Entry-level hospital cover with more inclusions than bronze level cover, designed for young singles, couples and families who aren’t looking for higher cover at this stage of their life.
Cover for the things you’re likely to need without having to pay for cover you don’t need, such as hip replacements, pregnancy and cataracts. Smart Starter Bronze Plus covers all your hospital accommodation costs (after any excess has been paid) in a contracted private hospital, contracted day-only facility or as a private patient in a public hospital.
Important Information
Inclusions
Waiting period: 2 months
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.
For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson's disease.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.
For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
For example carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for surgery for joint reconstructions.
For example: torn tendons, rotator cuff tears and damaged ligaments.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
For example: kidney stones, adrenal gland tumour and incontinence.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
For example: male sterilisation, circumcision and prostate cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the female reproductive system.
For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.
For example: melanoma, minor wound repair and abscesses.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for pain management that does not require the insertion or surgical management of a device.
For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and management of diabetes.
For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.
Waiting period: 1 day
National cover for emergency and medically-necessary ambulance services, including when an ambulance is called 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 or you are an admitted patient and need to be transferred to another hospital.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of blood and blood-related conditions.
For example: blood clotting disorders and bone marrow transplants.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital accommodation and anaesthetist costs for surgery to the teeth and gums. Dental surgeon costs are covered through Extras cover (such as Overseas Workers Essential Extras ), which must be purchased separately.
For example: surgery to remove wisdom teeth, and dental implant surgery.
Waiting period: 2 months (12 months for pre-existing conditions)
Limited benefits for hospital accommodation costs (equivalent to a shared ward in a public hospital) and medical devices and human tissue products for the investigation and treatment of conditions affecting the foot and/or ankle. There is no cover for theatre costs or the costs of the podiatric surgeon or anaesthetist.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident or congenital.
For example: burns requiring a graft, cleft palate, club foot and angioma.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.
For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.
Silver inclusion Gold inclusion
Restrictions
These services are limited to delivery as a private patient in a public hospital in a shared room.
Waiting period: 2 months
Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.
Waiting period: 2 months
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.
Exclusions
Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of medical devices and human tissue products.
For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Medically necessary hospital treatment for infertility, for example, retrieval of eggs or sperm, in vitro fertilisation (IVF), and gamete intra-fallopian transfer (GIFT).
Hospital treatment for surgery that is designed to reduce a person's weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
For example: gastric banding, gastric bypass, sleeve gastrectomy.
Hospital treatment for the provision of an insulin pump for the treatment of diabetes. The cost of an insulin pump is not automatically covered where hospitalisation is not required.
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).
Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis.
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.
For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis.
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Things you should know
Children can be covered on their parent’s policy until the age of 32 if they meet income and relationship criteria. A person with disability, can remain on their parent’s policy regardless of their age if they earn less than $105,000 and participate in the National Disability Insurance Scheme (NDIS). Find out more about keeping your kids covered
Choose either $500 or $750 per person per calendar year – this is the maximum excess you’ll pay per calendar year regardless of the number of hospital admissions.
For policies with more than one person insured (e.g., couple, family, and single parent policies), the maximum per policy per year is $1,000 or $1,500 respectively.
Benefits are only payable after serving the relevant waiting periods. Waiting periods apply when you’re new to private health insurance or you upgrade your cover. Waiting periods for hospital benefits are:
12 months for pre-existing conditions, except for psychiatric services, rehabilitation and palliative care which have a 2-month waiting period
2 months for all new conditions
1 day for ambulance
none for psychiatric services when upgrading cover (this waiting period can be waived only once a lifetime)
none for accidents.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by Doctors’ Health Fund (not your own doctor), existed during the 6 months before you purchased your hospital insurance or upgraded to a higher level of hospital cover. The fund medical practitioner must consider any information regarding signs and symptoms provided by your treating medical practitioner(s).
If an ailment, illness or condition is considered pre-existing:
new members must wait 12 months for any hospital benefits for that condition
members upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits.
Discuss gap cover with your doctor prior to admission. We pay benefits according to the Access Gap Cover schedule. Doctors need to opt in to Access Gap Cover and then choose whether to charge no gap or a known gap above the schedule amount. The known gap cannot be more than $500 per treating practitioner per episode. Find a doctor who participates in Access Gap Cover. Read more about the gap.
Wisdom teeth extraction and other dental procedures in a hospital require both hospital cover (for the hospital accommodation and anaesthetist) and Essential Extras or Total Extras (for the dental surgeon).
Extra protected with Extras Cover
Starter Extras
Entry-level extras cover available to singles and couples, when combined with Smart Starter Bronze Plus hospital cover.
Entry-level hospital cover with more inclusions than bronze level cover, designed for young singles, couples and families who aren’t looking for higher cover at this stage of their life.
Cover for the things you’re likely to need without having to pay for cover you don’t need, such as hip replacements, pregnancy and cataracts. Smart Starter Bronze Plus covers all your hospital accommodation costs (after any excess has been paid) in a contracted private hospital, contracted day-only facility or as a private patient in a public hospital.
Important Information
Inclusions
Waiting period: 2 months
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.
For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson's disease.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.
For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
For example carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for surgery for joint reconstructions.
For example: torn tendons, rotator cuff tears and damaged ligaments.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
For example: kidney stones, adrenal gland tumour and incontinence.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
For example: male sterilisation, circumcision and prostate cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the female reproductive system.
For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.
For example: melanoma, minor wound repair and abscesses.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for pain management that does not require the insertion or surgical management of a device.
For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and management of diabetes.
For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.
Waiting period: 1 day
National cover for emergency and medically-necessary ambulance services, including when an ambulance is called 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 or you are an admitted patient and need to be transferred to another hospital.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of blood and blood-related conditions.
For example: blood clotting disorders and bone marrow transplants.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital accommodation and anaesthetist costs for surgery to the teeth and gums. Dental surgeon costs are covered through Extras cover (such as Overseas Workers Essential Extras ), which must be purchased separately.
For example: surgery to remove wisdom teeth, and dental implant surgery.
Waiting period: 2 months (12 months for pre-existing conditions)
Limited benefits for hospital accommodation costs (equivalent to a shared ward in a public hospital) and medical devices and human tissue products for the investigation and treatment of conditions affecting the foot and/or ankle. There is no cover for theatre costs or the costs of the podiatric surgeon or anaesthetist.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident or congenital.
For example: burns requiring a graft, cleft palate, club foot and angioma.
Waiting period: 2 months (12 months for pre-existing conditions)
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest.
For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.
Silver inclusion Gold inclusion
Restrictions
These services are limited to delivery as a private patient in a public hospital in a shared room.
Waiting period: 2 months
Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.
Waiting period: 2 months
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.
Exclusions
Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of medical devices and human tissue products.
For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Medically necessary hospital treatment for infertility, for example, retrieval of eggs or sperm, in vitro fertilisation (IVF), and gamete intra-fallopian transfer (GIFT).
Hospital treatment for surgery that is designed to reduce a person's weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
For example: gastric banding, gastric bypass, sleeve gastrectomy.
Hospital treatment for the provision of an insulin pump for the treatment of diabetes. The cost of an insulin pump is not automatically covered where hospitalisation is not required.
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).
Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis.
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.
For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis.
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Things you should know
Children can be covered on their parent’s policy until the age of 32 if they meet income and relationship criteria. A person with disability, can remain on their parent’s policy regardless of their age if they earn less than $105,000 and participate in the National Disability Insurance Scheme (NDIS). Find out more about keeping your kids covered
Choose either $500 or $750 per person per calendar year – this is the maximum excess you’ll pay per calendar year regardless of the number of hospital admissions.
For policies with more than one person insured (e.g., couple, family, and single parent policies), the maximum per policy per year is $1,000 or $1,500 respectively.
Benefits are only payable after serving the relevant waiting periods. Waiting periods apply when you’re new to private health insurance or you upgrade your cover. Waiting periods for hospital benefits are:
12 months for pre-existing conditions, except for psychiatric services, rehabilitation and palliative care which have a 2-month waiting period
2 months for all new conditions
1 day for ambulance
none for psychiatric services when upgrading cover (this waiting period can be waived only once a lifetime)
none for accidents.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by Doctors’ Health Fund (not your own doctor), existed during the 6 months before you purchased your hospital insurance or upgraded to a higher level of hospital cover. The fund medical practitioner must consider any information regarding signs and symptoms provided by your treating medical practitioner(s).
If an ailment, illness or condition is considered pre-existing:
new members must wait 12 months for any hospital benefits for that condition
members upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits.
Discuss gap cover with your doctor prior to admission. We pay benefits according to the Access Gap Cover schedule. Doctors need to opt in to Access Gap Cover and then choose whether to charge no gap or a known gap above the schedule amount. The known gap cannot be more than $500 per treating practitioner per episode. Find a doctor who participates in Access Gap Cover. Read more about the gap.
Wisdom teeth extraction and other dental procedures in a hospital require both hospital cover (for the hospital accommodation and anaesthetist) and Essential Extras or Total Extras (for the dental surgeon).
Extra protected with Extras Cover
Starter Extras
Entry-level extras cover available to singles and couples, when combined with Smart Starter Bronze Plus hospital cover.
Silver inclusion
Gold inclusion