What is a Private Health Information Statement?
A Private Health Information Statement gives you a high-level overview of your health insurance cover. It can help you review an existing policy or consider other options. PrivateHealth.gov.au says there are three types of PHIS, depending on the type of health insurance policy you’re considering:
- Hospital: This type of PHIS includes clinical categories covered by a hospital-only policy. It identifies any restrictions, waiting periods and additional payments (excesses, co-payments and gaps) that apply to your policy.
- General treatment (extras cover): This form of PHIS describes features, as well as limits, for general treatment cover (also referred to as extras cover), outlining your coverage, waiting periods, benefit limits and example benefits for different services.
- Combined: This type of PHIS describes what’s included in a combined hospital and general treatment policy, including features and limitations, as well as coverage, waiting periods, benefit limits and examples of benefits.
A PHIS will also specify whether or not you are exempt from the Medicare Levy Surcharge (MLS), based on the policy you hold. As a general rule of thumb, you won’t have to pay the MLS if you have a hospital or combined health insurance policy, but you may have to if you don’t have private health insurance or if your policy only covers general treatment (extras).
What health insurance policies have a Private Health Information Statement?
All health insurance providers are legally required to supply a copy of the PHIS for every policy they offer to the Private Health Insurance Ombudsman. They may have to provide them in other circumstances too. For example, hif says that as an Australian health insurance provider, it also needs to share an applicable PHIS:
- with newly insured people
- with currently insured persons on a domestic policy, annually
- when a change is made that might be detrimental to an insured person
- as required.
What isn’t included in a Private Health Information Statement?
While it gives general insights, a PHIS won’t reflect your personal circumstances. Some information not given in a PHIS includes:
- Premium costs (net)
- Premium payment frequency (monthly, quarterly, yearly)
- Premium payment method
- Health insurance policy members (i.e. who is covered by your policy)
- Level of government rebate
- Age-based discounts (if they apply)
- If Lifetime Health Cover loading applies
If you have private health cover, you can usually find out most of these details from your provider by contacting them directly or logging in to your online account.
Where can you find a Private Health Information Statement?
Every PHIS can be found at Privatehealth.gov.au, an Australian Government initiative that’s managed by the Commonwealth Ombudsman. Your provider may also include it for you as a link or attachment if you receive your correspondence via email, or you may opt to receive it in the post as a paper statement.
What other information is available about a health insurance policy?
Conditions, inclusions, exclusions and waiting periods can apply with health insurance, so it’s a great idea to read the fine print. As well as the PHIS, consider reading wider documents your provider makes available to you, such as any Key Facts Sheets or Target Market Determination (TMD). If you aren’t sure about the terms of a policy, you can ask the provider directly.
Where can you find out about tax and health insurance?
You may want to know more about your health insurance and tax. You can find out more from the Australian Taxation Office (ATO) on topics such as the Medicare Levy and the private health insurance rebate. It may also be a good idea to speak to a tax agent if you have questions about your personal tax and how private health cover can affect it.
