Who needs joint replacement surgery?
According to the Australian Institute of Health and Welfare (AIHW), the most common age group for musculoskeletal surgery is 55 to 64. So if you're young and fit, you may think you don't need cover for joint replacement. Truth is though, anyone can be affected by painful joints, especially if you play a lot of sport or live an active lifestyle. In these cases, having joint replacement health insurance in place can help ensure you’re prepared for procedures such as knee or hip replacement surgery, if needed.
What's the difference between total and partial joint replacement surgery?
A total joint replacement involves a damaged joint being surgically removed and replaced with a new prosthetic (artificial) joint which has been designed to move just like regular joints.
A partial joint replacement refers to a surgery which involves using prosthetics to fix only the damaged parts of a joint. Whether you need joint replacement health insurance for surgery or joint health insurance for long-term support, HIF offers hospital cover options designed to support members at different stages of joint care.
What's the difference a joint replacement and a joint reconstruction?
A joint replacement typically involves removing the damaged joint and replacing it with an artificial joint with the aim of providing long term pain relief and improved mobility. In contrast, a joint reconstruction aims to repair damaged joints in order to offer temporary or permanent pain relief for joint disorders - for example, an Anterior Cruciate Ligament (ACL) injury such as a tear or sprain.
Understanding the difference between joint reconstruction vs replacement is important, as the most appropriate treatment depends on the type, location and severity of the joint disorder, as well as individual clinical circumstances. Common reconstructive procedures include arthroscopy, arthrodesis, osteotomy, resurfacing and small joint surgery.
Do hospital waiting periods apply?
Whether we’re answering your call, or helping you switch from another health fund, we don’t like to keep people waiting. But unfortunately waiting periods (the time you have to wait before you can claim for treatment) are a necessity. We wouldn't be able to offer our affordable premiums and generous benefits without them.
Waiting periods exist so we can protect our members against people who simply join us, claim large amounts and then leave. But we always try to keep waiting periods to an absolute minimum. That’s why, if you join us from another health fund, we’ll take your previous membership into account, so you won’t have to re-serve waiting periods on an equivalent level or lower level of health cover.
For many members, this can make a meaningful difference when planning elective procedures, particularly given the long waiting time for knee replacement in Australia through the public health system.
Please note that continuity in cover will not be offered if the financial date paid to with the previous health insurer is greater than 2 months from the commencement date with HIF.
For HIF Hospital cover, the waiting periods are as follows:
- 2 months: General hospitalisation
- 2 months: Psychiatric care, rehabilitation & palliative care (regardless of whether it's pre-existing or not)
- 12 months: All pregnancy and birth related services
- 12 months: Pre-existing conditions or ailments.
Will a pre-existing condition affect my cover?
The Pre-Existing Condition waiting period applies to new members and existing members who upgrade their policy to access higher-level benefits, including joint replacement health insurance. The test applied under the law relies on the presence of signs or symptoms of the illness, ailment or condition, not on a diagnosis (i.e. it’s not necessary for the member or their doctor to know what their condition is or for it to be diagnosed).
In forming an opinion about whether or not an illness is a pre-existing condition, an HIF-appointed medical practitioner will take into account information provided by the member’s treating doctor.
A pre-existing condition is defined as: ‘Any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of six months ending on the day on which the person became insured under the policy.’
Joint replacement FAQs
Medicare covers joint replacement surgery in public hospitals, however waiting times can be long. Private health insurance for joint replacement allows access to private hospitals and specialists, often reducing waiting times and offering greater choice.
Waiting times for knee replacement surgery in Australia can vary depending on whether treatment is received through the public or private system. Public hospital waiting times may extend for many months, while private health insurance can allow surgery to be scheduled sooner.
Joint replacement surgery is included under eligible Hospital Cover options. Coverage depends on the level of hospital cover held and applicable waiting periods.
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