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.

Medical repatriation (limit up to $100,000)

If you or a person covered under your policy suffers a serious medical condition or life-altering illness due to a condition covered under the policy and needs to return to your home country, we will pay benefits towards the reasonable costs of returning the member to their home country, subject to a Doctor’s Health Fund appointed medical practitioner determining that such arrangements are medically necessary and prior approval of costs by Doctors’ Health Fund up to the limit stated for the product. This may include travel accompanied by one qualified medical practitioner, if considered medically necessary.

Mortal repatriation (limit up to $10,000)

If you or a person covered under your policy passes away due to a medical condition covered by the policy, we will pay benefits towards the reasonable costs of returning the deceased person’s mortal remains to their home country subject to the prior approval of costs by Doctors’ Health Fund up to the limit stated for the product. This does not include costs for the funeral, cremation or for transporting a person’s ashes to their home country.

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.

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.

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.

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.

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.

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.

Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.

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.

Hospital treatment for surgery for joint reconstructions.

For example: torn tendons, rotator cuff tears and damaged ligaments.

Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.

For example: kidney stones, adrenal gland tumour and incontinence.

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.

For example: male sterilisation, circumcision and prostate cancer.

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.

Hospital treatment for the investigation and treatment of a hernia or appendicitis.

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).

Hospital treatment for the investigation and treatment of the female reproductive system.

For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

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.

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.

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.

Hospital treatment for the investigation and management of diabetes.

For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.

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 lungs, lung-related conditions, mediastinum and chest.

For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.

Hospital treatment for the investigation and treatment of blood and blood-related conditions.

For example: blood clotting disorders and bone marrow transplants.

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 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.

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.

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.

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.

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 dialysis treatment for chronic kidney failure.

For example: peritoneal dialysis and haemodialysis.

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 the investigation of sleep patterns and anomalies.

For example: sleep apnoea and snoring.

Bone marrow transfusion or transplant is a medical procedure that involves replacing unhealthy or damaged bone marrow with healthy marrow from a donor.

Organ transplant occurs when organs are removed from a donor and transplanted into someone who is experiencing illness due to organ failure.

This pays the cost charged by doctors while you are admitted to the hospital. The benefit is up to the AMA* list of medical services and fees, where a Medicare benefit applies. AMA fees are typically higher than the government’s Medicare Benefits Schedule (MBS), which means you may have reduced out-of-pocket expenses.

*AMA refers to the Australian Medical Association.

General Practitioners (GPs) are primary care doctors who provide comprehensive medical care for a wide range of health concerns. They are often the first point of contact in the healthcare system and play a crucial role in managing both acute and chronic conditions, offering preventive care, and coordinating referrals to specialists when needed.

Outpatient GP visits refer to medical consultations and treatments provided without hospital admission. These visits typically take place in community clinics, medical centres, or private practices, and patients return home immediately after their appointment.

Medical specialists are highly trained physicians who concentrate on a specific area of medicine, such as cardiology, dermatology, orthopaedics, or oncology. They possess deep expertise and advanced clinical knowledge in their chosen field, allowing them to diagnose and manage complex or specific health conditions.

Outpatient specialist services refer to consultations and treatments provided by these experts without requiring hospital admission. Patients typically visit a specialist in a clinic, private practice, or hospital outpatient departments, and return home the same day.

Pathology is a medical specialty that focuses on determining the cause and nature of diseases. By examining and testing body tissues (for example, biopsies, pap smears) and fluids (for example, blood, urine) pathology helps doctors diagnose and treat patients correctly.

Outpatient pathology services involve the collection and analysis of these samples without the need for hospital admission. These services are typically performed in pathology clinics, diagnostic laboratories, or outpatient departments.

Radiology is the specialty of medicine that deals with diagnosing and treating disease and injury using medical imaging techniques such as x-rays, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET), fusion imaging, and ultrasound.

Outpatient radiology refers to imaging services provided to patients who are not formally admitted to a hospital. These procedures are typically scheduled in advance and performed in radiology clinics, diagnostic centres, or hospital outpatient departments.

This covers a wide range of therapies, including dietetics, mental health, occupational, orthoptics, physiotherapy, pregnancy care, remedial massage, speech, podiatry and orthotics.

Pregnancy care services refer to medical care provided during pregnancy that does not require hospital admission. These services are essential for monitoring the health and wellbeing of both the expectant mother and the developing baby throughout the pregnancy journey.

Common outpatient pregnancy and birth services include:

• Routine antenatal check-ups with an obstetrician, midwife, or GP to monitor maternal and foetal health.
• Ultrasound scans to assess foetal development, position, and growth.
• Blood tests and screenings to detect conditions such as gestational diabetes, anaemia, or infections.
• Prenatal counselling and education to prepare for childbirth and parenting.
• Monitoring of high-risk pregnancies through more frequent assessments and specialist care.
• Postnatal follow-up visits to check on recovery and newborn health after delivery.

Outpatient psychiatric services refer to mental health care provided by a psychologist or psychiatrist without a hospital admission. These services are typically delivered in clinics, private practices, or outpatient departments, allowing patients to attend scheduled appointments and return home the same day.

This pays the benefits for travel and accommodation expenses incurred when you travel over 200km (one way) from your home for a hospital in-patient admission. Limit per day and per trip applies.

CPAP machine works by delivering a steady stream of pressurised air through a mask that covers your nose or mouth (or both), keeping your airway open during sleep. This prevents pauses in breathing caused by sleep apnoea, a condition where the throat muscles intermittently relax and block the airway.

This covers the prescription medicine administered during an inpatient hospital stay. The benefit depends on whether the medicines are listed on Pharmaceutical Benefits Scheme (PBS) scheme. You may still incur out-of-pocket costs.

This covers the PBS medicines prescribed according to PBS-approved indications outside of hospital (for example, by your GP). We will pay a benefit of 90% of the cost of the PBS Pharmaceuticals above the PBS patient contribution, to a limit of $600 per member per calendar year.

We will pay the applicable Minimum Benefits specified in the Prescribed list of Medical Device and Human Tissue Products.

Up to 3 trips