|
Excess
|
None
|
|
Co-payments
|
None
|
|
Waiting Periods
|
None for accidents
12 months for pre-existing conditions
12 months for obstetrics
2 months for everything else
|
|
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 necesarry 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. Contractual arrangements on pathology and radiology services ensure you have no out-of-pocket expenses for these services.
Medical services claims should be submitted directly to the Fund by your doctor or you. Do not submit medical services claims to Medicare.
|
|
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.
|
|
What you can expect to pay if you go to hospital
|
For personal items such as newspapers and television hire.
|
