Insurance doesn’t discriminate (unless you’re female)

4 minute read

Pregnancy care is excluded from most policies, flagrantly flouting the community rating system that is supposed to ensure equality.

A sponsored article in The Medical Republic titled “Health Insurance Means Fairness” has prompted me to write a response to remind people that the fairness implied is not equally distributed to all. 

I particularly liked the comment that “Our community rating system ensures equality and fairness for Australians and accounts protecting the health insurance. High claims don’t mean higher premiums and those who need claim aren’t disadvantaged because they need to access health care services”. A truly noble concept and one that on the surface, everyone would support and very few argue against. 

 Basically, community rating means that you can smoke, drink, take illicit drugs or jump out of planes and not have to pay increased premiums to cover these risky behaviours which are more likely to result in claims being made against your policy. The combined pool of money generated from the premiums of people who buy policies in the country is used to fund treatments for those insured. People with pre-existing conditions or partaking in risky behaviours are not expected to pay more for their insurance coverage. 

This principle is something that we in Australia, are very proud of and is in direct contrast to what happens in other countries where people with pre-existing conditions or other risks are simply unable to afford private health care insurance. 

 Now you would think that in a first world democracy like Australia, this lofty principle of community rating would and should apply equally across everyone in the nation. Unfortunately, this is not the case. 

If you happen to be a biological female and want insurance cover for reproductive health (which includes pregnancy) you are somehow legally able to be excluded from the community rating system and are required to pay DOUBLE what a man does to include his reproductive health needs!  

Pregnancy cover is only found in the most expensive top tier, gold policies which on average, cost double what the entry level bronze policies that cover most other conditions do. 

Remember that the community rating principle means that female contributors’ premiums go into the pool to help fund treatment of prostate issues and so on that they will never claim. It would only seem fair, therefore, that men and older Australians also contribute to the pool of funds that cover pregnancy which they will claim for. 

This is in fact, the very basis of community rating which keeps insurance premiums affordable for everyone. Why then, does our federal government specifically enable the private health insurers to practice gender-based discrimination. 

Spontaneous pregnancy is unplanned in more than 50% of cases and should be treated like any other “accident”. Pregnancy is a normal part of life and all methods of contraception (even tubal ligation and vasectomy) have a recognised failure rate. 

Pregnancy cover should be included in EVERY private health insurance product and it is a testament to how unfair health care funding for women in Australia is, that it currently is not. 

NASOG has written to the Human Rights Commission about this glaring inequity and received unsatisfactory replies along the lines that it is not worth pursuing. 

We continue to advocate for women and have asked successive federal government and opposition health spokespeople as well as ministers representing specific women’s interests and gender discrimination to rectify this grossly unfair loophole. To date, no political party, large or small has taken on this issue.  

Excluding pregnancy from basic health insurance premiums helps large insurers post record profits while increasing the costs to women and young families. This anomaly in insurance acts to virtually exclude women with an unplanned pregnancy from accessing treatment in the private sector unless they have very large funds available to them.  

Even small reforms, similar to that legislated for Australians with mental health issues, enabling them to upgrade from cheaper policies to more expensive one that cover mental health issues while waving the waiting period, would go a long way towards making access to private health insurance more fair to the women of Australia. 

Every woman in Australia must be outraged by this and should write to their federal member of parliament demanding the situation be rectified. 

Associate Professor Gino Pecoraro OAM is president of the National Association of Specialist Obstetricians and Gynaecologists. 

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