Top

Prime Choice hospital cover

Comprehensive cover without restrictions

More services with no gap, compared to the industry average

  • Uses the Access Gap Scheme for your doctor's bills, which reduces or eliminates out of pocket expenses
  • No exclusions or restrictions on services eligible for Medicare benefits
  • Flexible features, including a choice of whether or not to take an excess
  • Includes national cover for emergency and medically necessary ambulance services, including transfers between hospitals
  • Covers all costs of accommodation in a contracted private hospital or day-only facility, or a public hospital as a private patient, once any excess has been paid


  • Get quality health cover now, from the only health fund in Australia created by doctors, for doctors.

Quick Quote

I am...

I live in...

  • Please select...
  • ACT
  • NSW
  • NT
  • QLD
  • SA
  • TAS
  • VIC
  • WA

What is included:

Excess

Single membership options: no excess or $500 per calendar year.

Family, couple or sole-parent family membership options: no excess or $1,000 per calendar year.

Under the excess option, $500 of excess is paid per admission until the full amount of excess is paid for the year. The total excess amount applies to the entire membership not for each person covered by the membership.

The excess is applied as follows:

A single membership has an excess of $500 for the first hospital admission in any calendar year.

Couple, single parent family and family memberships have an excess of $500 for each hospital admission up to the limit of $1,000 in any calendar year. This limit applies to the entire membership, not to each person covered by the membership.

Co-payments 

None

Waiting Periods and pre-existing conditions

The benefits available under this product are only payable for services received after serving the relevant waiting period. Waiting periods apply when you’re new to private health insurance or you purchase cover with better benefits or conditions. More information.

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

No exclusions for services eligible for Medicare benefits

Benefit restrictions

None

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 after the excess is paid. In non-contract hospitals and day-only facilities the lowest contracted benefit is paid and you can expect to have out-of-pocket expenses.

Hospital services

After the excess is paid 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 you are an admitted patient can be covered by the Access Gap Cover scheme which reduces or eliminates your medical services out-of-pocket expenses. When your doctor agrees to participate in the Access Gap Cover scheme the Fund covers the scheme's scheduled amount for your treatment. The doctor may choose to charge you a payment above the scheme's scheduled amount. This may be no more than $400 per service, or for the birth of a child no more than $800 for the total confinement. 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. Claims using this gap scheme should be submitted directly to the Fund. Check that your doctors have marked any bills sent to you as Access Gap cover accounts. To find doctors who participate in this gap scheme use the Doctor Search facility on this website.

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 and 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 $70 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 $800 applies.

Examples of what you can expect to be out of pocket for if you go to hospital

Your excess For personal items such as newspapers and television hire. The difference between the Medicare Schedule fee and your doctor’s fee. From 1 August 2007 this will only apply if your doctor does not wish to participate in the Access Gap Scheme.

 

Looking for Extras Cover as well?

You can add Extras cover to your Hospital Cover

View Extras Options