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Glossary

Meanings of terms used in private heath insurance:

Term	Meaning
adult	any person who is not a dependent child
benefit	payment made by private health insurers towards health care costs claimed by policyholders
claim	the same as benefit
community rating	a system of setting premiums and providing access to health insurance that prevents insurers from discriminating by age (except as permitted by lifetime health cover), health, gender, race, sexual orientation, residence, occupation or any other characteristic that is likely to result in an increased need for treatment.
contribution	periodical payment made by a policyholder to purchase and continue health insurance
copayment	amount payable periodically by a claimant before calculating any benefit payable by an insurer
cover	transfer to a health fund of some liability for the cost or provision of a health treatment
deductible	initial amount payable by a claimant before calculating any benefits payable by an insurer
dependent child	a person who is under 18 years of age or is a dependent under the rules of the health insurer, and who is not more than 25 years of age and does not have a partner
excess	the same as a deductible
exclusion	provision in a private health insurance policy that excludes cover for a specific health condition
FED	a "front end" deductible similar to a deductible
general cover	insurance for treatment intended to manage or prevent a disease, injury or health condition, other than hospital treatment
health fund	an organisation registered to carry on the business of private health insurance in accordance with the Private Health Insurance Act 2007
hospital	an institution where patients can be admitted by a medical practitioner for management or treatment of a condition
hospital cover	insurance for treatment in hospital as a private patient
insurance	the same as cover
insurer	the same as health fund
lifetime health cover	a requirement on insurers to add loadings to premiums in accordance with government rules for policyholders who start hospital cover after they are 30 years of age
Medicare	a system financed from general taxation of providing access for all Australian citizens and permanent residents to treatment without charge in public hospitals and to subsidised services by medical practitioners
Medicare Levy Surcharge	an additional tax of 1% on taxable incomes (including reportable fringe benefits and family trust distributions) that exceed $70,000 a year for individuals and $140,000 for couples (slightly more with dependent children), payable in addition to the Medicare Levy while the taxpayer does not have appropriate private hospital cover
moiety	the same as copayment
overseas visitors and students	visitors and students who are not citizens or permanent residents are generally not entitled to many of the benefits from Medicare and the private health insurance system, and may be required to make other health care provision under their terms of entry to Australia
PHIAC	the Private Health Insurance Administration Council, an independent Statutory Authority which regulates the finances of the private health insurance industry in Australia
PHIO	the Private Health Insurance Ombudsman, a Commonwealth Government service for consumers with enquiries and complaints relating to private health insurance
policyholder	any adult covered by private health insurance
pre-existing condition	an ailment, illness or condition for which, in the opinion of a medical practitioner appointed by the health fund, signs or symptoms existed at any time in the previous six months
premium	the same as contribution
private health insurance	insurance provided by a health fund for hospital treatment or general treatment in accordance with the Private Health Insurance Act 2007.
private health insurance rebate	a subsidy paid by the Commonwealth Government of 30% or more (depending on age) of the premiums paid for private health insurance by citizens and permanent residents of Australia
private hospital	a hospital owned and operated by a charitable or religious organisation or by private investors
private patient	a person admitted to a public hospital who chooses to have private accommodation and doctors of choice, or a person admitted to a private hospital
public hospital	a hospital controlled by the government of a State or Territory or the Commonwealth
public patient	a person admitted to a public hospital and who accepts treatment by hospital doctors and accommodation in a shared ward
rate protection	the right to keep your rate unchanged until the next premium is payable
restriction	a provision in a health insurance policy that restricts cover for benefits for specific health conditions
risk equalisation	a system of compulsory transfer payments among health insurers designed to compensate for different demographics and to support community rating