Health funds should justify rate increases says ADA

In a submission to the Australian Competition and Consumer Commission on private health insurance, the Australian Dental Association calls for health funds to justify the decline in rebated benefits compared to premium increases.

ADA also calls for health funds to increase dental rebates for all dental services on an annual basis and for this review to be in line with CPI and/or premium adjustments – whichever is higher.

Furthermore, there should be no annual or lifetime limits on dental rebates in health fund policies, ADA argues.

Reports of health fund staff interfering in the appropriate referral of patients with complex care needs to specialists were also highlighted, along with the potential for serious health consequences for health fund members.

For major breaches of legislation, private health insurers should face financial penalties or – for repeated infringements – loss of licence to operate as a health fund.

In the 12-year period depicted in the Table below a surplus of nearly $7.4 billion has been achieved in ancillary health insurance schemes. In fact, over the last three years alone Private Health Insurers have realised surpluses in excess of $3 billion. ADA suggests therefore that health funds are using the surplus from ancillary cover to subsidise their other insurance products, as the declared overall profit of health funds does not reflect these massive profits from ancillary benefit schemes. Dental consumers deserve a better deal from health funds.