Under Australian law, all private health insurance companies are required to provide Standard Information Statements (SIS) regarding their policies. This allows you to review your existing policy and to make informed comparisons between different health insurance products.
What’s in a Standard Information Statement?
An SIS will include information on which health care services are covered in full and which are only covered in part. Covered in full means that you won’t have to pay anything for these services — your insurance provider will cover the cost. Covered in part means that only some of the costs will be borne by your private health fund; you will have to pay the rest of the money yourself.
A Standard Information Statement will tell you the benefit limit of a policy: this is the maximum amount that you can claim in a 12-month period. It will also detail any exclusions, medical services that are not covered by your policy. You will have to pay for any excluded services out of your own pocket.
Also specified are any additional payments, which may include:
- Excesses – the amount of any claim that you agree to pay, also called the front-end deductible
- Co-payments – costs you agree to share with your insurance provider
- Gaps – costs which are neither covered by Medicare nor your private insurance, and which you must cover out of your own pocket
A Health Insurance Summary
Note that an SIS is only intended to give you an overview of a product’s features and limitations so that you can easily compare health insurance. You can see if your broad needs are covered, and shop around for the best value. An SIS does not contain detailed information, however; for this, you will need to follow-up with the private health fund in question. In particular, if you see “other services” on a list, it’s sensible to check with the insurer to find out exactly what services are covered, partly covered or excluded.
There are three kinds of Standard Information Statements: General Treatment, Hospital and Combined.
A General Treatment SIS gives you a broad explanation of the features and limitations of a policy — what it covers, what is not covered, and what is only covered in part. Services covered by general treatment insurance include pharmaceuticals not covered by the Pharmaceutical Benefits Scheme, as well as specialist treatments like physiotherapy, dental care and eye care.
A Hospital SIS gives you an outline of the limitations and features of the hospital cover offered by a policy: what services (treatments, hospital accommodation, medical services, ambulance services if applicable) are covered in full, covered in part or not covered. You will also be able to see information on the kind of accommodation you can expect while in hospital; waiting periods; and additional payments such as co-payments, excesses, and gaps. An excess related to hospital care may be termed overnight excess, daily excess or patient moiety in an SIS.
A Combined SIS gives you all the details on both the General Treatment and Hospital elements of your policy.
When you compare health insurance Standard Information Statements, you may also notice figures stated for premiums or benefits. This is an amount for the purposes of comparison. Your rates may be different to those shown on the SIS, depending on your circumstances.