PHI companies accused of "discrimination" in pregnancy premiums

PHI companies accused of "discrimination" in pregnancy premiums | Insurance Business Australia

PHI companies accused of "discrimination" in pregnancy premiums

The National Association of Specialist Obstetricians and Gynaecologists (NASOG) has claimed that private health insurance (PHI) companies charge a higher level of cover if policyholders want to include pregnancy and birth-related services in their policy, which is often accompanied by a 12-month waiting period before they become eligible to use it.

In a report by ABC, Melbourne resident Samantha Burazin shared that she suffered from cholestasis – a liver disease that can spontaneously develop during pregnancy – when she had her first child. As the disease could lead to life-threatening complications for her baby and her, she asked the public health system to allow her to take extra blood tests for extra monitoring, to no avail. Therefore, during her next pregnancy, Burazin added a pregnancy cover to her PHI, but it came at quite the extra cost.

“We had to up the private health to the highest level; the price difference was an extra $50 a month, and then it increased again by $20. So, we're now paying an extra $70 a month,” Burazin said, as reported by ABC. “The fact you have to have it as well for 12 months before the pregnancy and birth cover kicks in is annoying. And you put the obstetric charge on top of that, which, for me, is around $3,000, so it costs quite a bit extra than going public.”

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NASOG claimed charging a higher level of cover is a form of discrimination when men's reproductive issues are covered at a lower level.

“Conditions specifically related to male reproductive health, such as testicular torsion or cancer and prostate issues, are covered in cheaper entry-level insurance policies, but pregnancy is only covered in the top level of cover,” said NASOG president Dr. Gino Pecoraro, as reported by ABC.

A year ago, NASOG wrote to the Human Rights Commission to address the issue, but has not yet received a response. It also launched a petition and wrote to “almost every” federal MP about the issue, but has not yet seen any progress.

“The federal government allows the health funds to get away with saying only women who have gold insurance policies will be covered for pregnancy, and that's just not fair,” Dr. Pecoraro said.

“It goes totally against the principles of community ratings for insurance,” he continued. “The government lets the health insurance industry, which is making record billion-dollar profits, get away with this.”

Private Healthcare Australia (PHA) chief executive Dr. Rachel David commented that the gold, silver, and bronze-tier system must be changed.

“It's made top hospital coverage very expensive,” Dr. David said, as reported by ABC. “Freeing the system up so that health funds can make their own choices about what treatments are in each tier is going to be important. If private health can guarantee that consumers are better informed about what they're covered for, then the strict tiering system becomes less important.”