Document ID: chunk:federal_register_of_legislation:F2024L00144:reg:65:p22
Version: federal_register_of_legislation:F2024L00144
Segment Type: reg
Provision Reference: reg 65 (pt 22/38)
Character Range: 101369–104239

the Medicare Levy Surcharge are exempted if they have a hospital treatment policy with an excess no greater than $500 for a policy covering a single person or an excess no greater than $1,000 for a policy covering more than one person.

Excess & Co-payments        Excess & Co-payments Policies- includes all policy holders who contribute to hospital treatment policies under which an agreed, excess, amount is paid by the policy holder for hospital treatment and/or general treatment services, reducing the benefit otherwise payable in exchange for lower premium costs.

                            Note: these can be combined with exclusionary policies.

                            Excess (also referred to as front-end deductible)

                            An excess is an amount of money a policy holder agrees to pay for a hospital stay before health fund benefits are payable. For example, if a policy has an excess of $200, the insured person will be required to pay the first $200 of the hospital costs if they go to hospital as a private patient. An excess could apply every time the insured person goes to hospital in a year, or it may be capped at a total amount that will be paid in each year.

                            Co-payment

                            With a co-payment, a policy holder agrees to pay an agreed amount each time a service is provided. For example, a policy may have a co-payment clause that requires payment for the first $50 for each day's hospital accommodation. If the policy has such a co-payment and they were in hospital for 5 days, they would have to pay $250, equal to $50 multiplied by 5.The total amount of co-payment that can be paid in a year is often limited to a set maximum amount.

Exclusionary Policies       Means where the private health insurance policy features an exclusion for a particular condition covered by Medicare and there is no coverage at all for medical treatment as a private patient in a public or private hospital or any other setting for that condition. Exclusionary tables exclude payment of benefits for a particular condition in all settings. (This does not refer to the case where the policy only covers the medical services to a limited extent, only in certain settings or only after a certain time.)

                            (This does not refer to the case where the service referred to is not covered by Medicare. For example cosmetic surgery.)

No Excess & No Co-payments  Means all policies other than Excess & Co-payments Policies. The sum of Excess & Co-payments and No Excess & No Co-payments policies will reflect the total hospital treatment policies.

Non-Exclusionary Policies   Means the policy does not have any exclusions (see Exclusionary Policies). The sum of exclusionary and non-exclusionary policies will reflect the total hospital treatment policies. NB: Where