Health Insurance Gap What Is That?}

January 9, 2019 By

Submitted by: Frank Wall

Private Health Insurance seems to have its own special language; so lets get rid of the confusion and clear out the jargon.

When it comes to Health Insurance, the one feature that has most people baffled is the Waiting Period. A point to remember is that the waiting period protects members of the fund (you) by ensuring that no contributor makes a large claim shortly after joining. This would then result in an unpleasant increase in your premiums. Make sure that you are completely aware of the different waiting periods for each claim area.

If you have an accident or an emergency; there is usually no waiting period after you have joined the fund. Also, if you wanted to change your Health Insurance fund, you dont have to re-serve the waiting periods for services that your previous Insurance covered. This is called Continuity of Cover and is a great point to confirm when doing your Private Health Insurance Health Check.

What is the Gap? Not a great chasm that you cross in a giant leap of faith with your eyes closed, but instead its the difference between what your doctor charges and what Medicare and your Private Health Insurance will pay for a particular service.

In Australia, anyone who is covered by Medicare can be admitted to a hospital as a public patient. This means that you are entitled to free treatment in a public hospital. Even if you have private hospital insurance, you can elect to be treated as a public patient. Doing this means that youll have no gap to pay.

Alternatively, if you decide to be treated as a private patient, your health fund will pay the hospital cost but you might still be left with some bills to pay. Why? If youre admitted as a private patient youll be charged medical fees. Medicare will cover 75 per cent of the schedule fee and your health fund will cover the other 25 per cent, but neither will cover what the doctor(s) charge over and above this. This is the Gap.

Some doctors have an arrangement with a health fund and dont charge a gap fee, but whether or not you have to pay some of the costs will also depend on your level of cover.

Check with your surgeon what the gap is likely to be.

A Co-Payment is different to your policy Excess in that the excess is an amount agreed upon in order to lower your premiums paid each calendar year, while the Co-Payment is an amount paid day-to-day for the services you receive in hospital. Check your Product Disclosure Statement if your co-payment is capped or required to be paid for day surgery.

TOP TIP: Make sure that youre not required to pay both a Co-payment and you annual Excess charges.

The Product Disclosure Statement (PDS) is the information relevant to the policy that you have decided to purchase from your chosen Health Insurance Fund.

This information should outline:

– Inclusions

– Exclusions

– Eligibility

– How to Apply

– Cooling off period

– Premiums

– Coverage

– Benefits

Once youve agreed to the PDS youll receive a Policy Document outlining your new Private Health Insurance cover.

Remember that you can always contact your Health Fund or the Financial Service Ombudsman if you have any issues relating to your policy.

About the Author: Frank Wall is a student of Private Health Insurance in Australia. He helps people

compare private health insurance cover

, find the

cheap private health insurance


best extras or anciliary cover



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