What is a Standard Information Statement? How this obscure document can help you understand your health insurance policy
A Standard Information Statement (SIS) is a summary of the benefits and limitations of a health insurance policy. Unlike a Product Disclosure Statement (PDS) that lists the terms and conditions of the policy in detail, an SIS is a snapshot of your cover and allows you to see the policy’s key features at a glance when reviewing your policy. Health insurance funds are required by law to provide an SIS with each policy they offer.
What does a Standard Information Statement do?
A Standard Information Statement allows you to see, at a glance, if your needs are being met by a policy, and it's a useful way of comparing the features of two similar policies.
There are three main kinds of Standard Information Statements:
- Hospital. Describes the key features and limitations of the hospital cover provided in the policy.
- Extras. Describes the key features and limitations of the ancillary cover provided.
- Combined. Describes the key features and limitations of combined hospital and extras cover.
What should you be looking for in a hospital SIS?
When reviewing a hospital SIS, you should take note of key features such as:
- Services covered. The hospital services covered including treatment, accommodation, medical services and ambulance and the extent to which cover is provided.
- Exclusions. Hospital services that aren’t covered and for which you will not be able to claim.
- Restrictions. Hospital services that are only partially covered, including those with restricted benefit limits and benefit limitation periods.
- Waiting periods. The periods of time you will have to wait before claiming for particular services.
- Excesses and co-payments. These are the amounts you will be required to contribute upfront towards your hospital treatment.
- Out-of-pocket expenses. Any gaps you may have to pay between fees charged for hospital services and percentages covered by Medicare and your private health insurance.
- Other features. Any additional features offered in the policy such as eligibility for loyalty schemes, health management programs or anything else.
What should you be looking for in an extras SIS?
When reviewing an extras SIS, you should look at the following key features:
- Services covered. The types of ancillary services covered such as dental, optical, physio, chiro, podiatry and natural therapies and whether the insurer has a preferred provider arrangement with any practitioners.
- Benefit limits. The maximum benefits you can claim for these services per person per year.
- Waiting periods. The periods you will need to wait before being able to claim for these services.
- Other features. Additional features offered such as loyalty schemes, preventative healthcare treatments and health management programs.
What should you be looking for in a combined SIS?
When reviewing a combined SIS, you should look at the key features pertaining to both hospital and extras cover including:
- Hospital services covered. Treatment, accommodation, medical services, ambulance, etc.
- Exclusions. Hospital services not covered.
- Restrictions. Hospital services only partially covered.
- Waiting periods. The time you will have to wait before claiming for hospital services.
- Excesses and co-payments. Amounts you must contribute towards your hospital treatment.
- Out-of-pocket expenses. Any gaps you may have to cover yourself.
- Extras covered. The types of ancillary services covered.
- Benefit limits. The maximum benefits you can claim per person per year.
- Waiting periods. The time you will need to wait before claiming.
- Other features. Additional features offered by the insurer.
How does information on your policy document differ from an SIS?
An SIS differs from Product Disclosure Statements (PDS) or product brochures in that it is a general overview only, while a PDS is a detailed description of the benefits, restrictions, exclusions and terms of your cover. The information supplied in an SIS is general information only and should not be relied on to provide an accurate picture of your cover. It can differ from your actual cover in several ways including:
- Premium amount. This may differ from the premium you actually pay as it is the basic monthly rate for that product and doesn’t take into account your personal payment frequency, your annual tax rebate, the level of your Lifetime Health Cover (LHC) loading or any discounts you may be receiving from your insurer.
- Benefit limits. The benefit limits in an SIS are based on new customers, so if you’ve been with your insurer for several years, you may have higher benefit limits than those listed.
- Excesses and waiting periods. These may also not be applicable to your circumstances, depending on the level of excess you have opted for and the amount of time you have held your policy.
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