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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
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Types of Private Health Insurance Cover
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a co-payment
With a co-payment, you agree to pay an agreed amount each time
a service is provided. For example, a policy may have a co-payment
clause that requires you to pay the first $50 for each day’s
hospital accommodation. If your policy has such a co-payment and you
were in hospital for 5 days, you would have to pay $250 ($50 x 5).
The total amount of co-payment you can pay in a year is often limited
to a set maximum amount.
- restricted benefits
If your policy has restricted benefits for some conditions you
will be covered for treatment as a private patient in a public hospital
for these conditions, but will face considerable out-of-pocket costs
if you were to be treated in a private hospital for these conditions.
If you are unsure about whether restricted benefits apply to your
policy you should ask your health insurer.
- a benefit limitation period
A benefit limitation period is where you are only entitled to limited
benefits for a particular condition or treatment for a set period of
time. After that period of time has elapsed you would normally be entitled
to full benefits for the condition or treatment. Some benefit limitation
periods may commence after standard waiting periods have been served.
If you are unsure about whether a benefit limitation period applies
to your policy you should ask your health insurer.
- public hospital table
Some health insurers offer policies that have restricted benefits for
all conditions. This policy is sometimes called a public hospital table.
Under this policy you will be covered for treatment as a private patient
in a public hospital, but will face considerable out-of-pocket costs
if you were to be treated in a private hospital.
- hospital-substitute treatment
medical, surgical, therapeutic, diagnostic or other services intended
to manage a disease, injury or condition. You should discuss with your
doctor if this type of treatment is an option for you. Health insurers
can cover chronic disease management programs and other types of services
outside of the hospital setting.
General treatment cover
General treatment cover (also known
as ancillary or extras) can assist with the cost of treatments such as
physiotherapy, optical treatment and dental treatment as well as costs
associated with disease management and prevention programs, depending
on your insurer’s policy.
Packaged products
You are able to take out either hospital or general treatment cover
on their own, and most health insurers offer packaged products that provide
cover for both hospital and general treatment services.
NOTE: You should regularly review your health insurance
needs in case you change your mind about whether you want to be covered
for particular conditions, or your circumstances change, and you therefore
need to upgrade your cover.
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