Are you covered for elective surgery?

Patients booked in for elective surgery were given a dose of disappointment recently as the federal government announced restrictions on most elective surgery from midnight 25 March 2020.

The restrictions were imposed to free up valuable medical resources in anticipation of an overwhelming number of COVID-19 patients.

But it also meant that many Australians were left wondering if their current health insurance policies were worth continuing, or if they were getting value for money on their policies.

Fortunately, thanks to our physical distancing and self-isolation efforts, the restrictions are starting to be lifted in what Prime Minister Scott Morrison has called a “gradual restart” of elective surgery. At the time of writing, some elective surgeries will be available from 27 April 2020.

This means that Australians can still realise the value of their health cover. And if you’re still looking to make savings on your health insurance, now is a good time to switch as you don’t need to re-serve waiting periods for services you’re already covered for unless you increase the cover for those services.

So, what elective surgeries are available during the COVID-19 pandemic and what isn’t currently allowed? We’ll update the information below as the restrictions change.

What are the categories of elective surgery?
Doctors use a set of guidelines to assign elective surgery procedures to an urgency category.

In general, a category 1 procedure is desirable within 30 days, a category 2 procedure within 90 days and a category 3 procedure within 365 days.

While the urgency depends on the doctor’s clinical assessment of the patient and their situation, there’s a default category for different elective surgery procedures. For example, a breast lump excision is category 1, while a hip or knee replacement is category 3.

What about urgent elective surgery?
Category 1 procedures and the more urgent category 2 procedures were not caught by the ban. Urgent elective surgery such as heart surgery, limb amputations and more urgent colonoscopy procedures should not have experienced any interruption.

When will restrictions be lifted?
Category 2 and some important category 3 procedures were scheduled to recommence in public and private hospitals from 27 April 2020. See the table below

The prime minister estimated that this first phase in lifting elective surgery restrictions will see the reopening of 25 per cent of closed elective surgery operating lists.

The arrangements will be reviewed again on 11 May 2020, with the government looking at whether the restrictions can be lifted further.

Getting the best value from your health fund for elective surgeries
There may be some ongoing disruptions due to a backlog of elective surgeries and the fact some surgeries are still subject to the COVID-19 restrictions.

However, we’re clearly heading in the right direction and the easing of restrictions means not only better health outcomes for many – it also means you can get the better value from your private health fund membership.

If you’re after the best value from your fund, it’s also worth spending some of your time in home isolation to review your current cover and compare health insurance funds.

This is one way to potentially save big dollars now and at the other side of the crisis. When reviewing your health insurance, remember that you don’t need to observe waiting periods for services you’re already covered for unless you increase the level of cover for those services.

Are you getting the most out of your health insurance?

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Why review your health cover?
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Written by YourLifeChoices Writers

YourLifeChoices' team of writers specialise in content that helps Australian over-50s make better decisions about wealth, health, travel and life. It's all in the name. For 22 years, we've been helping older Australians live their best lives.

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