Health Insurance Terms Explained: Your Plain-English Dictionary

Health insurance in Australia comes with its own set of words and phrases. If you hold an Overseas Student Health Cover (OSHC) or Overseas Visitors Health Cover (OVHC) policy, you will see these terms in your policy documents, on your certificate of insurance, and when you make a claim.

This guide breaks down the most common health insurance terms into plain English. We have grouped them by topic so you can find what you need quickly. Each term includes a short definition and, where helpful, a real-world example of how it works in practice.

All definitions on this page are general explanations. Your specific cover may differ. Always check your policy document or contact us for details about your health cover.

Health insurance for international students on a student visa (subclass 500). The Department of Home Affairs requires most student visa holders to hold OSHC for the full length of their visa (Department of Home Affairs, 2024). OSHC covers hospital treatment, doctor visits, some prescription medicines, and emergency ambulance transport.

Tip: You usually buy OSHC before you arrive in Australia, and it needs to last as long as your visa. If you extend your visa, you need to extend your cover too.

Health insurance for people in Australia on a temporary work visa, visitor visa, or other eligible visa. OVHC is not always a visa requirement, but it can help you pay for medical care while you are in Australia. Different levels of OVHC cover different things, so check what is included in the policy you choose.

Tip: If you move from a student visa to a 485 (Temporary Graduate) visa, you will usually switch from OSHC to OVHC. Contact your insurer to arrange this without a gap in cover.

These are the terms you will see when looking at what you pay and what your insurer pays.

The amount you pay for your health insurance policy. This includes all taxes and charges. You may pay your premium upfront for the full length of your visa, or in regular payments for your OVHC (such as monthly or quarterly), depending on your insurer and policy type.

A set dollar amount you pay before your insurer starts paying for a hospital stay. Your excess is listed on your certificate of insurance for your OVHC. It applies each time you are admitted to hospital as an overnight or same day patient. For same day hospital visits, you usually pay half the excess. The excess is payable once per adult, per financial year (1 July to 30 June). It does not apply to children under 18 on your policy.

The difference between what a doctor charges and what Medicare or your insurer pays. For example, if a doctor charges more than the Medicare Benefits Schedule fee, you pay the difference out of your own pocket.

Any amount you pay yourself that is not covered by your insurer. This can include co-payments, amounts above your policy limits, and costs for services that are not included in your health cover.

The amount your insurer pays towards your medical costs. Benefits are determined by the MBS (Medicare Benefits Scheme). They may be paid to you or directly to the hospital or doctor on your behalf. Each policy sets out the benefits available and any limits that apply.

The maximum amount your insurer will pay for a particular service or treatment within a set time (usually per year, per person). Once you reach the limit, you pay any extra costs yourself.

A waiting period is the time you need to wait after your policy starts before you can claim for certain treatments. You cannot claim for treatment received during a waiting period. 
 
Your waiting period starts from whichever of these dates comes last: the date you arrived in Australia, the date your eligible visa was granted, or the date your policy started. Visit waiting periods for more information on our waiting periods treatments.

An illness, injury, or health condition where signs or symptoms existed in the 6 months before your cover started. This includes conditions that were present but had not yet been diagnosed. A medical practitioner appointed by your insurer will form an opinion on whether a condition is pre-existing. If a condition is found to be pre-existing, a 12 month waiting period applies before you can claim for related treatment (unless you need emergency treatment as defined in your OSHC policy).

A person who has been formally admitted to a hospital or day facility. If you are admitted to hospital (even for a same day procedure), you are an in-patient. Your excess applies to in-patient hospital admissions for OVHC.

A person who receives a health service without being formally admitted to hospital. You can receive out-patient services at a hospital, a clinic, or a doctor's office. Common out-patient services include GP visits, blood tests, and X-rays.

A hospital that has an agreement with your insurer to charge set fees. Going to an agreement hospital usually means lower out of pocket costs for you. Your insurer can tell you which hospitals are in their network.

A list of medical services set by the Australian Government. Each service on the list has a standard fee (called the MBS fee or schedule fee). Your insurer uses this fee to work out how much benefit to pay. If your doctor charges more than the MBS fee, you may have out of pocket costs.

A government program that makes some prescription medicines cheaper. If your doctor prescribes a medicine that is listed on the PBS, you pay a set amount (called the PBS patient co-payment), and the rest is subsidised. Your health insurance may also help with some of these costs, depending on your policy.

An agreement between Australia and certain other countries that allows visitors from those countries to use some Medicare services. If you are covered under an RHCA, any treatment paid for by Medicare cannot also be claimed through your OSHC or OVHC policy. Visit Services Australia for more information on which countries are included and what is covered.

The document that confirms your cover. It shows your name, your policy type, your start and end dates, your excess (if any), and who is covered on your policy. Keep this safe. You will need it when you visit a hospital or make a claim.

A family member covered under your policy. For OSHC, a dependant can be your partner or your children (including adopted or step-children) who are eligible under your student visa. For OVHC, similar rules apply. A dependant partner must hold the same visa type as the primary visa holder. Waiting periods for dependants are calculated from the date they arrived in Australia, their visa was granted, or their cover started (whichever is later).

A temporary student visa that lets you stay in Australia while your new student visa application is being processed. If you held a student visa and were then granted a bridging visa, your OSHC policy can continue to cover you during this period.

The types of hospital treatment grouped by body system or condition. For example, "bone, joint and muscle" is one clinical category and "heart and vascular system" is another. Your policy lists which clinical categories are included and which are excluded. You can view the full list at privatehealth.gov.au.

A treatment or service your policy does not cover. If you are admitted to hospital for an excluded service, your insurer will not pay any benefits. Exclusions apply to both inpatient and outpatient benefits. Always check your policy to see what is and is not covered before you need treatment.

A request submitted to your insurer to pay for a medical service you have received. You can usually submit a claim online, through an app, or by post. You may need to provide your receipt, your Medicare statement (if applicable), and details of the treatment.

When your doctor or hospital sends the bill directly to your insurer instead of you paying first. If you visit a doctor in your insurer's direct billing network, you may not need to pay upfront for the visit. This makes the process simpler.

Treatment for a condition that poses an immediate risk to your health and needs urgent care. This includes things like suspected organ failure, serious bleeding, drug overdose, or any condition where you need to be admitted to hospital straight away. Waiting periods do not apply to emergency ambulance transport. They may still apply to follow up hospital or medical treatment after the emergency.