HCi glossary of health insurance terms
Like most industries, health insurance has its own words and terms that can be confusing if you’re not working in health insurance. To make it easy, we avoid jargon where possible and give you the HCi glossary.
If you are having trouble understanding health insurance, or have ideas for this glossary, please contact our friendly team on 1800 804 950 or via HCi Chat.
| Access gap cover | HCi and AHSA offer this program to allow members more choice and minimise medical gaps. Access Gap Cover gives members more clarity with private hospital cover to help reduce out-of-pocket expenses (medical gap) for in-hospital admissions. Doctors can opt-in or opt-out of the Access Gap Cover scheme at any time. |
| Accident | An unforeseen event or incident which results in an injury and requires immediate treatment or medical attention. |
| Admission | Treatment or medical attention as a Private Patient in a registered public, private or day hospital where a medical practitioner has admitted you and declared you an inpatient. Emergency room treatment in a private hospital is not an Admission. |
| Agreement hospital | A hospital with which we have negotiated a contract to minimise out-of-pocket expenses for most hospital related expenses. |
| Australian Health Services Alliance (AHSA) | A third party contracted by HCi to negotiate fees and benefits with hospitals and medical providers. |
| Benefit(s) | An amount that is paid to the member or the provider for approved services or treatment as covered by the policy. |
| Calendar year | 1 January to 31 December. |
| Claim | A request for the payment of benefits under fund rules and the member’s policy. |
| Certified entry age | The age at which you first got hospital cover. |
| Compensation | A payment you are legally entitled to, likely to receive, or have received payment from another party as compensation, damages or other benefits for expenses. For example, workers compensation or motor vehicle accident claims where an entitlement has been received. |
| Commonwealth Medical Benefit Scheme (CMBS) |
A list of Medicare services that are subsidised by the Australian Government. |
| Dependants | A Member may have one or more dependants on their HCi policy. HCi recognises partners and certain eligible children up to age 31 as dependants, subject to them meeting requirements. Please read our factsheet or call us to find out more about the types of dependant and the rules. |
| Exclusions | Services and treatments not covered by your health insurance cover. |
| Excess | An amount you have agreed to pay towards your hospital treatment. Each adult on a policy may have to pay an excess once per calendar year. |
| HCi | Health Care Insurance Ltd. |
| Lifetime Health Cover | A Federal Government scheme to encourage Australians to take out private health insurance earlier in life and continue to hold their cover. |
| Medical gap | (or ‘out-of- pocket’) is any amount above the listed Medicare Benefit Schedule Fee or Access Gap Schedule. We encourage you to contact your health provider to find out if you will have to pay a medical gap. |
| Medicare Benefit Schedule (MBS) | Medicare contributes a set amount for each treatment or procedure, as stated in the Government’s MBS. The Australian Government subsidises these services. Your doctor may charge more than the MBS fee so you may have to pay additional out-of-pocket expenses. |
| Member | A person who is a member of HCi in accordance with our constitution. |
| Medicare Levy Surcharge (MLS) | A levy on your taxable income of up to 1.5% depending on your level of income. MLS applies if you do not hold an appropriate level of hospital cover and your taxable adjustable income exceeds the limit set by the Federal Government. |
| Partner | A person who lives with the policy holder in a marital or de facto relationship. |
| Policy | The contract between you and Health Care Insurance Ltd which provides your private health insurance cover in exchange for a fee or premium. |
| Pre-existing conditions Illness or ailment | An ailment, illness or condition where the signs or symptoms existed during the six months before joining HCi (or upgrading to a higher level of cover). |
| Premium | An amount of money a member is required to pay for their private health insurance cover. |
| Private Health Insurance rebate | An amount from the Australian Government to help you meet the cost of private health cover. |
| Private Health Insurance Statement | A dated document that provides you with a summary of your health insurance cover. |
| Restricted Services |
A treatment that will only get a Government-set minimum payment towards hospital accommodation. For Restricted Services as a private patient in a public hospital, we will pay minimum shared room benefits. If you’re treated in a private hospital for a Restricted Service, you may incur substantial out-of-pocket expenses. |
| Same Day admission | An admission in a registered hospital or registered day hospital where you are discharged and admitted on the same date. |
| Waiting period(s) | A set time you and anyone else who is insured under the policy must continuously be covered for to qualify for any claims. This is set in accordance with the Private Health Insurance Act 2007. |
| You | The person or persons covered by the policy. |
Other helpful resources for you
Factsheets
Guides
Frequently asked questions
// Mobile App
HCi App
The new HCi phone app allows you to easily claim through the use of your smart phone.
Download the app and, when you have to claim, simply take a photo of your service provider’s receipts. Your claim will then be submitted electronically.
