Standard Information Statements

Standard Information Statements

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Standard Information Statements (SIS) are available on all private health insurance products available in Australia. Health insurers are required by law to provide these Statements so you can review your existing policy or compare private health insurance products.

There are three types of Standard Information Statements:

Hospital - describes the features and limitations of hospital cover, including the type of accommodation, which medical services are covered in full, part or not covered, waiting periods and additional payments (excesses, co-payments and gaps),
General Treatment - describes the features and limitations of general treatment cover, including which services are covered, waiting periods, benefit limits and example benefits for each type of service, and
Combined - describes the features and limitations of a combined hospital and general treatment cover, with details as above.

Items that can be restricted on a hospital policy

Below is the list of procedures which insurers are required to list if they are restricted or excluded on a hospital cover SIS:

Cardiac and cardiac related services: heart surgeries, including heart bypass, pacemakers, angiograms
Cataract and eye lens procedures
Pregnancy and birth related services, i.e. obstetrics
Assisted reproductive services (IVF, GIFT, etc)
Joint replacements i.e. shoulder, knee, hip and elbow including revisions
Hip and knee replacements
Dialysis for chronic renal (kidney) failure
Surgery by podiatrists
Sterilisation
Non-cosmetic plastic surgery
Psychiatric and rehabilitative services, including treatment for eating disorders, post-natal depression, and drug & alcohol rehabilitation
Palliative care
Hospital treatment for which Medicare pays no benefit eg. most cosmetic surgery

Please note that if the insurer includes "Other services (see insurer for detail)" it means that more services, other than the ones listed above, are restricted on the cover and you need to contact the insurer to find out what those services are.
For example, some insurers restrict or exclude gastric banding on some hospital covers but this item won't be listed on the SIS as insurers are only required to indicate whether one of the services listed above are restricted.

Guide to the SIS

Having used the search to find products, you can print these one-page statements outlining the key features of your health insurance product. Detailed guides for each type of statement can be downloaded:

A Standard Information Statement only gives a summary of the key product features. However, it does allow you to see if your broad needs are covered and where products differ in both price and features. You will need to contact the health insurer to get all the details about the product.

You should not rely on the $ amounts for premiums or benefits on the Statement as they are there for comparison only. The actual premium may vary depending on your circumstances, for example, your age and your age when you first got health insurance. Benefits will vary depending on the details of your policy, the treatments you are having, the hospital you visit and who treats you.

Note that some words used in the Statement may not be exactly the same as those that your insurer uses, but they will be able to explain any differences. The Glossary explains terms used on this site and alternate terms used by health insurers.

As with all types of insurance, conditions will apply, so don't just rely on the Statement - once you have full details from the insurer, make sure you read them carefully before signing up and paying your premium.