Health insurance glossary.

The term 'Basic Benefit' refers to when the benefit payable is equivalent to the benefits available if the service was provided in a shared room in a public hospital.

Benefit limitations may apply to some types of treatment. Where a benefit limitation applies, the level of benefit payable will  be equivalent to our Basic Hospital Cover.  The level of cover is for the cost of a shared  room in a public hospital and the cost of  surgically implanted prostheses. All other  charges are the responsibility of the patient

A benefit is the payment that is rebated back to the primary member for services received by an approved provider. Find out more about how to claim.

If you register for Direct Credit too, we'll also pay your benefits directly into your bank account so you never have to worry about cheques or bank queues again!
 

Benefits are payable by HIF on a calendar year basis. A calendar year is defined by HIF as 1st January to 31st December no matter what date you join HIF.

We've gone green! Our commitment to purchasing carbon credits means we're officially environmentally friendly. In fact, we're Australia's first and only certified Carbon Neutral (NOC02) health fund.

Find out more about our green credentials.

Heart (cardiac) procedures including medical treatment or surgical procedures for cardiac conditions such as, arrhythmias,  artery bypass grafts, coronary angioplasty, congenital defects, heart disease, heart transplants, pacemakers and defibrillators, stent insertion.

During cataract surgery, a patient's opaque (cloudy) natural lens is removed and replaced with a clear synthetic lens to restore the lens's transparency and improve the patient's vision.

Cataract surgery is generally performed by an Ophthalmologist (eye surgeon) in a surgical center or hospital, using local anesthesia.

In the private health insurance sector, the term Category refer to the type of membership you possess:

- Single
- Couple
- Single Parent Family
- Two Parent Family

Chiropractic treatments focus on diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, and the effects of these disorders on the functions of the nervous system and general health. It aims to locate offending spinal structures and reduce their effect on the nervous system.

Making a health insurance claim at HIF is as easy as falling off a log (only far less painful). In fact, the toughest bit is choosing from our host of convenient ways to make your claim – by email, in person, by fax or instantly with Extras eClaiming. In any case, it’s quick and easy. You’ll have your rebate in no time, and we offer some of the most competitive benefits in Australia.

Visit the How to Claim page for all the details or download a claim form now.

"Complementary Therapies"are included in all our ancillary cover options and pays benefits on:

  - Acupuncture
  - Homeopathy
  - Myotherapy
  - Naturopathy
  - Remedial Massage Therapy
  - Traditional Chinese Medicine

To find out more about the various benefits you could claim, visit the Extras Cover Options page.

Members that take out an HIF health policy have a 30 day cooling off period from the policy commencement date, in which time they may cancel their policy and receive a full refund of any premiums paid (provided no claims have been made against the policy).

A Day Surgery (sometimes also referred to as a Day Facility) is a private hospital or facility where patients are admitted, treated and discharged on the same day.

When you hear us refer to a "dependant", we mean a person who is dependant upon the primary member. This includes children, stepchildren, legally adopted children, or children to whom the primary member is the legal guardian. 

Dietetics is the study of diet and nutrition in relation to health and disease, and Dietetic specialists (Dietitians) aim to promote good health through proper eating. They develop modified diets, participate in research, and educate individuals and groups on good nutritional habits.

Elective Surgery is the surgical treatment of a condition that your doctor considers does not require immediate attention.

Electronic Claiming (or 'eClaiming') means that you can claim for Extras services on the spot using your HIF member card. Simply swipe it through the e-terminal* at your health service provider and your benefits will be deducted from the fee automatically. You just pay any additional out-of-pocket expenses (if there are any).

For  information on other ways to claim with HIF, check out our How to Claim page.

*Available at all HIF providers that use HICAPS  or iSoft e-terminals.

An excess is the amount selected on a hospital cover which the primary member agrees to pay before a benefit will be payable from HIF (basically, if you require an overnight hospital stay, your premiums can be reduced by applying an excess). 

For our Gold hospital cover option, you may choose one of the following excess options:

 - $0 (no excess)
 - $100 per person to a max of $200 ($100/$200)
 - $200 per person to a max of $400 ($200/$400)
 - $400 per person to a max of $800 ($400/$800)

For our GoldStar hospital cover option, you may choose one of the following excess options:

 - $0 (no excess)
 - $200 per person to a max of $400 ($200/$400)
 - $400 per person to a max of $800 ($400/$800)
 - $500 per person to a max of $1000 ($500/$1000)

Please note:

 - Excesses do not apply for same-day surgery.
 - Excesses do not apply for child dependents under the age of 18
 - Excesses are paid once per person per admission covered under the policy in a calendar year up to the maximum.

Conditions or services which are not covered by your health insurance policy (meaning that we won't pay benefits towards hospital or medical costs for these items). If the services are eligible under Medicare Benefit Schedule, you can still receive free treatment as a public patient, or pay the treatment costs as a private patient.

The term 'Extras' (or 'Essentials') is commonly used to refer to ancillary health services such as dental, optical, chiro, and physio treatment.

Here at HIF, our Extras health cover starts from a tiny $0.54c per day. Why not check out of great range of Extras Options and see how much you could save.

The '30% Federal Government Rebate on Private Health Insurance' was introduced to help Australians meet their health cover costs.

If you currently hold a green or blue Medicare card, you are entitled to claim the rebate on both hospital and ancillary products for private health cover.

Most of our members claim the rebate as a reduced contribution:

- 30% if you are under 65
- 35% if your membership includes a person between 65-69
- 40% if your membership includes a person aged 70 or over

You can also choose to pay full contributions through the year and then claim the rebate back at the end of the financial year through your tax return.

Also known as 'extras' or 'ancillary' cover, General Treatment Cover refers to health insurance purchased to cover non-hospital medical services that are not covered by Medicare, such as dental, optical, physiotherapy, other therapies and ambulance.

"Healthy Lifestyle" services are included in all our ancillary cover options, and benefits are payable on:

  - Health assessments
  - Health Management programs
  - Quit Smoking plans
  - Skin Cancer screening
  - Weight Loss programs

To find out more about the various benefits you could claim, visit the Extras Cover Options page.

HICAPS stands for 'Health Industry Claims And Payment Service' and is the technology we use here at HIF (along with IBA) to allow you to claim on-the-spot for most ancillary health services. Simply swipe your HIF member card in the HICAPS machine at the point of service (similar to an EFTPOS style transaction) to claim your benefits electronically.

For more information on the different ways you can claim with HIF, visit the How to Claim page.

Here at HIF, we pride ourselves on enabling member choice - so when it comes to using their preferred healthcare provider, we don’t restrict our members to ‘contracted suppliers’ like some of the other big private health funds do. We do, however, require members to visit 'HIF recognised' providers, which refers to healthcare providers who are legally qualified to practise in Australia (and are subsequently recognised by HIF).

Please call us on 1300 13 40 60 if you would like to confirm if a healthcare provider is recognised by HIF. 

Please note that HIF does not cover hypnotherapy services on any of our levels of health cover.

IBA is the technology we use here at HIF (along with HICAPS) to allow you to claim on-the-spot for most Extras health services. Simply swipe your HIF member card in the machine at the point of service (similar to an EFTPOS style transaction) to claim your benefits electronically.

For more information on the different ways you can claim with HIF, visit the How to Claim page.

An Inpatient is a person who has been admitted into an approved hospital or day facility, allocated a bed, and then discharged following treatment.

For all the details about Lifetime Health Cover (LHC) loading, please visit our Lifetime Health Cover page.

Major Dental refers to significant dental services, such as tooth extractions, crowns and bridges.

Why not check out our range of Extras cover options and take out cover for major dental services today.

A Medical Service is a service provided by a doctor, specialist, radiologist, pathologist or anaesthetist. 

Treatment that is deemed necessary by a medical practioner.

The Medicare Benefits Schedule (MBS) is the schedule of fees set by the government for standard medical services. Whether you have private health insurance or are a 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.

The Medicare Levy Surcharge (MLS) is levied on Australian taxpayers who earn above a certain income and don’t have private hospital cover.

The MLS is a Federal Government initiative designed to encourage individuals to take out private hospital cover and, where possible, to use the private hospital system to reduce demand on the public system. The surcharge is calculated at the rate of 1% of taxable income, in addition to the Medicare Levy of 1.5% that’s paid by most Australian taxpayers.

The MLS is imposed on individuals earning over the threshold who do not have an appropriate level of hospital insurance. If you currently earn over $80,000 per year as a single or $160,000 for couples or families, then you will pay an extra 1% Medicare Levy Surcharge at tax time.

However, the family threshold increases by $1,500 for each dependent child after the first dependent child (i.e. the threshold for a family with three dependent children would be $163,000). You can avoid this by taking out hospital cover with an excess of no more than $500 – all of our hospital cover options meet the requirement to avoid the MLS.

See our Pay Less Tax page for more information, and try our handy tax savings calculator to see whether you will incur the MLS this year.

Naturopathy is a complementary and alternative medicine which emphasises the ability of the body to heal and maintain itself, which practitioners believe is innate. It focuses on treating the cause of a disease rather than the symptoms themselves.

A Non-Contracted Hospital is a private hospital not contracted by the Australian Health Services Alliance or HIF, to provide services to HIF members. Out of pocket costs cannot be guaranteed in these hospitals (basic default benefit applies).

Obstetrics is defined as the branch of medicine concerned with pregnancy and childbirth, including the care of the mother and fetus throughout the pregnancy, childbirth, and the immediate postpartum period. 

Need maternity cover? Check out our popular maternity cover options

Occupational Therapy means the treatment or rehabilitation of persons who suffer physical or emotional disabilities. 

An outpatient is someone who has received medical treatment in a doctor’s surgery or casualty department and has not been admitted into hospital. Benefits for outpatient services are only payable by Medicare Australia.

The Pharmaceutical Benefits Scheme (PBS) provides a Government subsidy to reduce the price of some prescription medicines.

The Private Health Insurance Administration Council (PHIAC) is an independent Statutory Authority that regulates the private health insurance industry.

Podiatry means treatment of the foot, ankle or lower leg by a qualified podiatrist.

A Policy Holder is the holder of an insurance policy that is referrable to HIF. A holder of an HIF Insurance policy is referred to as the Primary Member.

Portability is the ability for people to transfer from one insurer to another, without re-serving waiting periods.

A Practitioner in Private Practice is a practitioner who does not:

(a) Use any publicly funded hospital, clinic, health centre or other such facility, including a facility provided by a municipal authority for, or in connection with, the provision of an Ancillary Service for which a Benefit is claimed under the Ancillary Table; and

(b) Receive publicly funded assistance or support, whether by way of remuneration, subsidy or otherwise, in connection with the provision of the Ancillary Service, except where the Ancillary Service is provided at the clinics of strategic alliance partners, joint ventures or HIF’s clinics.

A Pre-existing Ailment is defined by law as any ailment, illness, or condition that you had signs or symptoms in the opinion of a medical practitioner appointed by the fund existed of during the six months before you joined a hospital table or upgraded to a higher hospital table. This rule applies whether the ailment, illness or condition was known to the member or not.
 

Your Premium is the amount you pay for your private health insurance cover.

To view our range of competitive health cover options, visit the health insurance page or get a quick quote.

A Primary Member is the first named member, irrespective of who pays contributions to HIF for the provision of health cover. The primary member also holds the legal responsibility to ensure the membership is kept financial at all times, and holds the right to add or remove dependants from the membership. In the instance that the primary member wishes to provide authority for another person to act on their behalf, a spousal/agents authority is required.

Surgically implanted Prostheses include such things as hip replacements, artificial lenses and heart valves.
 

A Qualifying Period is any period, occurring immediately after joining the Fund or joining a higher benefiting table, during which either some or all Fund benefit is not payable.

The Federal Government contributes a proportion of your private health cover premium for permanent Australian residents. You can receive this rebate as a reduction in your premiums, a direct payment from Medicare or a tax rebate in your annual tax return.

To learn more about the rebate and what you could be entitled to, visit the Health Insurance FAQs page.

An Australian educational institution such as a school, college or university, recognised by the Commonwealth, State or Territory Governments.

Remedial Massage Therapy focuses on the treatment of soft tissue injuries, aching muscles and postural imbalances using a variety of techniques. It traces the discomfort as far as possible back to the original cause, healing both the cause of the disorder as well as the symptoms.

Restricted Services are hospital services which are only covered for payments at the basic benefit level.

All of our affordable Extras cover options include access to HIF’s SmartTeeth dental rebates.

All Australian health funds are required by law to provide Standard Information Statements (SIS) to members annually. The Statements enable health fund members to review their current policy and private health insurance products.

There are three types of Standard Information Statements:

Hospital - describes the features and limitations of hospital cover, including the type of accommodation, which medical services are covered in full, part or not covered, waiting periods and additional payments (excesses, co-payments and gaps)

General Treatment - describes the features and limitations of general treatment cover, including which services are covered, waiting periods, benefit limits and example benefits for each type of service; and

Combined - describes the features and limitations of a combined hospital and general treatment cover, with details as above.

High income earners (as determined by the Australian Taxation Office) will avoid the Medicare Levy Surcharge of 1% if they have private hospital insurance.

The surcharge is in addition to the normal Medicare Levy and may cost more than your private hospital cover costs.

Visit our Pay Less Tax page to find out more, or contact the ATO on 13 28 61 to determine your eligibility.

Theatre Fees are costs for procedures performed in an operating room, including those performed in day surgery facilities.

Traditional Chinese Medicine refers to a complementary or alternative medicine that includes a range of traditional medical practices originating in China. Practices include theories, diagnosis and treatments such as herbal medicine, acupuncture and massage.

The document transferred between registered health funds, detailing the member’s fund history (including Certified Age at Entry), confirmation of financial status of member and claims history.

The term Waiting Periods refers the time you will need to be a member before you can claim a benefit from HIF. Members coming from other recognised Australian health funds will not have to re-serve any waiting periods already served.

Current HIF promotions designed to reduce waiting periods

Join now and claim straight away on the most popular Extras services.
If you join HIF and your cover includes one of our great-value Extras options, we'll waive all 2 month waiting periods. That means that once you're a member and you've paid your first months premium, you can start claiming straight away on popular services like general dental, optical, chiro, physio, pharmacy, complementary therapies, and healthy lifestyle services. Find out more and join today

Switch from another fund and we'll honour your length of membership too.
As our way of saying thanks for switching to HIF, we'll also honour your length of membership with your previous fund. That means that if you're joining HIF on an equivalent level of hospital and/or Extras cover, you won't have to re-serve any hospital and/or Extras waiting periods and you'll also have access to greater benefits straight away! Find out more and join today