Lowering your premiums

Lowering your premiums

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Some health insurance policies will give you full cover for the costs of hospital accommodation and in-hospital medical charges. Other policies require you to meet some of the costs, in exchange for lower premiums.

You can elect to pay a lower premium in return for agreeing:

not to be covered for certain services (exclusions), or
to only receive limited benefits for a certain service (restricted benefits), or
to pay a set amount towards the cost of your hospital treatment (excess or co-payment).

You should regularly review your health insurance requirements at different stages in your life. Consider whether you have the policy that is most appropriate for you and whether you are covered for the relevant types of treatment you may need.

Exclusions

If your policy has an exclusion for a particular condition, you are not covered for treatment as a private patient in a public or private hospital for that condition.

For example, if your policy excludes obstetric services, hip replacements and knee replacements, and you go into hospital as a private patient for one of these conditions, your health insurer will not pay any benefits towards your hospital and medical costs.

Exclusions are listed on the Standard Information Statements available from this site. If you are unsure which conditions are excluded on your policy, ask your health insurer.

Restricted benefits

If your policy has restricted benefits for some conditions, you will be covered for treatment for those conditions but only to a limited extent. You will face considerable out-of-pocket costs if you have this treatment as a private patient.

Restricted benefits are listed on the Standard Information Statements available from this site. If you are unsure about whether restricted benefits apply to your policy, ask your health insurer.

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.

A 'benefit limitation period' is not the same as the maximum benefits payable for a specific type of service (eg $1,000 per year for dental services).

Benefit limitation periods usually commence after standard waiting periods have been served. If you are unsure about whether benefit limitation periods apply to your policy, ask your health insurer.

Excess

An excess is an amount of money you agree to pay for a hospital stay, before health insurer benefits are payable. This is sometimes referred to as a front-end deductible.

For example, if your policy has an excess of $200, you will be required to pay the first $200 of your hospital costs should you go to hospital as a private patient. An excess may apply every time you go to hospital in a year, or may be capped at a total amount that you will have to pay in a year.

Excesses are listed on the Standard Information Statements available from this site. If you are unsure how the excess on your policy works, ask your health insurer.

Co-payments

With a co-payment, you agree to pay a set amount each day you are in hospital. This can also be referred to as an overnight excess, daily excess or patient moiety.

For example, a policy may have a co-payment clause that requires you to pay the first $50 for each day of hospital accommodation. If your policy has such a co-payment and you were in hospital for five days, you would have to pay $250 ($50 x 5). The total amount of co-payment you pay per hospital stay is often limited to a set maximum amount.

Co-payments are listed on the Standard Information Statements available from this site. If you are unsure whether your policy has co-payments, or how the co-payments on your policy work, ask your health insurer.

Public hospital cover

Some health insurers offer policies that only cover you for treatment as a private patient in a public hospital. This policy is sometimes called public hospital cover or a 'basic 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 are treated in a private hospital.