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Understanding the lingo

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Private health insurance terminology can be confusing, particularly if you’re joining for the first time or considering switching funds. It’s easy to feel a little out of the loop… so let’s explore a few key terms to help you learn more about your cover and make better health insurance decisions.

Waiting periods

A waiting period is the time between taking out a health insurance policy, and when the benefits of that policy are available to you. Waiting periods apply when you first join health cover or rejoin after a break of more than 30 days without cover. They’ll also apply to the higher benefits when you upgrade your cover.

The maximum waiting periods for hospital cover are set by the Federal Government, but health funds can offer lesser waiting periods if they choose. Generally the maximum waiting period is for maternity and pre-existing conditions is 12 months. For most other services, it’s 2 months.

Extras cover waiting periods vary. For example, the waiting period for glasses or contact lenses might be 6 months while the waiting period for general dental services is usually 2 months and major dental is 12 months. Health funds can set their own waiting periods for extras services so you should check your health fund’s policy documents for the waiting periods that apply to your health cover.

Funds are often willing to waive some waiting periods to attract new members – we will let you know of these offers when discussing your health cover options.

Portability

The Australian Government has portability rules in place to ensure you can transfer to an equivalent hospital cover with another fund without penalty.

Under these rules, any waiting periods you’ve already served must be recognised by your new fund… so when you switch funds on the same or a lower level of benefits, you can claim straight away.

While there aren’t any Government regulations covering waiting periods for extras cover, most funds will recognise the waiting periods you’ve already served with your previous fund.

Portability also means the benefits you’ve claimed with your previous fund (year to date), will be deducted from your annual benefit limits with your new fund. But don’t worry, your annual limits will be refreshed at the start of the new year!

Excess

An excess is an amount you agree to pay if you’re admitted to hospital – this reduces the overall premiums you pay. The excess may be for the first time you go to hospital each year or may apply each time. Some excesses apply to each person covered, or there may be just the one payment that covers all people on the policy. If you’re unsure about how your excess works, check your policy documentation or contact the fund directly.

Co-payment

A co-payment is an amount you’re required to pay each day you’re in hospital, possibly up to a maximum per admission. For example, you may have a policy that requires you to pay $30 for every day you are hospitalised… so, if you’re in hospital for 3 days, you’ll need to pay an extra $90. Health cover policies can have a co-payment or an excess… or both.

Pre-existing Condition

A pre-existing condition is any condition that you have symptoms of during the 6 months prior to joining or upgrading your health cover, regardless of whether the exact cause was known. The waiting period for a pre-existing illness is 12 month if you haven’t been covered for that condition before (portability applies to pre-existing conditions – see above). In some cases, a doctor appointed by the health fund will decide if the condition is pre-existing.

Need more info? Call us on 1300 154 421 and speak to a Choosewell Health Insurance advisor or request a callback to discuss your needs.

To find out more about Lifetime Health Cover, the Medicare Levy Surcharge and the Federal Government Rebate, visit our FAQ page.

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