Should Health Insurance include cover for contraception medication and devices?

Health & Body
1

This hit me quite hard and until now it was unknown to me so I thought it prudent to share.

I am a dad of a late teenager daughter, who was prescribed the Pill. Our health fund, ( we of 30yrs membership) , refused to recognise the private script that should otherwise be eligible for cover. This what they say…

‘Contraception prescribed for birth control is done so in the absence of illness or disease and in turn doesn’t meet the definition of Pharmaceutical according to (our) Fund Rules’ and…’

Most doctors know that these rules can be circumvented by the letter outlining it has been prescribed for a myriad of medical conditions.’

In short your doctor may need to deceive the Fund to defeat its own (Funds) Rules to refund on the cost of the Pill.

I challenged these terms and their apparent attitude about this with vigor suggesting pregnancy is a big medical condition, (ask a mum), plus any number of genetic or other unwanted medical conditions could be avoided with contraceptives, a contraceptive therefore can avoid the precondition of pregnancy and also avoid related medical harm.
The funds do payout on any number of pills and gadgets to avoid any number of preconditions so why not so on contraceptives? Eg., type 1 diabetic is eligible to be refunded on a $10000 insulin pump to avoid medical decline or death for an existing condition. Avoiding an unwanted pregnancy and/or offspring is equally a medical issue, not to mention is the personal choice of a female, not a Fund.

I do not want to hash up the age old dispute of religious/church historical intervention, other than to declare, if you are the person potentially and personally on the receiving end of the medical condition - pregnancy, then you are intimately involved in the decision making.
I do not know, but I suspect denying the funding of contraceptives, reeks of historical religious/Victorian imposed moral influence, to me anyway, and if so, is obsolete and has no place in a medical insurance industry. Whatever the reason for it being incongruous with the Funds policy, consumer right to decide is paramount in a democracy and not the insurance industry that finds any reason to mitigate it costs.

I’m not a prolific social media tart but the denial to refund contraceptives on prescription for no other reason other than pregnancy/birth is deemed non medical, is a nonsense and wrong on all fronts.

I’d like to suggest you too check with your fund and if as broadly denied as my (union originating) fund declares, take them to task for all free thinking woman and supporting blokes. As a bloke, I am appalled.

Should I be outing the Fund by name?

2

I wouldn’t agree with the last statement as male contraceptives aren’t covered either. If they were and female ones weren’t, then there would be an issue.

Why, should the same principles apply to all contraceptives, over the counter medicines (e.g. aspirin, panadol), soaps and sanitisers or other healing items (bandaids, lotions etc)…that they are somewhat linked medically and should be covered by health funds?

I wonder if the ruling by the fund is because the pill when taken solely as a contraception is taken voluntarily and is an individuals choice, rather than something to help heal or manage an illness. A bit like having botox and expecting a health fund to provide part payment as it helps with one’s general wellbeing.

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3

“It helps with one’s general well being.“
Isn’t that why Health Funds exist and also offer to cover dental, and optical and physio, and fitness aids and … Even cash towards Gym memberships?

‘I feel better now!’ That great slogan says what they are offering. It must be about how we feel!:wink:

Getting a modelling job because you have a great Botox job, seems a world away from what you get when you get pregnant or all the other reasons a woman might choose or need to use contraceptives.

P.S.
Not to create a debate about something I’m not the wisest to comment on.
In the USA it would seem to be settled?

4

Botox is very much about

or

While Botox can be used by choice to make one feel better about one’s appearance, it also has some medical uses as well… used to treat conditions such as neck spasms (cervical dystonia), excessive sweating (hyperhidrosis), an overactive bladder and lazy eye. Like the pill, there are medical grounds for its use in addition to individual non-medical choices made for its use.

The other examples provided are also relevant as well…

Even eating a healthy diet is also about ‘It helps with one’s general well being’ and ‘I feel better now!’. If one starts adding individual choices on the basis of this criteria, where is the line drawn.

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5

Thanks Phb, I must have worded it poorly but was not , wanting to include male contraceptives (do they exist) … but refer to blokes who support womens right to determine…/ Also most medication is voluntary taken with the exceptions of Govt forced Imumisation for children or if your sanctioned (mentally compromised) by the Govt.
My point is that pregnancy creates significant medical consequence and choice to engage that medical condition and support ( including insurance) should follow like a myriad of other complex conditions. Botox I suggest might have a narrow support for facial reconstruction/disability - to resolve medical matters, perhaps not so much because your mirror is having a bad day…
Cheers

6

Preventing a potential medical consequence which may be claimable under the rules of a fund could be considered not overly relevant to the rules of whether an item is included in a coverage.

Lets use another example. A bicycle/motorbike helmet provides protection and a head injury as a result of head knock could occur if a helmet isn’t worn. If including the pill on the basis that it should be covered by health insurance, so should a motorbike helmet. Most things commonly used on a daily basis are there to prevent an injury, illness or other things which may ultimately result in a medical condition which otherwise be claimable under a health insurance fund. If one starts to broaden the claims to anything which may prevent a future claim, the floodgates would open and premiums would head skywards.

7

Two differing points of view?

And

Isn’t the line drawn were Australia’s women decide it needs to be drawn in respect of their needs?

I’ll add that one male treatment, reversible if so arranged has a Medicare schedule item and may be covered by your health fund. It’s also an ‘individual choice’.

P.S.
I’ve edited the topic title to more fully reflect the discussion. From ‘ Health Insurance affects the use of contraception’ to asking a question. Note it’s also an open question that can consider treatments irrespective of gender.

8

Some contraceptive pills are covered by the pharmaceutical benefits scheme and already subsidised to reduce costs to the consumer.

That could be financially crippling to the insurance industry. I am sure than many would like their expensive makeups covered by private health insurance as they have SPF ratings. While it may seem like a good idea, it is likely to end somewhere which won’t suit policy holders paying for the ‘additional benefits’.

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9

The Pill as an example is totally free on the NHS in the UK, it’s also one of the compulsory items included in the USA - Obama era Affordable Health Act.

They’ve both avoided needing to include free motorbike helmets in doing so.

Surely Australia can also include women’s contraceptive options without restriction?

That remains to be seen. Is there a survey that supports that outcome? They seem to be happy to pay for male Vasectomies which cost typically $2000. More if there is a decision to reverse one day in the future, also funded.

10

The UK has adopted an approach where contraceptives (irrespective is for males or females) are free for most citizens:

This approach is very different to that in Australia and most other countries.

Such policy may be more about population control measure, rather than in Australia where there is bipartisan policy for population growth ( have one for mum, one for dad and one for the country).

If Australia mandates private health insurance covers all contraceptives like the UK, then this would potentially require parliamentary approval. If this does ever occur, hopefully a public interest and financial impact test is also carried out before decisions are made so that the impacts on policies holders is known as part of the decision making process.

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11

I’ll take that as tongue in cheek, because the rationising of all things preventive to women, makeup.toothpaste, Botox automatically become viable kind of overstates the point a tad in comparing it to contraceptive support for women. The health consequences specifically and broadly to society is massive. It’s narrow minded to the extreme - possibly should be free always… in this humble Male’s opinion.
For a health insurance co. to hide their policy wording , not easily seen kind of speaks to its hidden agenda. Im allowed to control preg/birth liability as a male for $thousands yet the female Pill is denied. Having my bits snipped for a 5minue event hardly equates to the risk and consequence of 9mnths gestation with a dramatic risky finish. Now that is a medical event that should have self determined optional support.
I’ve said enough. Respect!

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12

Some funds will pay for Viagra, Cialis or Caverjects! To a limit. It does seem like a double standard if any fund paid benefits for one and not the other.

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13

These are used to treat a medical condition…erectile disfunction. Taking the pill solely as a contraceptive isn’t treating a medical condition, it prevents a potential future claim against the insurance policy. The issue at hand is whether a measure or treatment to prevent a potential future claim against a health insurance policy should be covered by the policy. As mentioned above, there are numerous other examples that fall outside that which can be claimed.

It appears that private health insurance doesn’t pay for the vasectomy, Medicare does under it’s standard schedules. Where one has hospital cover, private health insurance provides hospital cover should the procedure be done in a hospital.

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14

What then is the medical problem with erectile dysfunction other than lack of sex for an older person well past parenting age? I’ll not get into that here other than to reinforce my opinion that this is one of many double standards perpetrated and allowed for male vs female where justifications have reigned supreme since they began, and not limited to this topic. Even the GST discriminated until 1 Jan 2019.

15

I don’t know, but is it defined as a medical condition. One could also say the same things about other body parts which are no longer used for child bearing or needed in later years but subject to cancer or other medical conditions. Maybe these shouldn’t be covered either (I can hear the roar now when a health insurer starts removing treatment because they are no longer seen as been needed).

16

The former is for [fill in your reason], the latter life ending, and thus the two are not comparable. We can agree to disagree on the merits of refusal for contraceptives, acknowledging the GPs can play games writing scripts in various ways, so it is in fact as much a game as anything between the GP and extra’s holder. I’ll step back from detailing the explicit medical arguments used as medical conditions…

17

The other aspect is some health insurers don’t cover medicines already on the PBS…which some contraceptives are. The HCF website indicates why this is the case:

Can I claim for medications that are on the PBS?

No. Government regulations prevent private health insurers from paying a benefit towards the cost of drugs that you can receive through the PBS. Because we can’t determine whether individual members are eligible for the PBS subsidy, no drugs that are listed on the PBS qualify for an HCF benefit.

In addition to the above, this could be another reason why health insurers don’t cover such medicines.

18

And

As the link provided indicated. Medibank did say.
‘35% of the time there are no medical out-of-pocket expenses for this in-hospital procedure.’

Otherwise men are covered up to the level private by your policy. It is certainly not excluded from private health insurance, even though some would suggest it is purely a life style choice, not generally required for health reasons.

On Topic:
The original post to this topic put the proposition that health insurance should support the cost of supply of the contraceptive pill. As evident in the UK and USA both go further than the Australian health system in providing support for women’s options.

Isn’t the most important discussion required here about why the Australian Health system should do more, and not about why it does not? It sets double standards with the overall costs based on gender if we compare the most popular options available to men and women.

Rules can be changed for specific medications, if the Federal Health Minister so decides. The cost to the health system of change, if overall long term there is one, is a poor argument for not doing so, IMHO.

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19

From experience it is not the drug, but whether it is a PBS script. A private script can be paid by extras, a PBS script cannot. I had an antibiotic that was not ‘approved’ for my condition but was PBS supported for a short list of maladies. It was issued as a private script and my extras paid the difference above the PBS max out of pocket for that year.

For clarity, if the PBS max was $38 and the private script was $68 my extras paid $30. There was an annual limit of $200 for all non-PBS scripts at the time.

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