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Out-of-pocket
“The part you have to pay yourself.”
Excess
“The amount you pay before insurance helps with a claim.”
Annual limit
“The maximum your plan will pay for a certain service in a year.”
AGR
The Australian Government Rebate is a discount that the government provides on the cost of private health insurance.
Waiting period
“The time you must wait before certain services are covered.”
Benefit limit
“The maximum amount your plan will pay for a service.”
Pre-existing condition
“A health issue you already had before starting insurance.”
Medical Gap Network
Medical gap cover helps reduce the out-of-pocket costs you may have to pay when you receive treatment from a doctor or specialist. It covers the difference between what the doctor charges and what Medicare and your health insurance will pay
MBS
"MBS you can think of it like a recommended retail price"
Policy holder
“The person who owns the insurance plan.”
Annual limit
“The maximum your plan will pay for a certain service in a year.”
LHC
Lifetime Health Cover (LHC) is a rule that encourages people to get hospital insurance before they turn 31.
If you wait until after 30, you’ll pay 2% extra on your premium for every year you delay.
So if you join at 35, you’ll pay 10% more.
Coverage
“The services or treatments your insurance helps pay for.”
Premium
“The amount you pay regularly for your insurance plan.”
Pre-existing condition
“A health issue you already had before starting insurance.”
Medicare Levy Surcharge
Extra tax if you earn above a threshold and don’t have hospital cover.
Network provider
“A doctor, hospital, or service that works with your insurance plan.”
Policy exclusion
“Services or treatments that aren’t covered by your plan.”
Outpatient
“A service you receive without staying overnight in a hospital.”
Restricted Services
Services only partly covered — may leave you with big out-of-pocket costs.