STAR RATINGS REPORT. Health Insurance

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1 2015 STAR RATINGS REPORT Health Insurance

2 Health Insurance September 2015 Foreword CANSTAR s Health Insurance Star Ratings is the largest of our suite of ratings and awards. That is based on the sheer size of the rating. We have 273 profiles which cover various demographics across the states and territories in Australia. The number of profiles is boggling not to mention the 31,000 premium quotes or the millions of extras claims scenarios that we calculate. This whole process has provided us an appreciation for the task that we all go through when trying to choose the right health insurance policy for our individual needs. It is not only about finding a policy that will meet our budget, but also finding one that will provide the cover we need. With the large range of options available from multiple health fund providers, this process can be difficult. Mitchell Watson Research Manager That is where our Star Ratings step in to assist in putting you on the right path to finding a product that not only matches your budget but also provides value based on what it covers. In 2015, CANSTAR rated 895 health insurance policies from 22 providers. Our analysis covers various age profiles with different health needs: Young single males and females Young couples without obstetrics Couples and families with obstetrics Young families without obstetrics Young single parents Established families Established single parents Established single males and females Established couples Mature singles Mature couples Tax (avoiding Medicare Levy Surcharge and lifetime loading) We tell you what to look for and give you a list of 5-star Outstanding Value policies to choose from. Health Insurance 1

3 CURRENT HEALTH INSURANCE STATS How many Aussies have private health insurance? 47.4% of Australians (11,276,328 people) have policies covering hospital treatment. (According to APRA and PHIAC, as at June 2015) 55.8% of the population are covered for general treatment. 71,370 people signed up for general or ancillary extras treatment between March and June alone. How many people have lifetime health cover? In Australia in 2015, 85.4% of Australians with health insurance have lifetime health cover (LHC). This means they aren t paying more than they need to for their premiums good onya, Aussies! If you don t already have health insurance and you sign up when you are older than 30, your premium is made more expensive by a government penalty (2% loading for every year of your age over 30). You can use the government s Lifetime Health Cover calculators to find out if the loading would be or is being applied to you. Number of claims made in Hospital: We visited the hospital a lot during We made 2.9 million day trips for hospital treatment, with the majority of those days being in private hospitals. Other less common claims were for day hospitals and hospital substitute treatment (treatment in your own home or in community healthcare clinics). General treatment: million claims in total, including: Dental: million claims Physiotherapy: million claims Chiropractic: 9.71 million claims Podiatry: 2.62 million claims Acupuncture: 1.82 million claims Prostheses: 0.39 million claims We also made 1.48 million longer trips to hospital, and claimed for 8.3 million nights spent in hospital. Of those nights, 5.8 million were spent in private hospitals and 2.4 million in public hospitals. Speech therapy: 0.38 million claims Hearing aids and audiology: 0.06 million claims (64,000) Optical: million claims Natural therapies (on the rise!): 5.73 million claims Benefits paid in $13,279 million Hospital $4,554 million General treatment $49 million General treatment for CDMP (Chronic Disease Management Program) September

4 WHO ACTUALLY HAS HEALTH COVER? When it comes to having health insurance in place it is not surprising that the higher your personal income, the more likely you are to be insured. While even at very low income levels approximately of the population have private health cover in place, the proportion increases to more than 80% of those earning more than $90,000 and 90% of those earning $150,000 or more. Given the Medicare Levy Surcharge penalty that applies for singles earning over $90,0000 and families earning over $180,000, this is to be expected. When it comes to geography, Canberrans and Western Australians are the most likely to have both hospital and general cover, while residents of the Northern Territory are the least likely to have cover, as follows: Health Cover as a proportion of population Proportion of Region population with cover Hospital Extras Australia 47.3% 55.6% New South Wales 48.0% 57.4% Victoria 44.9% 51.2% Queensland 45.3% 50.5% South Australia 46.2% 59.1% Western Australia 54.3% 67.4% Tasmania 45.1% 51.6% ACT 58.2% 68.0% Northern Territory 39.0% 42.0% Source: Private Health Insurance Administration Council, Membership Trends March % 90% Proportion of taxpayers with private health insurance 80% 60% Taxable Income Health Insurance 3

5 HEALTH INSURANCE REBATE IS ON THE WAY DOWN In 1999, the federal government introduced a private health insurance rebate to help Australians with the cost of private health insurance premiums. In July 2012 this rebate began to be means-tested and the proportion of rebate that you receive is now dependent on your income threshold and your age. The rebate was initially set at of premiums for those aged under 65 (and a higher amount for those over 65 years of age). but the rebate is no longer In April 2014, a second amendment was made to the private health insurance rebate, so that the rebate is adjusted every year by the difference between the Consumer Price Index and the industry average increase in premiums. This was a way for the government to slow the growth in its expenses and save its ailing Budget, but it s not exactly kind to the average citizen. In the financial year, the standard policy owner received a 29.04% rebate, and that percentage will likely only decrease in the future. The rebate is tiered so that people earning more money than average will receive a lower rebate or no rebate. This meant that in , customers paid this much more for their health insurance than before: Tier Standard Tier 1 Tier 2 Rebate rate 29.04% 19.36% 9.68% Single $17.07 $11.38 $5.69 Family $34.18 (3 Big Macs, 8 takeaway coffees, or 2 movie tickets) $22.79 $11.39 Based on the current formula, we expect the rebate to decrease as follows, inflation figure stays around 2.75% and average premiums increase by 6.20% per year. Year Financial Year Rebate (listed by tier) 2013/ % 20.0% 10.0% / % 19.36% 9.68% / % 18.74% 9.37% / % 18.14% 9.07% / % 17.56% 8.78% / % / % 16.45% 8.23% / % 15.93% 7.96% / % 15.42% 7.71% / % 14.92% 7.46% / % 14.45% 7.22% Ouch! What can consumers do? Whether you re looking to buy health insurance for the first time or seeing how your current fund stacks up against the rest of the market, there are some things you need to consider to get the cover you need without breaking the bank. Know your budget. Health insurance is important, but it needs to be realistically affordable. If you re young and healthy (and a poor student), you might get away with the bare essentials. Also remember to budget for paying the gap when you do need healthcare services. Decide between General Treatment (extras/ ancillary) or Hospital Only cover. Extras cover is important for anyone who has regularly recurring needs like optical or physio. Extras also covers things like your essential yearly dentist visit. Know your family medical history. Make sure ahead of time that you re covered for complications that are likely to come down the track. Otherwise, you might face a waiting period when a serious condition arises. If you re thinking about starting a family, sign up for obstetrics (pregnancy) cover before you even start trying. There are substantial waiting periods for OB care that can mean you re footing the doctors bills for most of your pregnancy. Know what excess you want. The excess is how much you pay the gap when you make a claim. There s no worse time to face a bill than when you ve just had a medical emergency, and with hospital fees so high, increasing your excess just for a lower premium is something to consider carefully. Stick to what you need. Check the inclusions in your policy, and cut out anything you know you won t need like hip replacement surgery if you re 20, or obstetrics if you re 55. Keep it updated. As life changes, you need to keep updating the health benefits in your policy. If your current provider can t keep up, find a new provider with a policy that suits you better. September

6 WHAT DOES HEALTH INSURANCE COST? Each year the federal government approves health insurance premium prices rises fund by fund. The overall increase in 2015 (effective 1 April) was an industry weighted average premium increase of 6.18%. For the consumer, though, it s worth keeping in mind that an average figure masks a wide range of individual changes. The cost to you as an individual will depend on the fund you choose, the policy you select and your life stage and selected policy inclusions. As an indication of what you could expect to pay, though, CANSTAR has calculated the average premiums across the health policies we assessed for this rating, based on a combined hospital and general package, as follows: Combined NSW QLD SA TAS VIC WA Couples and Families - With Obstetrics $4,178 $4,345 $4,374 $4,434 $4,366 $3,991 Established Couples $3,893 $4,074 $3,961 $3,945 $4,045 $3,891 Established Families $3,834 $4,039 $3,900 $3,863 $3,988 $3,865 Established Single Parent $3,519 $3,683 $3,419 $3,542 $3,683 $3,582 Established Singles - Female $1,955 $2,050 $2,014 $1,989 $2,030 $1,961 Established Singles - Male $1,961 $2,055 $2,008 $1,989 $2,036 $1,964 Mature Couples $4,159 $4,228 $4,220 $4,256 $4,280 $4,259 Mature Singles $2,075 $2,119 $2,118 $2,130 $2,147 $2,128 Tax $1,819 $1,904 $1,839 $1,891 $1,908 $1,803 Young Couples - Non Obstetrics $3,548 $3,706 $3,519 $3,547 $3,686 $3,450 Young Family - Non Obstetrics $3,642 $3,819 $3,699 $3,735 $3,802 $3,703 Young Single Parents - Non Obstetrics $3,339 $3,480 $3,210 $3,398 $3,468 $3,443 Young Singles - Female $1,759 $1,847 $1,752 $1,757 $1,834 $1,729 Young Singles - Male $1,756 $1,847 $1,752 $1,759 $1,831 $1,726 Based on policies assessed by CANSTAR for 2015 Health Insurance Star Ratings Health Insurance 5

7 WHO OFFERS OUTSTANDING VALUE? This year CANSTAR has researched and rated 895 policies from 22 providers. These policies were put through rigid testing on how they perform across 14 different consumer profiles and in each state/territory in Australia. They were measured by the value they provide to Australians with consideration placed on the premiums charged, for hospital cover the excess/co-payments charged upon admission, in extras the out-of-pockets when visiting for example the dentist, the level of cover provided within the policy and how that suited different consumers and also some health fund level factors such as ease of making a claim, branch/ phone access and the accessibility to private hospitals and general treatment networks. This rating is the largest undertaken by CANSTAR and one which we are extremely pleased to provide to Australians. The health insurance space can be confusing with some many factors to be considered when choosing a health insurance policy. Along with our star ratings we also recognize the health funds that overall are offering outstanding value health insurance for cover types in States/territories and also on a national level. In 2015, CANSTAR has awarded two National Awards for Outstanding Value Health Insurance. BUPA Repeating its success of last year, BUPA has again provided award-winning value for Australians across both hospital, general (extras) and packaged (Hospital & Extras) cover. BUPA has achieved 5 star value across a majority of profiles assessed by CANSTAR. BUPA s success this year has been punctuated with a notable achievement of securing all state and territory awards for packaged cover. The key to this success has been the development of health insurance policies specifically targeted to life stages. For example, their Young Singles cover for the younger age group through to their Live Well cover for the mature segment. The family segments are not missed either with policies for growing families and those who are perhaps passed the growing stage (Established Families). BUPA (who also shares this achievement with Medibank) received a five star rating in all profiles for Extras cover. It is then easy to understand why they received the state awards in New South Wales, Victoria and South Australia. Their success in this space has been built off outstanding value policies including Bronze Extras, Silver Extras and their new policy Your Choice Extras. Along with a strong range of policies they also have a wide network of providers through their Members First network to help in keeping health costs down for their customers. In hospital cover, BUPA received the state/territory awards for New South Wales and Northern Territory. This is along with securing 138 five stars on their policies across Australia. The three levels of hospital cover offered (Budget, Standard and Top) performed strongly against a range of consumer profiles. September

8 Medibank Medibank has repeated its continued success by retaining the Outstanding Value Health Insurance Australia award for Medibank has had some notable changes in their corporate structure over the past year, but this hasn t changed our opinion on what they are delivering Australian s when it comes to Health Insurance. Medibank may not have achieved as many state awards this year but this has only masked what was a very strong performance. They were either top or second ranked in all states and territories bar one when it came to Extras and Packaged cover. In extras they received a five star rating across all profiles that includes 13 different consumer profiles across all states and territories. These results were spearheaded by their Basic and Top Extras policies. In addition, their customers are able to access Medibank s Members Choice network to help in keeping their health costs down. Their results are further highlighted by achieving the state awards in Queensland, Tasmania and Northern Territory. Medibank s offers a diverse range of packaged cover for their customers to choose. These have been based around life stages providing choice to Australian s as they progress through life. This includes cover for new families, settled families and young singles/couples who all have differing needs and don t particularly want to be paying for cover that they don t necessarily need. Across the various consumer profiles and states, Medibank s packaged cover policies received 349 five star ratings an amazing effort. In hospital cover Medibank was found to offer either outstanding or strong value across all profiles. Their top performing polices were their Basic and Top Hospital. STATE AWARDS Whilst the big players also dominated the State Awards, they were not dominant across the board, particularly in the important hospital category. State Award Winners Hospital Extras Package Queensland CUA Health Medibank BUPA NSW BUPA BUPA BUPA Victoria Mildura Health Fund BUPA BUPA South Australia Health Partners BUPA BUPA Tasmania GMHBA Health Insurance Medibank BUPA Western Australia GMF Health HBF BUPA Northern Territory BUPA Medibank BUPA Health Insurance 7

9 METHODOLOGY Health Insurance Star Ratings What are the CANSTAR Private Health Insurance Star Ratings? CANSTAR Private Health Insurance Star Ratings combine three separate health insurance product types (Hospital cover, Extras cover, and Packaged hospital and extras cover). The rating process for each of these product types employs a separate star ratings methodology consistent with the pricing and features model of the CANSTAR star ratings: TOTAL STAR RATINGS SCORE (T) = W 1 x PRICING SCORE (P) + W 2 x FEATURES SCORE (F) Below is a brief overview of the profiles to be rated so that consumers can use the star ratings results to find the most suitable products. The specific areas of need for both the young and mature profiles for both hospital and extras cover are listed under the inclusions heading of the star ratings methodology section of this document. All profiles are assumed to represent the average person from that demographic rather than either ends of the risk aversion spectrum. YOUNG SINGLES: MALE/FEMALE This profile caters to young to middle-aged singles (both male and female), no dependents and no immediate plans for children. While the average young singles do not consider themselves to be invincible, they are mostly concerned about having a safety net for hospital cover if they ever need it. Dental, optical, chiropractic and physiotherapy cover are also important areas of extras cover. YOUNG COUPLES NON OBSTETRICS This profile covers young to middle-aged couples who don t plan to have children or at least are postponing a family. They are looking for allround cover from their health fund but don t need to pay for obstetrics and IVF. A good hospital plan with extras like physiotherapy, dental, optical and chiropractic should provide all-round cover for this couple. COUPLES/FAMILIES WITH OBSTETRICS This profile covers young to middle-aged couples with a young child or children, as well as couples planning a family. This profile can be seen as growing families but like young singles, they are not yet concerned about cover for hip replacements and multi-focal lenses but are interested in cover for obstetrics and IVF, dental, optical, physiotherapy and chiropractic. Couples planning for children in the short-term should be taking out appropriate family cover now. YOUNG FAMILIES NON OBSTETRICS This profile covers young to middle-aged couples with a young child or children, and who will not be extending the family. They are confident that they will not be needing obstetrics or IVF cover. These young families still have a distinct need for a range of hospital and extras cover for both the parents and the growing children. 1

10 YOUNG SINGLE PARENTS This profile covers mostly young to middle-aged singles with a young child or children. The young parent is starting to think about cover they might need for their growing kids such as orthodontics but they are also thinking about other areas of cover they might have ignored when they were younger such as cardiothoracic surgery. Dental, optical, physiotherapy and chiropractic cover are also important areas of extras cover. ESTABLISHED SINGLE PARENTS This profile covers mostly middle-aged to mature singles with an older but still dependent child or children. These families have stopped growing so no longer need cover for obstetrics and IVF. The parent is starting to think about cover they might need for their growing kids such as orthodontics but they are also thinking about other areas of cover they might have ignored when they were younger such as cardio-thoracic surgery. Dental, optical, physiotherapy and chiropractic cover are also important areas of extras cover. ESTABLISHED FAMILIES This profile covers mostly middle-aged to mature couples with an older but still dependent child or children. These families have stopped growing so no longer need cover for obstetrics and IVF. The parents are starting to think about cover they might need for growing kids such as orthodontics but are also thinking about other areas of cover they might have ignored when they were younger such as cardio-thoracic surgery. Dental, physiotherapy, optical and chiropractic cover are also important areas of extras cover. ESTABLISHED SINGLES: MALE/FEMALE This profile covers mostly middle-aged to mature singles (both male and female) with no dependents and no immediate plans for children. This profile has started to think about other areas of cover they might have ignored when they were younger such as cardio-thoracic surgery. Dental, optical, physiotherapy and chiropractic cover are also important areas of extras cover.. ESTABLISHED COUPLES This profile covers mostly middle-aged to mature couples who don t plan to have children or at least are postponing a family. The couple have started to think about cover they might have ignored when they were younger such as cardio-thoracic surgery. Dental, optical, physiotherapy and chiropractic cover are also important areas of extras cover. MATURE COUPLES This profile caters to mature couples that no longer have or never had dependent children. This profile is more concerned with areas of cover such as cardio-thoracic surgery, hip replacements or multi-focal lenses. Due to the natural processes of aging their health insurance requirements differ from that of young singles. Dental, optical, chiropractic and physiotherapy are also important areas of extras cover. MATURE SINGLES This profile caters to mature singles (both male and female) that no longer have or never had dependent children. We did not wish to draw a finite line as far as the age where maturity begins but this profile is now more concerned with areas of cover such as cardio-thoracic surgery, hip replacements or multi-focal lenses. Due to the natural processes of aging, their health insurance requirements differ from that of young singles. Dental, optical, chiropractic and physiotherapy are also important areas of extras cover. TAX PROFILE This profile caters to singles looking for health insurance primarily to avoid tax implications associated with the Medicare Levy Surcharge (MLS) and the lifetime loading. These individuals are not as concerned with the benefits of health insurance compared to those in the other profiles, however would prefer a low-cost hospital plan. 2

11 State/territory awards Each fund s top performing policy per state/territory across all star ratings profiles are then aggregated to come up with the state/territory awards for all three product categories: Hospital, Extras, and Packages. The state/territory awards are awarded in the following states/territories: Queensland, New South Wales/ACT, Victoria, Tasmania, South Australia, Western Australia and Northern Territory. Each profile is given a weighting towards the state awards. Young singles male/female 3.75% each Young couples non-obstetrics 7.5% Couples/families with obstetrics 12.5% Young families non obstetrics 7.5% Young single parents 5% Established families 10% For example: Established single parents 5% Hospital Cover Extras Cover Package Cover Established singles male/female 5% each Established couples 10% Mature singles 12.5% Mature couples 12.5% 3

12 National awards Each fund s state/territory performance across the three product categories is weighted to supply a state/territory score. Below outlines the weightings for each product category: Hospital cover Extras cover State/territory score Packaged cover The state/territory scores are weighted based on population data sourced from the Australian Bureau of Statistics. The national award is then awarded to the top three performing funds across Australia. Queensland New South Wales & ACT Victoria Tasmania South Australia Western Australia Northern Territory 4

13 Hospital cover star ratings Hospital cover products will be rated across seven states/territories and 14 profiles so that consumers from any demographic will be able to identify a shortlist of five-star products that are best suited to their individual needs. Eligibility for each of the 98 state/territory-profile combinations will depend on product availability for the state/territory and whether the insurance cover is for singles, single parents or couples and families. Products nominated for families are also eligible to be compared in the single parent profile in accordance with the sales practices of the private health insurance industry. The methodology can be summarised as follows: Pricing score Premium Excess & co-payments Policy information 80% Feature score Fund information 20% Each profile combination is subject to different weightings depending on preference to price or features. Based on our profile descriptions, the weightings for each of the profiles are as follows: Price Feature Young Singles Young Single Parent 65% Young Families - Non Obstetrics 65% Couples/Families - With Obstetrics 60% Young Couples - Non Obstetrics Mature Singles 60% Mature Couples 60% Established Singles Established Single Parent Established Families Established Couples Tax 90% 10% 0% 20% 60% 80% 100% 5

14 Eligibility requirements For a Hospital policy to be considered in CANSTAR s ratings it needs to meet the following criteria: Not be restricted to certain groups or a corporate policy Not be a public hospital or public shared policy Exempt the policy holder from the Medicare Levy Surcharge Available for new policy holders Be approved by the Private Health Insurance Ombudsman (PHIO). There are seven profiles that have a minimum level of comprehensive cover for a policy to be considered: Profiles Cardiac Joint replacement (hip and knee) Obstetric Established Mature Couples/families with obstetrics 6

15 Price score The weights applied to the premium and excess and co-payments components are profile specific. The weights for each profile can be summarised below: Young Singles Young Single Parent Young Families - Non Obstetrics Couples/Families - With Obstetrics Young Couples - Non Obstetrics Mature Singles Mature Couples Established Singles Established Single Parent Established Families Established Couples Tax Premium 75% 65% 75% 65% 65% 75% 75% 90% Excess & Co-payments 10% Premium The base premium for Hospital cover insurance products will be used as the main point of cost comparison. Peer products will be compared and the product with the lowest cost will be awarded the highest base premium score. All other peer products will be awarded a relative score based on their cost in comparison to the market average premium. Excess and co-payments 0% 20% 60% 80% 100% This is a scenario based on assessments to assess the amount of excess or co-payment required for each hospitalisation. There are seven scenarios used in the assessment: Scenario No. of admissions/year Length of stay/admission Weight nights nights nights nights 10% nights nights 5% nights 5% 7

16 Feature score The feature score is made up of two assessments based on product-specific features and fund-specific features. These are weighted respectively at 80% and 20%. Feature score Policy information 80% Fund information 20% Fund information Fund information is made up of the following sections provided by the private health fund. More information on each of the sections is discussed in the following pages. Below summarises the weights of each of the sections: General information Agreement network 45% Fund information 20% Other service benefits 10% Accessibility 20% Medical Gap Performance 10% 8

17 General information This section includes general information relating to the health fund. This includes but is not limited to online application, direct debit payments, payment frequencies and maximum age of dependants. Agreement network The breakdown of agreement network and its relative weightings are outlined as follows: Agreement network Private hospitals 60% Day hospitals Agreement private hospitals The number of agreement hospitals available in a state represents the level of choice a patient has in healthcare providers that will not charge a gap fee. For each state-profile combination, the number of no-gap hospitals for the relevant state will be compared against the number for other health funds to determine the no-gap hospital contribution to the star ratings score. The health fund that has the most total no-gap hospitals in that state will earn the maximum score towards all its eligible hospital cover products while all other health funds will be awarded a score based on their number of no-gap hospitals relative to the institution with the most no-gap arrangements. Agreement day hospitals The number of agreement day hospitals available in a state represents the level of choice a patient has in healthcare providers that will not charge a gap fee. For each stateprofile combination, the number of no-gap day-hospitals for the relevant state will be compared against the number for other health funds to determine the no-gap dayhospital contribution to the star ratings score. The health fund that has the most no-gap day-hospitals in that state will earn the maximum score towards all its eligible hospital cover products while all other health funds will be awarded a score based on their number of no-gap day-hospitals relative to the institution with the most no-gap arrangements. 9

18 Other service benefits This section looks at a number of additional services provided by the provider at a fund level. These additional services include: Health/nurses hotline availability and hours of operation Home doctor services/after-hours doctor service availability and hours of operation Wellness and health guides (electronic or hard copy) Pre/post-hospital services (e.g. obstetrics and cardiac) Accessibility Accessibility is measured across the following: Branch access: The number of branches per state/territory Online access: Functionality through the health fund s online member services Mobile access: Functionality through the health fund s mobile application Phone access: Functionality through the health fund s phone service Each access area is weighted as follows: Medical Gap Performance Accessibility Branch access Internet access Mobile access 10% Phone access 20% Medical gap refers to the difference between doctors fees for in-hospital services and the benefit paid by health funds. Some health funds have agreements with doctors for members to not to incur any out-of-pocket expenses. Whilst doctors can decide whether a particular patient is covered by a fund s gap scheme, a good indicator of the quality of a fund s gap cover arrangements is the percentage of medical services that incurred no gap payments. This data is sourced from the Private Health Insurance Ombudsman s (PHIO) State of the Health Funds Report. 10

19 Policy information Hospital cover policies vary in the types of procedures that are insured. The table below lists some of the more common hospital inclusions and their relative importance to the various profiles. Category Young Established Mature These additional inclusions are considered in consumer profiles where female-only inclusions are more likely to be required. { Assisted reproductive 5% 3% - Obstetrics 10% 1 5% - Hysterectomy 2% 1% 1% Cardiac 10% Cataract eye lens 1% 5% 10% Orthopaedic 20% 20% 18% Joint replacement 12% 83% Reconstructions 88% 75% 17% Palliative 1% 2% 2% Plastic non-cosmetic 5% 5% 2% Psychiatric 10% 13% Rehabilitation 10% 8% 10% Renal dialysis 1% 5% 7% Sterilisation 1% 2% 1% Ear, nose and throat 10% 12% 1% Colonoscopy 4% 10% 9% Gastric banding 2% 2% 1% Wisdom teeth 5% 2% - Emergency accidental 2% 1% 1 Obstetrics cover is required for policies in the Couples/Families with Obstetrics profile, and so is not included in the feature score. 11

20 Extra cover star ratings Extras cover products will be rated across seven states/ territories and 13 profiles so that consumers from any demographic will be able to identify a shortlist of five-star products that are best suited to their individual needs. Eligibility for each of the 91 state-profile combinations will depend on product availability for the state and whether the insurance cover is for singles, single parents or couples and families. Products nominated for families are also eligible to be compared in the single parent profile in accordance with the sales practices of the private health insurance industry. The methodology can be summarised as follows: Pricing score Premium Out-of-pockets Feature score Policy information 85% Fund information All profiles are subject to the same weightings for price and features. This recognises that although the mix of services required may change over various life stages, extras cover is taken out less for the purpose of insurance but more to be used on a regular basis. Young Singles Young Single Parents Young Families - Non Obstetrics Couples/Families - With Obstetrics Young Couples - Non Obstetrics Mature Singles Mature Couples Established Singles Established Single Parent Established Families Established Couples Price Feature 0% 20% 60% 80% 100% 12

21 Eligibility requirements For an Extras policy to be considered in CANSTAR ratings it needs to meet the following criteria: Not be restricted to certain groups or a corporate policy Available for new policy holders Be approved by PHIO. There are no individual profile eligibility requirements. Pricing score The weights applied to the premium and out-of-pocket components are the same across all profiles. Young Singles Young Single Parents Young Families - Non Obstetrics Couples/Families - With Obstetrics Young Couples - Non Obstetrics Mature Singles Mature Couples Established Singles Established Single Parent Established Families Established Couples Premium Out of Pockets Premium 0% 20% 60% 80% 100% The base premium for extras cover insurance products will be used as the main point of cost comparison. Peer products will be compared and the product with the lowest cost will be awarded the highest base premium score. All other peer products will be awarded a scored based on their relative price against the average market price. Out-of-pockets The out-of-pockets component of the pricing score is a scenario-based calculation. The calculation uses 100 hypothetical new policy holders who have met all the waiting period requirements and their use of dental, optical, physiotherapy and chiropractic over a 12-month period. The policy holder usage is based on PHIAC data with the min/max usage based on the star ratings profiles. The cost for the services used is based on the national average cost. 13

22 Where a health fund has network providers, we have used its standard schedule costs for the proportion of policy holders who use a network provider. Where a health fund does not have network providers, the standard costing will be used in the calculations. All limits are incorporated into the calculations including item limits, sub limits, category limits and group limits. The total out-of-pockets is indexed for each of the 100 policy holders per policy. The policy with the lowest out-of-pocket scores will receive the full score. The 100 indexed scores are then averaged to provide a policy out-of-pocket score. The policy with the greatest average out-of-pocket score will receive a full score and all other policies scores will be indexed. Feature score The feature score is made up of two assessments based on product-specific features and fund-specific features. These are weighted at 85% and respectively. Fund information Feature score Policy information 85% Fund information Fund information is made up of the following sections provided by the private health fund. More information on each of the sections is available in the following pages. Below summarises the weights of each of the sections: General information Fund information Agreement network Accessibility 14

23 General information This section includes general information relating to the health fund. This includes but is not limited to online application, direct debit payments, payment frequencies and maximum age of dependants. Agreement network The Agreement network looks at the number of providers that a health fund has an agreement with. The fund with the greatest amount of agreement providers in a particular speciality will receive a full score and the remainder of funds will be indexed off the greatest amount. Dental Agreement network Optical Physiotherapy Chiropractic 10% 15

24 Accessibility Accessibility is measured across the following: Branch access: The number of branches per state/territory Claim access: The points where a policy holder is able to claim outside of branches including phone, post, online and HICAPS Internet access: Online functionality including claiming Mobile access: Functionality through mobile including claiming Phone access: Functionality through the health fund s phone service Each access area is weighted as follows: Branch access Claims access Accessibility Internet access 10% Mobile access 10% Phone access 10% 16

25 Policy Information Extras cover policies vary in the types of services that are insured. The table below lists some of the more common extras inclusions and their relative importance to the various profiles. Category Couple/ family with obstetrics Young singles (male and female) and couples Young families and single parents (nonobstetrics) Established singles (male and female) and couples Established families and singles parents Mature (singles and couples) Dental Inclusions 42% 42% 41% 43% 34% General dental 65% 63% 64% 66% 63% 74% Major dental 17% 20% 17% 17% 19% 18% Orthodontic 11% 12% 12% 10% 11% - Endodontic 7% 5% 7% 7% 7% 8% Major Inclusions 42% 43% 42% 39% Optical 43% 42% 42% 38% Chiropractic 21% 21% 22% 26% 28% Physiotherapy 36% 37% 36% 36% 32% Minor Inclusions 16% 17% 16% 20% 17% 26% Acupuncture 13% 12% 13% 10% 6% 4% Podiatry 19% 24% 19% 20% 18% 27% Psychology 13% 18% 12% 10% 11% 12% Glucose monitor 6% 5% 6% 5% 6% 7% Hearing aids % 6% 12% Ambulance 6% 5% 6% 5% 6% 8% NonPBS % 12% 7% Massage 19% 19% 19% 10% 6% 4% Naturopathy 6% 5% 6% 5% 6% 4% Speech therapy 6% - 6% 5% 6% 4% Occup. therapy % 6% 4% Wellness 12% 12% 13% 10% 11% 7% 17

26 Package cover star ratings Packaged hospital and extras cover products are rated across seven states/territories and 13 profiles so that consumers from any demographic will be able to identify a shortlist of five-star products that are best suited for their individual needs. Eligibility for each of the 91 state-profile combinations depends on product availability for the state and whether the insurance cover is for singles, single parents or couples and families. Products nominated for families are also eligible to be compared in the single parent profile in accordance with the sales practices of the private health insurance industry. The methodology can be summarised as follows: Premium Pricing score Excess & co-payments (Hospital) Out of pockets (Extras) Fund Information Feature score Hospital Inclusions Extras Inclusions Ambulance Cover

27 Each profile combination is subject to different weightings depending on preference to price or features. The weightings for each of the profiles are as follows: Young Singles Young Single Parents Young Families - Non Obstetrics Couples/Families - With Obstetrics Young Couples - Non Obstetrics Mature Singles Mature Couples Established Singles Established Single Parent Established Families Established Couples Tax Price 65% 65% 65% 60% 60% 60% 60% 60% 60% 85% Feature Pricing score 0% 10% 20% 60% 80% 90% 100% The weights applied to the premium and out-of-pocket components are profile specific. See below for weights: Premium Hospital Excess/Co-payment Extras Out of Pocket Young Singles Young Single Parents Young Families - Non Obstetrics Couples/Families - With Obstetrics Young Couples - Non Obstetrics Mature Singles Mature Couples Established Singles Established Single Parent Established Families Established Couples Tax 60% 65% 60% 60% 65% 55% 65% 60% 60% 65% 10% 20% 10% 20% 20% 10% 10% 10% 20% 20% 0% 20% 60% 80% 100% 19

28 Premium The base premium for extras cover insurance products will be used as the main point of cost comparison. Peer products will be compared and the product with the lowest cost will be awarded the highest base premium score. All other peer products will be awarded a relative score based on how much more expensive they are (i.e. if a product costs twice as much as the cheapest, it will earn half the base premium score of the cheapest product). Out-of-pocket payments The out-of-pockets component of the pricing score is a scenario-based calculation for both hospital and extras cover. For hospital cover, we use six scenarios to calculate the amount of excess or co-payment required for each hospitalisation. See page 10 for more information. For extras cover, the calculation uses 100 hypothetical new policy holders who have met all the waiting period requirements and their use of dental, optical, physiotherapy and chiropractic over a 12-month period. See page 14 for more information. 20

29 Feature score The feature score is made up of three assessments based on product-specific features of hospital and extras cover and fund-specific features. The weights applied to each of the three assessments are profile specific. The chart below outlines the weights for each of the profiles: Fund Information Hospital Cover Extras Cover Ambulance Tax Couples/Families - With Obstetrics Young Singles Young Single Parents Young Families - Non Obstetrics Young Couples - Non Obstetrics Mature Singles Mature Couples Established Singles Established Single Parent Established Families Established Couples 45% 45% 45% 45% 45% 45% 45% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 0% 20% 60% 80% 100% Ambulance cover is included separately as some package products include it in their hospital cover and others in the extras component. 21

30 Fund information Fund information is made up of the following sections provided by the private health fund. More information on each of the sections can be found in previous pages of this methodology, which is referred to in the methodology tree below. Below also outlines the weights of each of the sections: Refer to page 9 For general information General information Refer to page 9 For hospital agreement networks Agreement network Hospital agreement Extras agreement Fund information Medical Gap Performance 20% Claims access Refer to page 15 For extras agreement networks Branch access Accessibility 26% Online access 10% Other service benefits 5% Mobile access 10% Refer to page 16 For accessibility Refer to page 10 For other service benefits Phone access 22

31 Policy information Package cover policies vary in the different level of cover for each type of insurance (hospital and extras). To see an outline on how each of the covers are measured, refer to page 12 for hospital inclusions and page 20 for extras inclusions. Fund eligibility To be included in a states/territory star ratings a health fund (fund) is required to have a minimum market share of 0.4% in that particular state/territory or have a minimum of 5% of its total policies in that particular state/territory. Should a fund not meet either criterion, it will be entered into its home state only. To be eligible for a state/territory award, the fund will be required to have a minimum of 0.4% market share. Should a fund not be eligible for a state/territory award, that state/territory will carry a zero score towards the national award. Does CANSTAR rate all products available in the market? We endeavour to include the majority of product providers in the market and to compare the product features most relevant to consumers in our ratings. However, this process is not always possible and it may be that not every product in the market is included in the rating nor every feature compared that is relevant to you. How often are all the products reviewed for ratings purposes? All ratings are recalculated annually based on the latest features offered by each provider. CANSTAR also monitors changes on an ongoing basis. The results are published in a variety of mediums (newspapers, magazine, television, websites, etc.). 23

32 How are stars awarded? The products are ranked with each category based on the total score received. The stars are then awarded based on the distribution of the scores with the objective to award the top 5-10% of products with the CANSTAR five-star rating. The results are reflected in a consumer-friendly CANSTAR star rating concept, with five stars denoting outstanding value. Does CANSTAR rate other product areas? CANSTAR researches, compares and rates the banking and insurance products listed below. These star ratings use similar methodologies to guarantee quality, consistency and transparency. Results are freely available to consumers who use the star ratings as a guide to product excellence. The use of similar star ratings logos also builds consumer recognition of quality products across all categories. Please access the CANSTAR website at if you would like to view the latest star ratings reports of interest. Account based pensions Business life insurance Deposit accounts Health insurance Landlord insurance Margin lending Package banking Reward programs Travel insurance Agribusiness Car insurance Direct life insurance Home & contents Life insurance Online banking Personal loans Superannuation Travel money cards Business banking Credit cards First home buyer Home loans Managed investments Online share trading Pet insurance Term deposits Youth banking 24

33 COMPLIANCE DISCLOSURE and LIABILITY DISCLAIMER To the extent that the information in this report constitutes general advice, this advice has been prepared by Canstar Research Pty Ltd A.C.N AFSL and ACL ( Canstar ). The information has been prepared without taking into account your individual investment objectives, financial circumstances or needs. Before you decide whether or not to acquire a particular financial product you should assess whether it is appropriate for you in the light of your own personal circumstances, having regard to your own objectives, financial situation and needs. You may wish to obtain financial advice from a suitably qualified adviser before making any decision to acquire a financial product. Canstar provides information about credit products. It is not a credit provider and in giving you information it is not making any suggestion or recommendation to you about a particular credit product. Please refer to Canstar s FSG for more information. The information in this report must not be copied or otherwise reproduced, repackaged, further transmitted, transferred, disseminated, redistributed or resold, or stored for subsequent use for any purpose, in whole or in part, in any form or manner or by means whatsoever, by any person without CANSTAR s prior written consent. All information obtained by Canstar from external sources is believed to be accurate and reliable. Under no circumstances shall Canstar have any liability to any person or entity due to error (negligence or otherwise) or other circumstances or contingency within or outside the control of Canstar or any of its directors, officers, employees or agents in connection with the procurement, collection, compilation, analysis, interpretation, communication, publication, or delivery of any such information. Copyright 2014 CANSTAR Research Pty Ltd A.C.N The word CANSTAR", the gold star in a circle logo (with or without surmounting stars), are trademarks or registered trademarks of CANSTAR Pty Ltd. Reference to third party products, services or other information by trade name, trademark or otherwise does not constitute or imply endorsement, sponsorship or recommendation of CANSTAR by the respective trademark owner. 25

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