100 - $4,700
  - Endometriosis: $6,000 - $14,000
• For every one dollar paid to Southern Cross in premiums, Southern Cross pays back an average of 90 cents to their members in claims (based on the previous 5 years figures averaged).
• Southern Cross has no shareholders or overseas owners. We were told this is because they would rather service New Zealanders than be beholden to any outside financial interests.
• During the 2013 financial year, Southern Cross paid out $639.1 million in claims.
• Southern Cross currently services 817,822 members in New Zealand.
• In a worrying industry wide trend, Southern cross' member numbers decreased in 2013. Southern Cross numbers dropped by 0.5% compared to an overall trend in the industry of 0.7%. SC are attempting to draw attention to the negative consequences of not having medical cover (including the mortgagee sales example above) to reverse this trend.
• Southern Cross has an A+ financial strength rating given by Standard and Poor's.

Interested in Health Insurance?  Call us on 09 307 8200 or email enquiry@sprattfinancial.co.nz

Travel Insurance Claim Update

A few weeks back I arrived back to Auckland after an amazing two week journey to the United States. Awesome that is, apart from my journey home being affected by cancelled flights, leading me to have to stay another two nights in LA that I had not budgeted for! (Read the full story here)

Today, after I had filed the claim with Southern Cross Travel Insurance a few days earlier, everything was sorted and my claim was accepted. It was easier than I had anticipated too. All I had to do was fill out some forms, which weren't as daunting or lengthy as you might expect, and attach the relevant receipts and hotel information. There were also facilities on their website that let me do it all online if I had chosen to. They then were excellent in updating me on the process by email and by phone.

They said it would be processed within six days and it ended up being done in two. All in all, having the cover only set me back $70, whereas not having it and having to pay for my added expenses out of pocket would have set me back over $500. That's a considerable return on my investment. I admit to once scoffing at 'unnecessary' travel insurance, but after this, never again.

Thanks to Southern Cross Travel Insurance too for processing everything so quickly and efficiently.

Insurance MythBusters: "You have to be critically ill to claim on your Trauma Insurance"

I hope everyone out there had a fantastic Christmas and New Year. The weather was disappointingly a little iffy, but the spirit of the occasion endures beyond surface level things like that, so I hope you valued your time with family and friends.

Mythbusters is one of my favorite shows. Science, interesting facts, big explosions and old wives tales being put to the test. What's not to love? I brought it up in the office and asked our team what they thought the biggest myths are regarding insurance that are out there, and this one was among the first they mentioned (stay tuned for more!).

Busting insurance myths may not involve as many cool explosions, but they could result in an explosion of cash in your wallet!

A lot of people think that Trauma insurance cover means just that. 'Only for significant trauma'. Significant trauma as in, life threatening or critical ailments and conditions. Certainly these conditions are usually covered, but there are often far more that you can claim for that most people are completely unaware of.

Conditions such as deafness and procedures such as an angioplasty are mostly not critical conditions, and yet you can sometimes make a claim for them just as readily as the others. The actual conditions that you can claim for may differ depending on the insurance provider, but we've had many people we're connected to surprised when they've brought up a condition, and we ask them if they've claimed for it. One in particular had a cancerous mole removed from their arm. He didn't think much of it and during our annual review with them, he just brought it up to us in casual conversation. He was more than happy when we consulted and found it met the conditions on their policy for a claim they didn't even know he was entitled to!

So if you do have a Trauma Policy, take a close look at the policy wordings so that you'll know exactly what's covered and what's not (it can differ between insurers and between plans). OR, if the confusing technical language is a bit too much for you, good news. We have a user friendly, easy to understand brochures that can help. Just let us know and we can send you one out free of charge. If you have any other questions, let our expert admin staff know.

Conclusion: Squarely busted. There are literally all sorts of conditions and procedures that are not critical or life threatening that may be covered under your Trauma Insurance. So if you don't have a policy and this belief was holding you back, don't let it any longer. If you do have a policy, take a look at precisely what's covered. You might have a pleasant surprise in your future.

When Insurance Works - Our Recent Claims

Insurance is sometimes regarded as protecting against something that's never really going to happen to us. We can however assure you that couldn't be further from the truth. We help manage our clients' claims all the time and we see that critical illness is a real and ever present danger. We've in the past had 16 claims in a single month, and we manage several dozen long term claims, some that have been running for as long as nine years.

Here is a section of our processed claims during 2013. 

Trauma/Critical Illness Claims

1. Bowel Cancer.
2. Loss of Hearing
3. Breast Cancer
4. Leukaemia
5. Cancer (Undefined)
6. Cancer (Undefined)
7. Cancer (Undefined)
8. Parkinson's Disease 

Income Protection Claims

1. Mental Health
2. Severe back Injury
3. Chemical Sensitivity
4. Automobile Accident
5. Stroke
6. Post concussion syndrome.
7. Back Injury
8. Heart failure/Cardiomyopathy
9. Lung Cancer
10. Prostate Cancer
11. Stroke
12. Hand Injury/Surgery
13. Wrist Injury/Surgery
14. Mental Health
 

Life Insurance Claims

1. Cardiac Condition
2. Cancer (Undefined)
3. Cardiac Arrest
4. Cancer (Undefined)
5. Bowel Cancer
6. Cardiac Arrest
7. Cancer (Undefined)
 

Permanent Disability Cover (TPD) Claims

1. Pneumococcal Meningitis
2. Post Concussive Epilepsy
3. Severe Hip Injury

Other Claims

1. Business Overheads Cover: Hand Injury/Diverticulities
2. Waiver of Premium: Back/Neck Injury

Sometimes, clients are unaware of the conditions of their cover and don't make a claim when they in fact, could. We're here anytime to take a look for you and answer all your claims questions as well as manage your claims and take the stress out of your hands. If you need help with any claims issues, don't hesitate to get in contact with us anytime. 

Have any claims or insurance questions you have answered anytime.

Defining Insurance Terms

A lot of the jargon and terminology surrounding insurance can be difficult for people not familiar with the industry to understand. Worse, many insurance companies or brokers use these terms expecting full knowledge. Here is the definition of some of the most important terms you might come across when dealing with insurance.

1. Policy 

An insurance policy is a contract between yourself and the insurer. The policy provides conditions that once you fulfill, you will receive payment from the insurer in the amount agreed to when the policy is taken out. For example, a life insurance policy is an agreement between you and the insurer to pay a certain amount (called the sum assured) in the event of death. A Total Permanent Disablement Policy will provide payment once you fulfill the conditions of being unable to work due to illness or disablement for longer than a specified period of time. And so on and so forth. An insurance policy is what you pay premiums for as well as what you make a claim upon.

2. Premiums 

The price you pay to keep a policy in force. Most premiums are paid monthly, and the amount depends upon the type of insurance, the sum assured and other factors such as your age, your health or the amount of people covered by the policy.

3. Claims 

A claim is the action you take when you have fulfilled the conditions of your policy and wish to be paid out the sum assured.

4. Pre-Existing Conditions 

A pre-existing condition is a physical health or mental health condition which were already present at the time of taking out the policy. Pre-existing conditions can be excluded from your insurance coverage or can cause your premiums to be higher, as the insurance company is taking on a higher risk by insuring you.

5. Exclusions

Events or conditions that are not covered by your insurance policy. For example, in many life insurance policies there is a suicide exclusions whereby death by suicide will not result in the insurance paying out ie. it is 'excluded' from your cover.

6. Insurance Broker

An insurance broker is different from an insurance company in that a broker does not sell insurance to you directly. A broker searches the marketplace on your behalf, taking your needs and your individual circumstances into account to secure the best possible deals on the insurance policies you are looking to take out. A broker's job is to work for the client and work for their interests and not the interests of the insurance companies. Our company, Spratt Financial Services is a team of insurance brokers, operating under this definition.

7. Waiting Period 

The waiting period is the amount of time (agreed upon at the time of taking out the policy) which must pass after an event before you can collect your insurance benefit. For example, in an income protection policy with a waiting period of 4 weeks would mean that you will receive your agreed upon benefit from the policy 4 weeks after being rendered unable to work by illness or disability.

8. Living Benefits 

This is a feature that can be included in life insurance policies that allows you to receive payment on your life insurance before you die under certain circumstances. Usually, these involve diagnosis of terminal illness such as cancer or the need for specialised care.

9. Waiver of Premium

A feature that can be added to an insurance policy that will ensure that your insurance remains in place and active if you fail to make premium payments due to illness or disability. The waiver of premium will usually remain in effect for as long as you are disabled and unable to make premium payments. This feature will cost an additional premium.

10. Qualifying Event

An occurrence that triggers your insurance payout or claim. For instance, a death in the case of life insurance or a surgical procedure in medical insurance.

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Is Your Current Insurance Sufficient?

After 20 years working in the Insurance industry, there is one thing about insurance of which we am absolutely convinced. Insurance works best when it is used as the funding for a plan that will protect a business, family or estate that is confronted by the disablement process. If you already have an insurance package and you want to know whether your insurance package will really be sufficient for your needs, here are the questions you should know the answers to:

What Will You Need The Cover For?

Specifically, use a pen and paper and write down what the claim proceeds will be used for when they are paid out. If you can't do this now before tragedy strikes then you may be facing trouble later.

Will You Be Able To Claim Soon Enough?

Death cover pays out in the event of actual or impending "medical death". However, we know that 94% of all deaths are due to medical conditions not accidents and 65% are due to degenerative medical conditions such as cancers, heart disease and strokes which can kill slowly over what may be an extended period of time. During this time, unable to work and unable to support yourself, your family or your business, you will be facing tremendous financial strain which your insurance may not cover for. Will the bank or your creditors wait until you are terminally ill before your death cover pays out? This is perhaps the most crucial consideration to take into account when assessing your insurance. We can help you ensure that you are fully covered financially in the face of these worrying statistics as unfortunately, basic life cover is most of the time, simply not sufficient.
 

Is It Enough Of A Claim?

It may sound strange, but a $250,000 insurance claim may not be enough to repay a $250,000 mortgage even assuming you want to repay all of it. You may have additional interest payments, penalties for being in arrears and you may need to pay a Solicitor, Trustee or your Accountant to carry out these transactions for you.

Do You Have The Right Insurance?

This applies to the type of income protection policy you may or may not have, what your health insurance actually covers or the way that permanent disability or critical illness components are structured within the overall portfolio of insurance. These two components may or may not reduce the remaining life cover once they have paid out which could create major problems at the very end of the disablement process.

Even assuming that you or someone close to you will be physically, mentally and emotionally capable of applying the claim proceeds to the predetermined targets is not supported by our experience of dealing with over 160 claims.

What is the best way of answering these questions fully? Use our experienced professional advisers to not only design and review the underlying plan, but to execute it and carry out the tasks they are best suited to handle. If you don't have a plan now, prepared with clear-headed purpose, then any insurance you do have may well be insufficient or not adequately fit to your unique needs. Use our experienced professionals if you need guidance or advice.

For more information on how our team of advisors can assist with managing your insurance program, contact us by calling 09 307 8200 or by email at enquiry@sprattfinancial.co.nz.

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Highest health insurance payouts 2012.

"Southern Cross' biggest health insurance payout last year was for a spinal surgery costing $160,000, its latest statistics reveal.

Another spinal surgery cost $151,000 and $100,000 was paid out for a larynx removal.

Cancer, heart disease and spinal conditions were the causes of the highest health insurance claims paid by the association.

All of the patients who made the top 10 highest claims were aged over 64. The oldest was 76.

Chief executive Peter Tynan said it demonstrated the value of insurance. “No one wants to be ill but, if the unexpected happens and you need timely access to treatment, it can be very comforting to have the financial aspect taken care of.”

Those aged under 30 put in a high number of claims for tonsillectomies and dental procedures, for women aged 20-39 endometriosis surgery was common and for people over 50, hip and knee replacements, cataract extraction and skin lesion removals were in high demand.

Tynan said: “If they choose to self-insure, people should have realistic expectations of what they’ll need.”

A survey carried out by Southern Cross last year revealed that 79% of New Zealanders thought they would have to pay for some of their elective healthcare in retirement. But only one in five had started saving and many thought that savings of less than $10,000 would be sufficient."

Original Article Here.

It's always interesting to get a look at figures such as these. Imagine the burden of having to take on those kind of costs by yourself after retirement. The point about self insurance is interesting too, and it plays into a point I have discussed at other times on this blog. New Zealander's sometimes can lack perspective on just how prohibitive illness can be. This is due to a combination of factors, such as inadequate proliferation of the statistics and case studies involved, as well as a strong, independent, yet sometimes wrong headed 'she'll be right' sort of attitude. This attitude has seen Kiwis take on and achieve incredible feats, but it doesn't work so well when applied to your health, your ability to earn and protecting your family or your business from very real risks.

We certainly hope these risks are taken into account and that some of these figures demonstrate that savings of less than $10,000 certainly won't be enough if serious illness rears its ugly head.

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Our Unique Claims Service

If there is one aspect of our service we value above all else, it is getting our clients insurance claims through effectively, quickly and with the least stress possible.

Claim time, even when considered in the absence of the health or illness circumstances surrounding it, is an extremely stressful time. A time that is not helped by a panoply of forms, questions and going back and forth with insurance companies.

Whether you require pre-approval, a claim on your health insurance for a procedure, income protection after being rendered unable to work or in the worst case scenario, a claim for a critical illness or death, our professional team is there to help and support you. We have experience and a perfect record in getting the claims you need through and managing your claim for you during any crisis on an ongoing basis. We will arrange the necessary forms, get them to you, help you fill them out and then have them processed. We will then administer and take command of the claims process, always keeping you informed of what is happening.

Also, in our experience, clients can also be missing out on claims they could be receiving through a poor understanding on their own policies or the terminology of insurance providers. We can also help you with this, discerning for you precisely when you can claim and how much for.

If your claim is a single lump sum, our Head of Practise will personally visit you to assist with completing the forms and fully working through the claim with you, giving you personal expertise and one to one service to take the stress away. If you become one of our valued clients, we offer to you all the resources to help you at claim time and manage the difficulties in the easiest and most effective manner.

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Insurance Selection Advice

When our team of advisers considers your insurance needs and acts to helps you secure an insurance package, we use a set of criteria that in our experience produces the best results in both the long and short term for you the client.

We list it here to give you a perspective on what our experience has found to be the most important factors in insurance, which can differ greatly from what the public expects when they try to go it alone. We hope it helps you when it comes time to manage your insurance plans.

Ranked from Most to Least Important

1. Claims Paying Experience and Performance.

To our mind, the most important part of any insurance policy is how it will operate at claim time. This is the time you really need flawless service to ease your financial burdens and thus claims performance is the most crucial part of what we look for when we secure you an insurance package. Typically, the events that necessitate a claim come with considerable financial and emotional stress for you and those close to you. We look at the efficiency, fairness and sensitivity with which the insurer carries out their work at these times and make sure you have the most efficient and stress free claims possible.

2. Underwriting Performance.

During your life, things will have gone wrong or begun to have gone wrong with your health and these are of concern to the insurer. We require them to look at these issues in the holistic perspective of your entire life and come up with reasonable solutions that are competitive, fair and accurate. The performance of underwriters is defined by the amount of research they do into your specific circumstances and just how much of a balanced perspective they are prepared to take.

3. Policy Specific Wordings and Definitions Relevant to You.

We focus on the individual person and their individual needs. We look for the issues you face, and what you need from your insurance in order to achieve your outcomes. This is our starting point, rather than a product focussed outcome. Insurance should be tailored to an individual, as catch all insurance solutions can more often than not be inadequate. This is something anyone trying to get the right insurance should take into account, and something we insist on. 

4. Long Term Price Stability.

Changes to your health over time may prevent you moving to another insurer should your current insurer’s premium rates become uncompetitively expensive. We actively avoid insurers who have shown long term instability of premium rates, and our experience gives us the edge to know in which areas certain insurers perform better than others.

5. Immediate Cost.

The best option for you is rarely the cheapest option (as detailed more extensively in our article here), but our priority is always to ensure your insurance is competitively priced among the panel of insurers that we do business with. The most important selection criterion is thus to get the best possible deal for your needs that we can in terms of immediate cost.

If you're having trouble with your insurance, feel free to get in contact and our experienced advisors will get you the best cover possible that meets your specific needs and will save you hassle at claim time.

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Health Insurance FAQ

Here are the questions we have heard most often over the years regarding health insurance (aka medical insurance). Look for future FAQs to deal with questions about other forms of cover.
 

Do I Really Need Health Insurance?

Although it may seem easy to adopt a standpoint of ‘it won’t happen to me’ as it relates to insurance, it is an unfortunate statistical fact that you will require hospitalisation, surgery or medical procedures at some point in your life, in many cases more than once. Within the current medical system, the only way to ensure that you and your family will receive the treatment you need promptly is by taking out health and medical insurance. Although cover may seem unnecessary from a short sighted mindset, the alternative of having to bear the burden of excessive treatment expenses can make the cost of premiums a small price to pay in the long run. Not having it is taking a chance. From my own personal point of view, having health cover has spared me over $20,000 in costs after I was unexpectedly diagnosed with Crohn's Disease. Before that, I was completely healthy with no real health issues. It can happen, and it can ruin lives. Make an informed decision.
 

Which type of Health Cover is best for me?

The primary benefits of having health or medical insurance are guaranteed protection from the risk of having to pay for your own treatment, as well as obtaining the best possible care with the least amount of delay or stress. In general, for most cases, a hospitalisation and surgical, combined with a tests and specialist policy will provide you with a basic and effective level of cover. We also specialise in more specific insurance plans covering optical and dental expenses, and also routine GP visits and checkups. As to which specific plan is the best for you, it will depend on personal factors in your life. Do some research, or get in contact and our advisers can take you through the options completely free and with no obligation.
 

Which company has the best Health Insurance policy?

The answer to this question will vary depending on your own personal needs from your insurance plan. There are a number of factors which need to be taken into account when choosing a provider. Every company is slightly different in the way that it structures its cover. For instance when insuring your family, some companies base their premiums on the age of the youngest adult covered, some have ‘per-child’ premiums, whilst others have a flat rate no matter how many children are covered. Companies also differ in the way they process claims. In general though, both Southern Cross's VIP Plans and Sovereign Assurance's Majorcare can be relied upon as excellent options.
 

Should I choose an excess?

Adding an excess to your policy can have practical benefits in the long run, as most companies offer a discount on the monthly premium for doing so. This saving, over time, can add up to a significant total over the course of several years. Furthermore, it is an unfortunate fact that premiums will continue to increase over time. Adding an excess is one of the options we can provide you in order to mitigate these increases, keeping your insurance costs manageable. In general, an excess of some sort is generally a good idea.
 

How much can I claim?
Your policy will have a ceiling amount that you can claim per operation or procedure, and these amounts are variable based on the type of cover and the company providing the insurance plan. These limits are designed to be high, in order to accommodate almost every possible medical scenario.  

Do I need to remember details of my Medical History?

It is necessary that you can recall as much as you can of your significant medical history. The main thing when completing an application for insurance is to disclose as much as possible of any past medical treatment or consultations. Failure to do so could impact claims on your insurance policy.

Are there alternatives to Medical Cover?

Not really. Although it may be tempting to think that you could save the money you would normally pay into a medical insurance policy for possible future use, the levels of medical inflation means that an investment would need to grow at an unrealistic rate to keep up. Obviously, there is a chance that you could go through your entire life without ever making a claim (which would be a good thing) but there's also the possibility that you need to make several significant claims, even one of which could be crippling to your financial prosperity to pay out of your own pocket. So unless you have significant savings, medical insurance is almost essential.

How much will my premiums increase annually?

Again this will depend on the choice of company. Some have age-related premiums increasing each year, whereas others calculate premiums on five year age bands. Regardless of how often these age-related increases are applied, you can expect to receive an increase every year or so to reflect higher than expected claims (company wide rather than specific to you) or to take the rise in medical costs into account. Factors that contribute to higher claims costs include:

• Restricted access to public health care.
• New medical technology (more costly to provide).
• An aging population (with higher average claims amounts).
• Rising medical inflation (increasing consultation, treatment and equipment costs). Increasing premiums are a necessary fact of life in terms of insurance, however we can provide several strategies in order to lessen these costs. These strategies can include adding an excess, shifting insurance providers or making policy adjustments, always ensuring your best interests are our top priority.

Increasing premiums are a necessary fact of life in terms of insurance, however we can provide several strategies in order to lessen these costs. These strategies can include adding an excess, shifting insurance providers or making policy adjustments, always ensuring your best interests are our top priority.

If you have any questions regarding your insurance, feel free to post a comment below or get in contact with us, we'd be happy to help.

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Insurance: Why cheaper is not always better

Sometimes when selecting their insurance, people are inclined to gravitate immediately to the cheapest possible option. Cheaper is better right? Well, we definitely understand the desire to have more money in pocket, but in the insurance market, the best way to accomplish this may not actually be to dive straight in to the cheapest cover. What is crucial to know is that whilst insurance premium costs can sometimes be daunting, there are factors that are often neglected that can dwarf these costs in the long run. Unfortunately, when it comes to insurance, cheaper is definitely not always better.

One of the most important factors we look at when we seek out a policy for a client is how the insurer will perform at claim time. If a policy is cheap but the insurer will throw up obstacles when it comes time to claim on your policy, the cost both financially and emotionally can be immense. Our advice does take cost into consideration and always attempts to secure our clients the best possible deal, but from a larger and more beneficial perspective. We know that you don't want to be fighting battles with your insurer during your most stressful times, and even more crucially, we know that when things go wrong in your life, you need assurance that you will be supported financially promptly and with the minimum of concern.

Some insurers also can be more trying than others in their requirements for not only claims, but aspects such as policy alteration, changing direct debits, increasing, adding cover or underwriting. Your insurance needs to work for you, and do its job to cover your financial assets in the event of medical issues or permanent disablement, and sometimes it is worth spending a few extra dollars to secure the best possible service in all aspects.

With a bit of searching, research and a bit of professional advice, you can get insurance that's both effective and affordable. It just takes some time and a bit of inside help. We're happy to be that help. If you have any questions or concerns about what you're getting from your insurance let us know.

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