Frequently Asked Questions
When you take out or upgrade a policy, you may have to wait for a set period before you can claim certain benefits.
Your annual limit is, quite simply, the maximum amount per calendar year (from 1st January – 31st December) that your policy will cover for specific goods or services.
Inclusions refer to everything covered as part of your policy, and exclusions are those that aren't. These will vary depending on your level and type of cover.
If certain services are restricted in your policy, you may only be covered for some of the costs in certain situations. For example, go to a private hospital for treatment that is a local service or benefit of your hospital policy. You will have a higher gap payment than if you receive treatment as a private patient in a shared ward of a public hospital.
This is the amount you have to pay upon admission to the hospital, and it will vary depending on your policy.
It means an out-of-pocket expense, that is, an expense that is not covered by your policy. This could include accommodation costs at a non-agreement hospital or medical fees above what is covered by the MBS (Medicare Benefits Schedule). The gap will be billed to you by your provider, and it is best to check up-front the potential out-of-pocket expenses.
In the lead-up to hospital admission, there will be appointments with GPs and specialist/s, and there may also be pathology and radiology tests. Under Health Insurance legislation, health funds are not permitted to cover these outpatient appointments. You will need to check with your GP or Specialist for any out-of-pocket costs you may need to pay.
Prior to a pre-booked admission or at the earliest possible time after an emergency admission, you must be provided with Informed Financial Consent so you can understand any out-of-pocket costs you may incur. If you require further clarification regarding out-of-pocket costs, contact the hospital, specialist or other medical providers for additional information.
If you are an Australian taxpayer who does not have private hospital insurance and you earn over a certain amount, you may have to pay extra. We are talking 1% to 1.5% per year. The ATO has a private health insurance rebate calculator and a Medicare levy calculator to help you determine how much that is, based on your income.
If you take out private health insurance, the federal government may contribute towards some of your premium; this contribution is called the Australian Government Rebate on private health insurance. The percentage of this rebate is set each year and varies according to age and income.
If you wait until after the first of July following your 31st birthday to take out hospital cover, you'll pay a 2% loading on top of your premium for every year you wait and the loading applies for 10 years of continuous hospital cover. The maximum loading for LHC is 70%.
You should be informed in writing about the cost of treatment before you are admitted to hospital or treated by your specialist.
This certificate shows your age when you took up the cover, the length of your membership, the level of cover, any waiting periods you have served and claims made in the previous 12 months. This certificate is required when you move from one health fund to other.
These are just a few of the common terms, but if you are unsure about the language in your policy, you can always contact us or call the insurer whose product you wish to purchase.
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