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Top hospital cover

Unique hospital cover paying up to the AMA fees list

No preferred provider networks, so you choose who treats you

  • Unique Top Cover pays up to the Australian Medical Association (AMA) fees list
  • Unlike other medical gap schemes, there's no requirement for your doctor to opt-in to this scheme, so you have complete freedom to choose who treats you
  • No excess, no exclusions or restrictions on services where Medicare pays a benefit
  • Includes national cover for emergency and medically necessary ambulance services, including transfers between hospitals


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

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What is included:

 

Excess

None

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.

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.

Our Top Cover is unique and pays medical benefits up to the AMA List fee. Medical benefits for covered services may be paid under the Access Gap Cover Scheme for the first 12 months if you are upgrading your cover. More information.

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. 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 (after serving relevant waiting periods), 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.

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

  • Personal items such as newspapers and television hire.
  • Prostheses cost if charged above the minimum cost.

 





Looking for Extras Cover as well?

You can add Extras cover to your Hospital Cover

View Extras Options