Terminology

Gap
This is the difference between what your specialist charges and what Medicare and your health fund will pay for a particular service. Some specialists have an arrangement with a health fund and don’t charge a gap fee, but whether or not you have to pay some of the costs will also depend on your level of cover.

LHC (Lifetime Health Cover)
LHC applied to everyone born after 1 July 1935 and it sets your premium rating for life when you first take our private health insurance. For each year you remain uninsured after the age of 31, there is a penalty increase of 2% on top of the normal premium.

IFC (informed financial consent)
Before you agree to medical treatment or a surgical procedure, your doctor should discuss all charges you may have to pay out of your own pocket. This is called informed financial consent.

MLS (Medicare Levy Surcharge)
This is a tax paid over and above the 1.5% levy we all pay. It applied to singles without private health insurance who earn over $73,000. MLS also applied to couples earning a combined income over $146,000 (increases by $1,500 for each child after the first).

30% Rebate
This is the amount paid by the Federal Government toward the cost of your private health insurance. For every $1 you pay in premiums you are entitled to 30 cents back. You can take this as a reduction presentation of a receipt from your fund, or a tax deduction at the end of each financial year. The rebate increases to 35% for people aged 65-69 and 40% when 70 or over.

Excess
This is the amount you agree to pay for hospital services in exchange for lower premiums. In some cases you will contribute each time you go to hospital and in other cases; you only have to pay a set amount each calendar year. For example, if you agreed to a $250 excess you will pay the first $250 of your hospital costs if you’re admitted as a private patient. Some policies only charge the excess if you’re admitted to hospital overnight rather than having day surgery.
Co-Payment
This is where you agree to pay a part of each hospital service you use. If your policy has a $50 co-payment clause, for example, you will pay $50 each day towards hospital accommodation. In this case a week in hospital would cost you $350.

Waiting Periods
Health funds have set waiting periods before you are entitled to certain benefits. These waiting periods will be clearly stated in your policy and will only apply to some services. If you’re thinking of starting a family and you’d like to use one of the deluxe birthing suites in a private hospital, it pays to adjust your health insurance well in advance because there’s a 12 month waiting period for obstetrics. If you’re going to hospital at any other time it’s always best to call your health fund to check your eligibility.


General Treatment Cover
These are the ‘extras’ offered in your health policy. Coverage may depend on your type of policy and your health fund but they generally include a variety of services such as physiotherapy, dental, optical, podiatry and some alternative therapies.