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Excess
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None
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Co-payments
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None
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Waiting Periods
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None for accidents
12 months for pre-existing conditions
12 months for obstetrics
2 months for everything else
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Exclusions
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None
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Benefit restrictions
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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.
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Ambulance
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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
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Accommodation
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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
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Hospital services
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All costs are covered for theatre and labour ward services while you are an in-patient.
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Medical services
gap cover
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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.
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Pharmaceuticals
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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.
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Prostheses
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Covers 100% of the minimum cost specified for government approved prostheses.
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Other
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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.
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What you can expect to pay if you go to hospital
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For personal items such as newspapers and television hire.
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