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Topics in this Section Introduction Contents General Information Surcharges and Incentives About Private Health Insurance Types of Cover Questions You Should Ask Common Terms Insurer Contact Details

General Information Page 1 | 2 | 3 Health care can be expensive. As the basis of Australia's health care system, Medicare covers many health care costs. Private health insurance provides additional cover for some services not covered by Medicare. What Medicare provides Australia's Medicare system is available to all permanent residents. Norfolk Island does not participate in the Medicare program; however Australian citizens who have been living in Australia and move to Norfolk Island from the mainland will be eligible for Medicare on return visits for up to a period of five years. The Medicare system has three parts: hospital, medical and pharmaceutical. Hospital Hospital treatment includes treatment provided in a hospital setting as well as treatment outside of hospital premises, such as in an aged care facility or in a patient’s residence, as long as these services are co-ordinated and provided by a hospital. Hospital costs relate to a range of services including hospital accommodation, theatre fees and intensive care. If you choose to be a Medicare (public) patient, you can be treated, at no charge, in a public hospital by a doctor appointed by the hospital. You cannot choose your own doctor. When you are a private patient in either a public or private hospital, you will be charged for the hospital accommodation and other hospital services you receive. These charges are likely to be lower if you are treated by a hospital outside the hospital’s premises. Private health insurance may cover some or all of these charges. Medical As a public patient being treated by a public hospital, your medical costs will be covered under Medicare. If you are a private patient receiving treatment from a hospital, Medicare will cover you for 75% of the MBS (Medical Benefits Schedule) fee. Private health insurers have arrangements in place which may cover some or all of the doctors’ fees for your hospital treatment. Unless your private health insurer has a gap cover arrangement in place with your doctor which will cover all of your doctor’s charge, you may have to contribute towards the doctor’s bill out of your own pocket. Pharmaceutical Under the Pharmaceutical Benefits Scheme (PBS) you pay only part of the cost of most prescription medicines purchased at pharmacies. The rest of the cost is covered by the PBS. If the pharmaceutical is not ‘supplied’ on the PBS then private health insurers can choose whether to pay a benefit. Ambulance Cover Medicare does not cover the cost of emergency or other ambulance services. Ambulance cover arrangements differ between States. You should check what arrangements apply where you live. In States that do not offer universal ambulance cover for residents, you can arrange ambulance cover through the ambulance authority in your State and/or your health insurer. Private health insurers may pay or reimburse you for all or part of your annual subscription to your State ambulance authority, or the costs associated with transportation. If you take out a hospital insurance policy in New South Wales or the Australian Capital Territory, you will find your private health insurance premium includes this cover. If you are a pensioner or a low income earner in these two States, your premium may be reduced because you are entitled to free ambulance cover. Top of Page When you are a private patient in a hospital As a private patient - whether you are insured or not - you have the right to choose your own doctor, and decide whether you will go to a public or a private hospital that your doctor attends. You may also have more choice as to when you are admitted to hospital. As a private patient, in either a public or private hospital, you may need to pay some or all of the costs for a range of services such as: hospital accommodation; theatre fees; intensive care; medications, dressings and other consumables; prostheses (surgically implanted); diagnostic tests; doctors' services. Treatment as a private patient in a private hospital can be very expensive. Private health insurance will cover some or all of these costs. Page 1 | 2 | 3 Top of Page

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Private Health Insurance Administration Council Suite 16, Level 1, 71 Leichhardt Street, KINGSTON ACT 2604 Telephone 02 6215 7900 | Facsimile 02 6215 7977 | Email phiac@phiac.gov.au

Last modified: 22 July, 2005