Accommodation covers meals and a bed in hospital, and includes all in-hospital-provided services including nursing care. It does not include treatment by doctors or other health professionals.
- Agreement hospital
Private hospital or day surgery contracted with an insurer to provide services at low or no out-of-pocket costs.
Acupuncture treatment involves inserting small needles into various points in the body to stimulate nerve impulses.
Medicare does not cover the cost of emergency transport or other ambulance services. Depending on your state of residence, you can purchase ambulance cover from an insurer or subscribe to a state ambulance service, or you may be covered by state government arrangements. For more information see: What is covered - Ambulance
- Ancillary policy
- Ancillary services
Health services provided by health professionals, but which are not classed as Medical or Hospital, and are not covered by Medicare. Ancillary services include physiotherapy, dental services, speech therapy, ambulance travel, home nursing and spectacles. May also include some medicines that are not on the Pharmaceutical Benefits Scheme (PBS). Also known as General Treatment.
- Annual limits
The maximum benefit payable for a particular service within a 12 month period. Annual limits can be calculated based on a calendar year, or financial year, or for every 12-month period from the anniversary date of taking out a private health insurance policy.
Small item used to compensate for reduced functionality, such as a hearing aid or colostomy pouch.
The Australian Prudential Regulation Authority is an independent body that regulates the financial aspects of the private health insurance industry.
- Artificial aids
See: Health aids
- Assisted reproductive services
In Vitro Fertilisation (IVF) treatment and Gamete Intra Fallopian Transfer (GIFT) are two of the most common procedures for treating infertility which are covered by health funds. Infertility is defined as the inability to conceive after one year of regular, unprotected intercourse. In the context of private hospital insurance, cover for reproductive services refers specifically to hospital admissions and does not include cover for non-admitted treatments. For more information, see: Factsheet - Assisted Reproductive Services.
- 'Available From' date
The 'Available From' date in a SIS is the date that the policy is available for purchase. This date only appears on a SIS when the product is not currently available and it's available for purchase date is in the future. Once that date has passed the 'Available From' information disappears from the SIS.
The amount you can claim from the insurer for a specific service. This may be listed on the SIS as a dollar amount (maximum benefit) or as a percentage amount (percentage benefit). For example:
- Maximum benefit - for each visit to a physiotherapist you can claim up to $50
- Percentage benefit - for each visit to a physiotherapist you can claim up to 75% of the total cost
Some policies may use a combination of both dollar and percentage amounts (for example: for each visit to a physiotherapist you can claim 75% of the cost up to a maximum of $50). This kind of benefit is not currently displayed on the SIS so it’s important to check with your insurer about what your policy cover.
- Benefit limitation period
Before 1 July 2018 some private health insurers imposed benefit limitation periods (BLPs) of up to 24 months for some categories of hospital treatment. During a BLP, you are only entitled to restricted benefits for a particular condition or treatment for a set period of time. Insurers have now ceased this practice.
- Blood glucose monitors
A device to measure the concentration of glucose in the blood. Benefits for blood glucose monitors may be deducted from an overall health aid limit – check with your insurer for details. See also: Health aids
Regional office or agent for a health insurer.
Additional trading name for an insurer, used in one or more states.
- Basic general treatment policy
- Basic private hospital policy
A basic level of private hospital policy which excludes or restricts one or more major medical services, such as cardiac and cardiac-related services. No benefits are paid for excluded services and only limited benefits are paid for restricted items. For more information on Basic hospital cover, see How health insurance works.
- Cardiac and cardiac-related services
Cardiac treatment relates to the heart and blood vessels. Some products that exclude or restrict cardiac-related services may also exclude or restrict lung-related (thoracic) treatment.
- Cataract and eye lens procedures
A cataract is a clouding of the clear lens in the eye and is one of the leading causes of vision impairment. In advanced cases, surgery to the eye lens may be performed to restore vision.
- Categorytop of page
Type of membership: Single, Couple, Family or Single parent family.
Chiropractors use spinal adjustments to treat health problems that are related to nerves, skeletons and muscles.
The general level of cover on a given policy, to allow easy comparisons:
- For General Treatment policies: Comprehensive, Medium or Basic
- For Hospital policies: Top Private, Medium Private, Basic Private or Public
- Closed policy
A policy which is no longer available for sale, but which continues to cover existing members.
- Community rating
Private health insurance is 'community-rated'. This means that everyone is entitled to buy the same product, at the same price, and is guaranteed the right to renew their policy. A health insurer cannot refuse to insure you, or refuse to sell you any policy you want to buy. There are some exceptions to this - for example, you will pay a higher premium if you have a Lifetime Health Cover loading.
- Comprehensive general treatment policy
A high level general treatment policy providing cover for most or all of: general dental, major dental, orthodontics, optical, physiotherapy, chiropractic, occupational therapy, pharmaceuticals, podiatry, hearing aids.
For a hospital policy a co-payment is a set amount that you agree to pay for each day you are in hospital, in exchange for lower premiums. For example, you may agree to pay the first $50 per day in hospital. Most co-payments have a limit on the number of days they apply per stay. It can also be called an overnight excess, daily excess or patient moiety.
For a general treatment (also known as Extras or Ancillary) policy you may be required to pay a co-payment for some services before a benefit will be paid. For example, it is common for pharmacy items to require a co-payment of the equivalent to the amount listed for the items on the Pharmaceutical Benefits Scheme (PBS)
Always check with your insurer about what co-payments you may need to pay.
- Corporate policy
A policy developed by a health insurer for a specific company, generally available to employees of that company only.
- Cosmetic surgery
Cosmetic surgery refers to treatment to enhance appearance. As this type of treatment is not medically necessary, Medicare does not pay a benefit towards cosmetic surgery. Health funds are not required to pay benefits towards hospital treatments where Medicare does not pay a benefit.
- Daily excess
- Day surgery
A private hospital or facility where patients are admitted, treated and discharged on the same day. Also called day facility.
- Default benefit
The “default” or minimum benefit is the lowest amount that a health insurer is permitted to pay for a hospital admission that is included on policy. See: Minimum Benefit
- Dependent child
A dependent child is an unmarried person under the age of 18 years. A health insurer may choose to continue considering a person between the ages of 18 and 24 years as a dependent child, but will usually require certain conditions to be met - for example, the person may have to be a full-time student. These conditions vary between health insurers, so check with your insurer to see which rules they apply. See also: Young adult dependant.
- Diagnostic tests
Diagnostic tests can include such things as x-rays and blood tests.
- Dialysis for chronic renal failure
Dialysis removes waste products and excess fluids from the body for people with kidney failure. Some forms of dialysis treatment such as haemodialysis require hospital admissions three or more times per week, for four to six hours each time.
- Department of Health
The government department which is responsible for policies relating to private health insurance.
- Drugs, dressings and other consumables
Drugs, dressings and other consumables are additional services to support hospital treatment. These included medications, bandages, crutches and surgically implanted prostheses (such as hip replacements, artificial lenses and heart valves).
- Elective surgerytop of page
Surgical treatment of a condition that your doctor considers does not require immediate attention.
- Eligibility Checking System
An online system that hospitals can use to electronically confirm the membership details and benefits for a patient who is to be admitted to hospital for treatment. This system is available on-line 24 hours a day.
- Emergency treatment
Emergency treatment occurs when the patient is treated by the medical practitioner within 30 minutes of presentation and the patient is in danger of suffering loss of life, limb, bodily function or mental stability, is in severe pain or is bleeding. For insurance purposes, your health fund may have a different definition of 'emergency' - check with your health fund for details.
- Endodontic services
Also called a front-end deductible, 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 type of hospitilisation (e.g day surgery or overnight stays) you may only have to pay a part excess (for example an excess of $500 may apply to overnight hospitilisation but only $100 applies to day surgery.)
What excess (if any) you will need to pay depends on the policy you take out. Always check with your insurer.
Conditions or services which your health insurance policy does not include, meaning that your insurer will not pay benefits towards hospital or medical costs for these items. If you choose to proceed as a private patient for an excluded service, you will have very large out of pocket expenses. If the services are eligible under Medicare, you can still receive treatment as a public patient – however, public hospital waiting lists will apply and you should discuss this option with your doctor. For more information, see: Private health insurance, Factsheet - Policy Exclusions and Restrictions
- Free text box - Other features
Generally, the free text boxes on a SIS are used by Insurers to display any features or information about the policy that does not fit into the SIS format. This may include disease management programs and other programs that support healthy lifestyles, discounts, bonus schemes, waivers, reductions, or additional services offered.
- Front-end deductible
Private health insurance organisation.
- Fund type
The public availability of fund: Open or Restricted.
A 'gap' is the amount you pay out of your own pocket for treatment in hospital, either for medical or hospital charges over and above what you get back from Medicare or your private health insurer. Some health insurers have gap cover arrangements to insure against some or all of these additional payments.
- Gap cover arrangements
Gap cover arrangements minimise any gaps between the Medicare Benefit Schedule (MBS) fee and what doctors actually charge. Some gap cover arrangements provide partial cover for the gap between the MBS fee and actual doctor's fee. Other gap cover arrangements provide full cover. Doctors can decide to use the gap cover arrangements on a case-by-case basis, so full cover cannot usually be guaranteed by the insurer.
- Gastric banding and related services
Gastric banding involves the placement of a band around the stomach to reduce its capacity. This is the most common form of obesity surgery or bariatric surgery. Policies which restrict or exclude gastric banding and other obesity surgeries will also exclude any adjustments and reversals to the original surgery, so if you have received this treatment in the past it’s important to make sure you continue to be covered in future.
- General treatment policy
Health insurance to cover non-hospital medical services that are not covered by Medicare, such as dental, optical, physiotherapy, other therapies and ambulance. Also known as 'extras' or 'ancillary' insurance.
- General dental
Minor dental services, such as annual checkups, cleaning and fluoride treatment. Whether specific items are classified as general or major dental depends on each insurer’s fund rules, so check with your insurer for details.
- Health aids
Also called ‘artificial aids’, this category covers a range of devices which health funds may cover under General Treatment policies. Two common examples are hearing aids and blood glucose monitors. Contact your insurer for more details about health aids covered on your policy.
- Health fundtop of page
- Hearing aids
A device to amplify and change sound to assist people with hearing impairments. Benefits for hearing aids may be deducted from an overall health aid limit – check with your insurer for details. See also: Health aids
Health Industry Claims And Payment Service. Allows you to make your claim at the point of service via an EFTPOS style transaction using your Health Fund membership card.
- Hip replacements
Hip replacement surgery is a technique that removes an impaired hip joint and replaces it with an artificial joint (prosthesis).
- Hospital insurance
Health insurance to cover your costs as a private patient in hospital, including hospital accommodation, medical treatment and ambulance (in some states).
- Hospital treatment for which Medicare pays no benefit
Medicare does not recognise or pay benefits towards some forms of hospital treatment, such as treatment that is not medically necessary (for example, cosmetic surgery) or experimental treatments. Health funds are not required to pay benefits towards hospital treatments where Medicare does not pay a benefit.
See: Monthly premium
- Informed financial consent
The provision of cost information to patients; including notification of likely out-of-pocket expenses (gap), by all relevant service providers, preferably in writing, prior to admission to hospital.
A patient who has been formally admitted to a hospital or day facility.
- Intensive care
Hospital treatment for actual or potential life-threatening illnesses, injuries or complications.
Specific medical service for which a benefit might be paid, identified by MBS code or an insurer's own code. Specific sample items are listed on the SIS.
- Joint replacements
Joints refer to the shoulder, knee, hip and elbow. Replacement surgeries remove impaired joints and replace them with artificial joints (prostheses).
- Knee replacements
Knee replacement surgery is a technique that removes an impaired knee joint and replaces it with an artificial joint (prosthesis).
- Labour ward fees
Labour ward fees include costs for delivery of babies in a birthing suite.
- Lifetime Health Cover (LHC)
Lifetime Health Cover is a Government initiative introduced from 1 July 2000. It was designed to encourage people to take out hospital insurance earlier in life, and to maintain their cover. People who take out (and keep) hospital insurance before their 'base day' pay lower premiums throughout their lifetime than people who join later. Generally, your base day is the later of 1 July 2000 or the 1 July following your 31st birthday. If you join after your base day, you pay 2% more for each year you are aged over 30 for your private hospital insurance premiums than someone who joined before their base day. If you join at 35, you pay 10% more and if you join at 50, you'll pay 40% more. LHC only applies to hospital policies - there are no age penalties or incentives for general treatment policies. For more on LHC, please see: Lifetime Health Cover.
- Limited services policy
There are hundreds of MBS (Medicare Benefits Schedule) items that a hospital policy may or may not cover. If a policy covers 10 or less of these items it is flagged as a limited services policy so that you know this particular policy has lower coverage than the average and you will see the following text displayed in the 'What's covered if I have to go to hospital' section: A limited number of services are covered, see below.
For further information about what is and is not covered in any policy contact the insurer directly
- Lifetime limit
The maximum benefit payable for a particular service for the lifetime of the member. If you use up your lifetime limit and transfer to a new insurer, your new insurer may deduct the benefits you have already claimed from your new policy’s lifetime limit – check with your insurer for details.
- Loyalty incentive schemes
Some insurers have loyalty incentive schemes that reward long-term members by increasing either the annual limit or the benefit amount you can claim for specific services. Please contact your insurer for further information about loyalty incentive schemes.
If you change insurers, loyalty limits and benefits are generally not transferrable.
- Major dentaltop of page
Significant dental services, such as complex fillings, tooth extractions, crowns and bridges. Whether specific items are classified as general or major dental depends on each insurer’s fund rules, so check with your insurer for details.
- MBS payable item
Services listed under the Medicare Benefits Schedule, which includes medical services necessary to maintain your health. Some services are not covered by MBS, such as elective cosmetic surgery.
- Medicare Benefits Schedule (MBS)
The schedule of fees set by the government for standard medical services, based on a fair price and how much Australia can afford to pay for the total health system. Whether you have private health insurance or are a private patient paying for all your own costs, the government provides a rebate on nearly all medical fees. This rebate is currently 75% of the MBS fee for in-hospital medical fees and 85% of the MBS fee for specialist medical fees incurred out of hospital. You can purchase hospital insurance to cover the remaining 25% of the MBS fee and gap cover for any potential additional fees incurred in-hospital.
- Medical expenses
Medical expenses are charges for medical procedures performed during a hospital stay. This includes items such as surgeons' fees, obstetricians' fees, radiology, pathology and anaesthetists. Medicare pays 75% of the MBS fee for these services.
- Medical gap
- Medicare Levy Surcharge (MLS)
The Medicare Levy Surcharge is levied on Australian taxpayers who earn above a certain income and do not have private hospital insurance. The Surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public system. The Surcharge is calculated at the rate of 1% to 1.5% of taxable income. It is in addition to the Medicare Levy of 2%, which is paid by most Australian taxpayers. The Medicare Levy Surcharge is imposed on individuals earning over the threshold who do not have an appropriate level of hospital insurance. For the current income thresholds, see Medicare Levy Surcharge.
- Medicare Levy Surcharge exemption
Most hospital policies are sufficient to exempt you from being liable to pay the Medicare Levy Surcharge. If you plan to use your insurance for exemption from the Surcharge, check with your insurer to ensure it meets the Surcharge requirements. General treatment policies, overseas visitors and overseas students health cover policies do not exempt you from the Surcharge.
- Medical service
A service provided by a doctor, specialist, radiologist, pathologist or anaesthetist.
- Medium general treatment policy
General treatment policy providing cover for most or all of: dental, major dental, optical, physiotherapy, chiropractic, podiatry, occupational therapy, but without orthodontics, health management, appliances, etc.
- Medium private hospital policy
Private hospital policy which covers more services than Basic hospital cover but still excludes or restricts one or more major medical services, such as pregnancy and birth related services or major joint replacements. No benefits are paid for excluded services and only limited benefits are paid for restricted items. For more information on Medium hospital policies, see How health insurance works.
- Minimum benefit
The minimum benefit (sometimes called the "default" benefit) is the lowest amount that a health insurer is permitted to pay for a hospital admission that is included on policy. It is equivalent to the amount a public hospital would charge a private patient for a shared room, usually as an all inclusive daily rate of approximately $250-$300 depending on where you are in Australia.
If you are entitled to only the minimum benefit and are attending a private hospital, the extra charges you will need to pay yourself include the amount above what the hospital charges for accommodation as well as theatre or labour ward plus any fees for medical services and other items such as pharmaceuticals that aren’t covered by your insurer (see What is covered? for further details).
The cost of theatre or labour ward in a private facility depends on the complexity of the procedure being performed and can range from a couple of hundred dollars to several thousand dollars. If you are proceeding with private hospital treatment and are only entitled to a minimum benefit, it is strongly recommended that you obtain a quote from the hospital and medical practitioners before admission.
- Monthly premium
The amount you pay for your health insurance each month. Note that the prices shown on the Standard Information Statement is not a quote and should only be used to compare the cost of different health insurer policies. The prices show the full monthly premium and the monthly premium with the Standard Rebate deducted. It does not include any Lifetime Health Cover loading or factor in any discounts that may be available or the different level of Rebate that may apply - most people are eligible for the Standard Rebate, but this may vary depending on your income and age group. Contact your insurer for a specific quote.
Naturopathy uses a range of alternative approaches to medical treatments. Naturopathy can include nutrition, dietetics, herbal medicine, homoeopathy and massage.
- Non-cosmetic plastic surgery
Plastic and reconstructive surgery involves the evaluation and treatment of any physical deformity that can be corrected by surgery, whether acquired (for example, skin grafts following burns) or congenital (for example, repair of cleft palates). These forms of treatment are considered medically necessary, rather than cosmetic. For more information, see: Factsheet - Plastic and Reconstructive Surgery
- Non-PBS Pharmaceuticals
Includes prescription pharmaceuticals which are not listed on the Australian government’s Pharmaceutical Benefits Schemes (PBS). Pharmaceutical benefits usually require a co-payment from you, equivalent to the normal PBS payment, before your insurer will pay benefits. Not all non-PBS pharmaceuticals are eligible for benefits, as insurers may choose not to pay for certain items (for example, compound pharmaceuticals). To check whether specific items are eligible for benefits, check with your insurer.
- Norfolk Island residents
From 1 July 2016, residents of Norfolk Island are eligible for Medicare benefits and can therefore also purchase Australian private health insurance policies. Residents of Norfolk Island can purchase the same policies as residents of NSW.
- Obstetricstop of page
Management of pregnancy, labour and delivery and associated care, provided in hospital. For more information, see: Factsheet - Obstetrics
- Optical (e.g. prescribed spectacles/contact lenses)
Includes prescription lenses, spectacle frames, and contact lenses.
The branch of dentistry that specialises in the diagnosis, prevention and treatment of dental and facial irregularities. It generally involves the use of braces, removable appliances, functional appliances or headgear.
- Other services
Where a Standard Information Statement lists ‘Other services’, you should check with your insurer for details about items which are not listed on the SIS.
‘Other services’ on a Hospital policy might include, for example, cancer treatments such as chemotherapy and radiotherapy, diagnostic procedures such as colonoscopies or biopsies, or podiatric surgery.
On a General Treatment policy, ‘Other services’ could include health management programs, health aids and appliances, and natural therapies.
- Overnight excess
- Palliative care
The care of patients with serious illness to relieve pain. In-hospital palliative care treatment is covered or restricted on all Hospital policies. The maximum waiting period on this service is 2 months, even if the condition is pre-existing.
- Patient moiety
The Pharmaceutical Benefits Scheme (PBS) provides a Government subsidy to reduce the price of some prescription medicines.
- Performance report
An annual report card developed by PHIO for each insurer in each state. The report is available on each insurer's information page on this website.
See: Non PBS Pharmaceuticals.
The Private Health Insurance Ombudsman (PHIO) provides an independent service to help consumers with health insurance problems and enquiries. The Ombudsman also publishes reports and consumer information about private health insurance.
Physiotherapy uses manual therapies, exercise programs and electrotherapy techniques to restore proper functioning to the body or reduce the impact of permanent disease or injury.
- Podiatric surgery
The surgical treatment of conditions affecting the foot, ankle and related lower extremity structures by accredited and qualified specialist podiatrists. When foot and ankle surgery is performed by an accredited podiatric surgeon, funds are required to pay the minimum benefit toward hospital costs. However, as this item is not usually fully covered, it is important to check with your insurer, surgeon and anaesthetist to confirm your benefits and likely out-of-pocket expenses.
Treatment of conditions affecting the foot, ankle and related lower extremity structures.
The ability for people to transfer from one insurer to another, without re-serving waiting periods.
- Pre-existing condition
A pre-existing condition is an ailment, illness or condition, the signs or symptoms of which, in the opinion of a medical practitioner appointed by the health insurer, existed at any time during the six months prior to taking out hospital cover or upgrading to a higher level of cover. Health insurers are able to impose a maximum 12 month waiting period for hospital treatment for ailments, illnesses or conditions that are considered to be pre-existing. For psychiatric care, rehabilitation and palliative care, the maximum waiting period is two months, even if the condition is pre-existing. If you are going to hospital during your waiting period, it is important to check with your health insurer prior to the admission as to whether you will be covered or if the condition will be deemed pre-existing.
- Preferred provider
Some health insurers have arrangements with general treatment or extras providers (known as preferred providers) to provide services to their members at a higher benefit rate than that of a non-preferred provider.
Each insurer has their own preferred provider network - please contact your insurer for further information about their preferred providers.
- Pregnancy and birth related services
Also known as obstetrics. In the context of private hospital insurance, this refers specifically to hospital admissions for the birth of a child and does not include cover for non-admitted check-ups and treatments. The maximum waiting period for this service is 12 months. For more information, see: Factsheet - Obstetrics
Fee payable for health insurance policy. See also Monthly premium.
- Premium discounts
Insurers may offer discounts on premiums, such as an administration discount for members who pay by direct debit.
- Previous name
If a health insurance policy has changed its name, the website will link to the SIS showing the new name.
- Private Health Insurance Rebate
Most Australians with private health insurance currently receive a Rebate from the Australian Government to help cover the cost of their premiums. The Private Health Insurance Rebate is income tested. For more information see Australian Government Private Health Insurance Rebate.
- Private hospital
A hospital run as a commercial and/or charitable operation.
- Private patient in a private hospital
Depending on the circumstances, being a private patient in a private hospital or a private day hospital facility allows you to choose the doctor(s) who treats you at a time that suits you. This is provided your doctor(s) has an arrangement with that hospital to treat private patients and the hospital you have chosen has beds and has available the services you will need.
As a private patient in a private hospital, you may be charged for a range of services which could include:
- care in intensive/critical care units,
- doctor(s) services (including diagnostic tests),
- operating theatre fees,
- allied health services (eg. physiotherapy),
- dressings, medications/drugs, other consumables,
- surgically implanted prostheses (eg. artificial hips),
- personal expenses such as TV hire and telephone calls.
The hospital and the treating doctor(s) should, where possible, advise you about the services for which you will be billed.
- Private patient in a public hospital
Being a private patient in a public hospital gives you a choice of doctor(s). Depending on your illness or condition and your needs, this may or may not be the same doctor(s) who would have been allocated to you by the hospital as a public patient. Public hospital waiting lists still apply and you will not be given priority over public patients.
As a private patient in a public hospital, you may be charged for a range of services which could include:
- hospital accommodation,
- doctor(s) services (including diagnostic tests),
- surgically implanted prostheses (eg artificial hips),
- personal expenses such as TV hire and telephone calls.
Health insurance cover on a specific range of services, with specific levels of excess/co-payment, offered at a set price within one state.
- Product code
The code used by an insurer to identify their own specific policies.
- Prostheses (surgically implanted)
Surgically implanted prostheses include such things as hip replacements, artificial lenses and heart valves.
A person or business qualified to supply medical services, such as a clinic, therapist, dentist, etc.
- Psychiatric services
The treatment of mental illness, including drug and alcohol rehabilitation, eating disorders, and post-natal depression. In-hospital psychiatric treatment is included or restricted on all Hospital policies. The maximum waiting period on this item is 2 months, even if the condition is pre-existing. In some cases, you may be able to upgrade and obtain an exemption from this waiting period - see Waiting periods.
Psychologists deal with people in their everyday lives or within their work environment to help them function better and to prevent the development of problems in mental and physical health. Some general treatment policies provide benefits for psychology - check with health funds for details.
- Public hospital
A hospital funded by the Government. 'Recognised' public hospitals have access to the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme and private health insurance arrangements.
- Public hospital policy
A hospital policy with restricted benefits for all conditions. This policy is sometimes called a 'basic table'. You will be covered for treatment as a private patient in a public hospital, but may face considerable out-of-pocket costs for treatment in a private hospital. Public hospital waiting lists still apply and you will not be given priority over public patients.
- Public patient
You are a public patient if you choose to be treated in a public hospital under Medicare, by a doctor appointed by the hospital.
- Ratetop of page
In the context of private hospital insurance waiting periods, this refers to specific hospital rehabilitation treatment programs which are deemed by the health insurer to be relevant and appropriate for the treatment of the patient's disease, injury or condition. The waiting period is 2 months, even if the condition is pre-existing.
- Remedial massage
Deep massage to treat injuries and speed recovery (for example, strains, sprains, bruising).
- Restricted benefits
- Restricted access insurer
- Restricted fund
- Restricted membership insurer.
A health insurer providing insurance to a specific industry or group, usually on a not-for-profit basis. You must be a member of the industry or group to join the fund. In some cases, family members are also eligible.
Condition or services which this insurance policy covers to a limited extent, and will pay reduced benefits on hospital admissions. It is not sufficient to cover the cost of a private room in a public hospital or any room in a private hospital. If you are admitted to a private hospital for treatment that is restricted by your policy, large out of pocket expenses will apply. You will have to pay the full theatre fees and other costs as well as the difference for accommodation fees; in some cases theatre fees can exceed the cost of accommodation. If the services are eligible under Medicare, you can still receive treatment as a public patient – however, public hospital waiting lists will apply and you should discuss this option with your doctor. For more information, see: Private health insurance, Factsheet - Policy Exclusions and Restrictions
- Same-day patient
You are a same-day patient if you are admitted, treated and discharged on the same day. Also called day surgery.
Standard Information Statement. A summary of health insurance policy details provided in a standard A4 format for easy comparison.
- Speech pathology
Speech pathology is the assessment and treatment of communication and swallowing disorders. Speech pathology is covered on some general treatment policies - check with health funds for details.
Australian State or Territory. Also called Jurisdiction.
- State of the Health Funds Report
The annual report on insurer performance and service delivery, prepared by PHIO and available online at the PHIO website.
Availability of specific policy: Available or Closed.
Vasectomies and tubal ligations are forms of permanent contraception or sterilisation. Although these procedures may be reversed in some cases, they are usually called permanent because reversal is difficult and cannot be guaranteed.
The maximum benefit payable for a particular service within a 12 month period, which is deducted from a larger limit. For example, a policy may have a combined $500 limit for acupuncture, naturopathy and remedial massage, with a sub-limit of $300 for each service – meaning the most you could claim in a single year for one of those services is $300, while the remaining $200 could be claimed against one or both of the other two.
A suspension of health cover means that, with the agreement of your health insurer, you may stop paying your premiums for an agreed period of time. You will not be able to claim any benefits during your suspension. It is important to check whether you will need to re-serve any waiting periods after a period of suspension as rules vary between health funds. In addition, if you are over the income threshold you will be required to pay the Medicare Levy Surcharge for the period that you are suspended. Health insurers may grant suspensions at their own discretion for circumstances such as working or studying overseas, financial hardship or temporary unemployment. Your Lifetime Health Cover status is not altered during a period in which your health fund suspends your health insurance.
- Tabletop of page
Former name for health insurance products.
- Theatre fees
Theatre fees are costs for procedures performed in an operating room, including those performed in day surgery facilities.
- Top private hospital policy
A private hospital policy with no restrictions or exclusions on MBS payable items. For more information on Top hospital cover, see How health insurance works.
- Treatment exclusions
Type of health cover: general treatment cover, hospital cover or combined cover.
- 'Valid from' date
The date a new health insurance policy will be available for purchase.
- Waiting periodtop of page
How long you will need to be a member before you are eligible for benefits. The Government has set maximum waiting periods for benefits for hospital services, but insurers can set their own waiting periods for general treatment benefits. The SIS lists waiting periods in months for standard services.
- Young adult dependants
Insurers may choose to continue covering people aged between 18 to 24 on their parents’ policies, as young adult dependants, in exchange for a higher premium. Check with your fund to see what rules apply to you. See also: Dependent child.