Southern Cross: Claims keep growing

Southern Cross paid out 2.3 million claims last year, worth $803.4 million.

Wednesday, May 27th 2015, 6:00AM

by Susan Edmunds

Although just 7% or 163,370 of those claims were for elective surgery, they accounted for 73% of costs.

Southern Cross said the number and cost of surgeries it funded each year kept climbing.

It has had 23% growth in the number of surgeries funded and a 32% increase in the associated costs in the past five years.

In 2014, five Southern Cross members were paid more than $125,000 in medical claims each.

The top claiming policyholder was paid $157,832, and the following four received $139,954, $128,470, $125,002 and $124,966 respectively.

Peter Tynan, Southern Cross Health Society chief executive, said there were many conditions that required complex and expensive treatment.

“While we all hope we will never need these treatments, you just never know what’s around the corner and it highlights what a valuable safety net health insurance can be.”

Imaging and tests were the most-claimed procedure, costing more than $70 million. Skin procedures were next, followed by total knee replacements, total hip replacements and colonoscopies.

Tynan said that although the claims received varied greatly depending on the age and gender of the claimant but all ages benefited from insurance.

“We tend to see more tooth extractions for those aged under 30, for women aged 31-40 endometriosis surgery is predominant and after 50 years, hip and knee replacements, colonoscopies, cataract extraction and skin lesion removals are in high demand.”

In the last calendar year, for every dollar of premium, Southern Cross paid out over 90 cents in claims.

Tynan said: “Last year we paid 72% of the country’s health insurance claims, so we have a significant amount of data on what healthcare actually costs and what people actually claim for. Our policy benefits and limits are constructed with this knowledge in mind. It also means Southern Cross members get extremely good value for every dollar of premium they pay.”

Tags: health insurance Southern Cross