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Insure? Not Sure?

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

Common Terms Used by Private Health Insurers

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Accommodation

Accommodation covers meals and a bed in hospital, and includes all hospital-provided services including nursing care. It does not include treatment by doctors or other health professionals.

Ancillary services

See General treatment services

Benefit limitation period

Limited benefits are paid for certain conditions for a specified period of time. This is not the same as a waiting period during which no benefits are paid for a period of time after you purchase a policy.

Broader Health Cover

Health insurers may now offer cover under their hospital policies, for treatment in settings other than hospitals – for example in your own home – as well as programs to manage chronic disease.

Co-payment

A co-payment is where you agree to pay an agreed amount each time a service is provided. For example, a private health insurance policy may have a co-payment clause that requires you to pay the first $50 for each day’s hospital accommodation.

Dependent child

‘Dependent child' is defined as a person:
(a) who is:

I. aged under 18, or

II. a dependent child under the rules of the private health insurer that insures the person; and

(b) who is not aged over 25 or over; and

‘Dependent child non-student' means a person who:

(a) is aged between 18 and 24 (inclusive) and was born before 1991; and

(b) is a dependent child under the rules of the private health insurer that insures the person as referred to in subparagraph (a) (ii) of the definition of ‘dependent child’ in the Private Health Insurance Act 2007, whether or not the person is wholly or substantially dependent on an adult insured under the same health insurance policy; and

(d) is not receiving full-time education at a school, college or university.

Note: A ‘dependent child non-student' is therefore a ‘dependent child’ as defined in the Private Health Insurance Act 2007.

Diagnostic tests

Diagnostic tests can include such things as x-rays and blood tests.

Drugs, dressings other consumables

Drugs, dressings and other consumables are additional services to support hospital treatment. They include medications, bandages and crutches, prostheses (surgically implanted items such as hip replacements, artificial lenses and heart valves).

Elective surgery

Elective surgery is treatment of a condition your doctor considers does not require immediate attention.

Excess

An excess is an amount that you agree to pay towards the cost of hospital treatment in exchange for lower premium costs. You may be required to pay an excess every time you go to hospital, or only the first time, depending on the private health insurance policy you take out. An excess is also known as a front-end deductible.

Extras

See General treatment services

Federal Government Rebate

For every dollar that you contribute to your private health insurance premium, the Australian Government will give you back 30 cents. For health insurance members aged between 65 and 69 years, this amount increases to 35 cents, and for members aged over 70 years it is 40 cents.

Front end deductible

See Excess.

Gap

The term 'gap' generally means the difference in the amount that your doctor charges and the amount that is covered by Medicare and your health insurer, i.e. the amount that you must pay for your medical services received in hospital.

It can also refer to the difference between what your hospital charges and the amount that is covered by your health insurer.

General treatment services (previously known as ancillary or extras)

General treatment services are services, such as physiotherapy, speech pathology and podiatry, which are provided by health professionals.

Intensive care

Intensive care is treatment for actual or potential life-threatening illnesses, injuries or complications.

Labour ward fees

Labour ward fees include costs for delivery of babies in a birthing suite.

Lifetime Health Cover

Lifetime Health Cover was introduced on 1 July 2000. Under Lifetime Health Cover, health insurers are required to charge members different premiums based on the age they are when they first take out hospital cover. If a person does not have hospital cover on 1 July following their 31st birthday and decides to take out hospital cover later in life, they will pay a 2% loading on top of their premium for every year they are aged over 30. The loading will cease if the person has had hospital cover for a continuous period of 10 years.

Low Front End Deductible

Your front end deductible (also known as excess) must be equal to or less than $500 per annum for single policies or $1,000 per annum for families/couples to be considered a low front end deductible.