Cover highlights Unique gap cover with benefits for hospital in-patient medical services paid up to the AMA list of services and fees. Premium cover with no excess No exclusions or restrictions for services eligible for Medicare benefits National Ambulance Cover
What you get: Effective 1 April 2011 Excess None Co-payments None Waiting Periods None for accidents 12 months for pre-existing conditions 12 months for obstetrics 2 months for psychiatric, rehabilitation and palliative care (whether or not for a pre-existing condition), and all other treatments Exclusions None Benefit restrictions Plastic and reconstructive surgery benefits for hospital and medical costs are restricted to services eligible for Medicare benefits. When chosen for cosmetic reasons only default hospital accommodation benefits apply. Ambulance National cover for emergency and medically necessary ambulance services when an ambulance is called to attend you but you are not subsequently taken to hospital it is medically necessary for you to be transported by an ambulance to be admitted to hospital you need immediate medical attention at a hospital or other approved facility you are an admitted patient and need to be transferred to another hospital Accommodation In a contracted private hospital or day-only facility, or a public hospital as a private patient, all costs of accommodation are covered. In non-contract hospitals or day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses Hospital services All costs are covered for theatre and labour ward services while you are an in-patient. Medical services gap cover The cost of doctors' services delivered while an in-patient are covered by our premium gap cover. Medicare pays 75% of the Medicare Schedule fee, your Fund benefits pay the remainder up to a total equal to the AMA List fee, you pay any amount charged above the AMA List fee. Most pathology and radiology providers have contracts with us, so while you are an admitted patient most of these services will have no out-of-pocket expense. Medical service claims should be submitted directly to the Fund by your doctor or you. Pharmaceuticals In a contracted private hospital or day-only facility, or a public hospital as a private patient all costs of PBS pharmaceuticals related to the condition being treated are covered, and the cost of non-PBS items related to the condition being treated are covered as per the contract with the hospital. In non-contract hospitals or day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses. Prostheses Covers 100% of the minimum cost specified for government approved prostheses. Other Up to $100 per day for travel and accommodation where a doctor certifies the need for a parent, spouse or child to be with a member in hospital more than 200 kms from home. An annual limit of $1,000 applies. What you can expect to pay if you go to hospital For personal items such as newspapers and television hire.
Looking for Extras Cover as well? You can add Extras cover to your Hospital Cover View Extras Options