HCi glossary of health insurance terms

Like most industries, health insurance comes with its own words and definitions that can be confusing for those not working in health insurance. To make it easy, we avoid jargon where possible and explain the relevant words below for you.

If you are having trouble understanding health insurance or want any words added to this glossary, please contact our friendly team on 1800 804 950 or via HCi Chat.

 

Access gap cover A scheme offered by HCi in partnership with AHSA 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 member has been admitted by a medical practitioner and declared 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 entitlement and payment of benefits in accordance with fund rules and the product the member holds.
Certified entry age The age at which you took up hospital cover.
Compensation A payment you are legally entitled to, likely to receive, or had 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.
Contribution(s) An amount of money a member is required to pay to us to receive private health insurance cover.
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 visit our website or call us to find out more about the different dependant types and the rules that apply.
Exclusions Services and treatments not covered by your health insurance cover.
Excess If you are going into hospital you may have to pay an excess once per calendar year. An excess is the amount you have agreed to pay towards a claim on your hospital insurance.
HCi Health Care Insurance Ltd.
Lifetime Health Cover A private health insurance initiative introduced by the Australian Government in July 2000 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 medical gap.
Medicare Benefit Schedule (MBS) Medicare contributes a set amount for each treatment or procedure, as laid out in the Government’s MBS. This schedule is subsidised by the Australian Government. Your doctor may choose to 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 A pre-existing ailment, illness or condition is one where the signs or symptoms existed during the six months before joining HCi (or upgrading to a higher level of cover).
Private Health Insurance rebate An amount from the Australian Government to help you cover the cost of private health insurance.
Private Health Insurance Statement A dated document that provides you with a summary of your health insurance cover.
Restricted Services

A service where we pay the minimum benefit set by the Government 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 on the same date as you were admitted.
Waiting period(s) A period of time set by HCi in accordance with the Private Health Insurance Act 2007 by which you and anyone else who is insured under the policy must continuously be covered by before anyone insured can receive a paid benefit.
You The person or persons covered by the policy.

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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.