Health Insurance Terms Glossary

AccessGap cover is HIF’s medical gap cover arrangement, designed to minimise or eliminate out of pocket expenses for medical services whilst an inpatient in a registered overnight hospital or day facility.

The technique of inserting and manipulating fine filiform needles into specific points on the body, with the aim of relieving pain and for therapeutic purposes. Acupuncture focuses as much on the prevention of illness as on the treatment.

The period of time during which a person is admitted as an inpatient for a condition or illness into an approved hospital/day facility for the purpose of receiving hospital treatment until the time they are discharged from the hospital/day facility.

Ancillary or Options or Extras cover you for services that Medicare don’t pay a benefit on. They include services such as:

• Dental
• Optical
• Physiotherapy
• Chiropractic
• Complementary Therapies
• Ambulance

The maximum amount of benefits payable to a member in a calendar year, commencing January 1 and ending December 31.

When a provider or service is recognised by HIF.

Treatment by a registered nurse in a patients home that has been approved by a medical practitioner. This service does not include domestic services and members must have a hospital product to claim a benefit on this service.

When the benefit payable is equivalent to the benefits available if the service was provided in a shared room in a public hospital.

The payment due to the primary member for services received by an approved provider.

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

With cardio being the heart and thoracic the chest, surgery included in this grouping would include heart bypass surgery and lung surgery.

Surgery which replaces the opaque (cloudy) natural lens, with a clear artificial one.

Focuses 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.

Dietetics aims to promote good health through proper eating. They develop modified diets, participate in research, and educate individuals and groups on good nutritional habits.

On a family membership, dependants include single children under 21 years or full time student under 25 years.

You can claim on-the-spot at your provider by swiping your membership card through HICAPS or IBA software fitted EFTPOS machines.

The amount selected on a hospital cover which the primary member agrees to pay before a benefit will be payable from HIF.

Services that are not covered by a benefit and where all costs are paid by the member.

Exercises designed to treat a limited number of issues related to the muscular imbalance or co-ordination of eye movement between both eyes.

The fund is HIF (Health Insurance Fund of WA).  The fund name for tax purposes is HIF.

The Federal Government introduced the rebate to assist 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 Insurance.

Most HIF 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 you membership includes a person aged 70 or over

Some members choose to pay the full contributions through the year and claim the rebate back at the end of the financial year through their tax return.

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

The Federal Government introduced the lifetime health cover loading to encourage Australians to take out Private hospital insurance at a younger age. For every year over the age of 30 that you don’t have private hospital insurance a 2% loading is applied to the cost of the insurance. For example a single 37 year old would pay 14% lifetime health cover loading. The loading can become complicated and can vary due to different circumstances such as adding a partner, previous covers, being overseas and new immigrants. We highly recommend you contact HIF if you have any questions relating to calculating your lifetime health cover loading. Loading does not apply to ancillary cover.

Treatment that is deemed necessary by a medical practioner.

The Medicare Levy Surcharge (MLS) is levied on Australian taxpayers who do not have private hospital cover and who earn above a certain income. The MLS is a Federal Government initiative to encourage individuals to take out private hospital cover, and where possible, to use the private hospital system to reduce the demand on the public system.

The surcharge is calculated at the rate of 1% of taxable income. It is in addition to the Medicare Levy of 1.5%, which is 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. The threshold is $73,000 for individuals and $146,000 for families or couples.

HIF’s domestic hospital covers meet the Federal Government requirements for avoiding the MLS. See Pay Less Tax for moreThe Federal Government introduced the Medicare levy surcharge to encourage high income earners to join Private Health Insurance. Currently if you earn over $73,000 per year as a single or $146,000 for a couple or a family then you will pay an extra 1% Medicare levy surcharge at tax time. You can avoid this by taking out hospital cover with an excess of no more than $500. All HIF hospital covers meet the requirement to avoid the Medicare levy surcharge.

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.

The treatment or rehabilitation of persons who suffer physical or emotional disabilities.

Treatment involves the manual or physical manipulation of the musculoskeletal system. Most often used to treat neck and back problems.

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.

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

Hospital services which are only covered for payments at the Basic benefit level.

Remedial massage 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.

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.

Waiting periods are 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.