Hospital benefits

Hospital cover provides benefits for in-hospital treatment, including accommodation, medical costs and doctors’ fees. It exempts you from the Medicare Levy Surcharge and you may also be eligible for a rebate on the cost of your premium.

Term Definition
Private Hospital Select this option to be treated in your choice of agreement private hospital with choice of doctor and greater flexibility in scheduling surgery.
Private patient in public hospital Select this more budget option to be treated as a private patient in a public hospital with your choice of doctor and possibly a private room, depending on your policy.
Heart Surgery Treatment of the heart and blood vessels including open heart surgery, bypass surgery, angiograms and stents. Especially recommended for those with a family history of heart disease or persons with high risk (smokers, high blood pressure, high cholesterol).
Birth Related Services Includes a range of in-hospital care related to pregnancy, labour, delivery and post-natal care. Remember there is a 12 month wait so choose this feature well in advance of pregnancy.
Assisted Reproduction eg. IVF A range of in-hospital treatment for infertility using reproductive technology, including IVF. Includes day surgery such as egg collection and embryo transfers. Remember there is usually a 12 month wait so choose this feature well in advance of treatment.
Major Eye Surgery Treatment for major eye lens procedures including cataract surgery.
Joint Replacement A range of services which include investigative procedures, surgery and replacement of joints, including elbows, shoulders, knees and hips.  Recommended for people at risk of joint injury (very active lifestyles, seniors, etc).
Non cosmetic plastic surgery Treatments for corrective surgery for physical deformities, eg. breast reconstruction for cancer victims and skin grafts for burn treatment.
Surgery by podiatrist Benefits toward surgical treatment of the ankle, foot and lower extremities.
Sterilisation Includes a range of permanent surgical contraceptive procedures including vasectomies, tubal ligation and hysterectomies.
Gastric Banding Covers medically necessary obesity or bariatric surgery involving the reduction of stomach capacity through the placement of a band to the medicare scheduled fee.
Dialysis Is the removal of excess fluids and wastes from the body.  Recommended for those suffering kidney failure
Palliative Care Includes medical support during serious and terminal illnesses. Palliative care is limited to a 2 month wait even for pre-existing conditions.
In-Hospital Psychiatry Benefits towards approved programs treating mental illnesses including depression, schizophrenia and eating disorders. Psychiatric benefits are limited to a 2 month wait even for pre-existing conditions.
In-Hospital Rehabilitation A range of post-operative treatment and recovery therapy eg, after a stroke or surgery.
Non medicare services A range of procedures that Medicare doesn’t cover. Read policy descriptions to check specific procedures.
Ambulance Ambulance cover varies between policies and can also depend on the State where you live. Refer to the policy brochure for full details.

Extras benefits

Extras cover provides benefits for treatment outside of hospital that Medicare doesn’t cover.

Term Definition
General Dental Benefits for minor services including regular check ups, scale and cleans, and most preventative services.
Major Dental Benefits for more complex dental work including tooth extractions, crowns and bridges.
Endodontic Benefits for root canal therapy and treatment for exposed tooth nerves. Tooth decay or damage that could lead to infection may need endodontic treatment.
Orthodontic Benefits for the treatment or prevention of facial irregularities, including braces, retainers and headgear for treating jaw misalignments. Recommended for families with children who may need braces.
Optical Benefits for prescription lenses, frames and contact lenses.
Physiotherapy Benefits for treatment from a recognised physiotherapist for treatment including manual therapy, exercise programs and hydro- or electrotherapies to restore proper functioning of the body.
Chiropractic Benefits for treatment from a recognised chiropractor to address musculoskeletal issues using spinal adjustments.
Podiatry Benefits for treatment from a recognised podiatrist to address disorders of the feet, ankles and lower limbs. Recommended for active sportspeople and those with walking disorders (eg. pigeon toed children).
Acupuncture Benefits for treatment from a recognised acupuncturist involving the insertion of small needles into the body’s pressure points to stimulate nerves and improve health.
Naturopathy Benefits for treatment from a recognised naturopath using non-invasive techniques such as massage, nutrition and herbal medicine to restore wellbeing. Considered beneficial for sufferers of stress, fatigue, digestive complaints, etc.
Remedial Massage Benefits for treatment from recognised providers of deep massage to treat injury.
Psychology Benefits for treatment from a recognised psychologist to address issues with mental and physical health. Some funds only pay for services when performed by a Clinical Psychologist – please check policy for details.
Glucose monitors Benefits toward glucose monitors to assist in the management of diabetes. Check policy descriptions to check if supplies and consumables are also covered.
Hearing Aids Benefits toward devices designed to correct hearing impairment. Check policy descriptions as some deduct hearing aid benefits from an overall health aid limit.
Non PBS Pharmaceuticals Benefits toward some prescription pharmaceuticals not listed on the Government’s Pharmaceuticals Benefits Scheme (PBS).
Ambulance Ambulance cover varies between policies and can also depend on the State where you live. Refer to the policy brochure for full details.

Additional Definitions

Term Definition
Excess An excess is an amount that you agree to pay towards the cost of hospital treatment in order to lower your premium.
Benefit Limitation Period A benefit limitation period (BLP) is where you are only entitled to limited benefits for a particular cover for a set period of time. In most cases, you would normally be entitled to full benefits for the condition or treatment once that period has elapsed.  BLP’s usually commence after the standard waiting period has been served.
Co-Payment A co-payment is a set amount that you agree to pay for each day you are in hospital in order to lower your premium.
HICAPS Health Industry Claims & Payments Service (HICAPS) allows you to claim on healthcare treatments on the spot, at time of payment. Using similar technology to EFTPOS, you swipe your health fund card at the terminal and it’ll communicate to your insurer the details of your claim – immediately affecting the amount owing. Learn more about HICAPS.
Orthotics Benefits paid towards custom made Orthotics (also known as orthotic insoles, shoe inserts, or orthoses).  These are devices placed inside the shoes with the purpose of restoring natural foot function.
Speech Therapy Benefits paid towards assessment and treatment of communication and speech disorders by a recognised speech therapist.  Eg. treatment for stroke victims, young children and people with disabilities affecting speech.
Occupational Therapy Occupational therapy is the training of people with physical injury or illness, psychological or social disability or learning problems. This cover pays benefits towards treatment by a recognised occupational therapist.  Eg. restoring physical function for stroke, burn or accident victims, treatment for people with disabilities such as cerebral palsy
Dietetics Benefits paid towards the promotion of health and disease prevention through diet by a recognised Dietician
Eye Therapy Eye therapy is a physical therapy for the eyes and brain that develops eye coordination and treats a number of common visual problems.  This cover pays benefits towards treatment by a recognised eye therapist for conditions such as crossed eyes, lazy eye and double vision.
Lifestyle Products Pays benefits towards approved courses and programs which help you to live a healthier life eg. quit smoking, fitness and weight management  courses.  Cover varies between funds .
Pre-Existing Waiting Period A waiting period for hospital treatment for ailments, illnesses or conditions that are considered to be pre-existing.  For in-hospital psychiatry, rehabilitation and palliative care, the maximum waiting period is two months, even if the condition is pre-existing.
Restricted Benefits Means that some cover may apply but to a limited extent.  Some examples of restrictions include being covered for a benefit but only as a private patient in a public hospital or having to serve an extra waiting period.  Always check the fund’s policy brochure for details.
Benefit Limitation Period (BLP) This is a period of time, following the normal waiting period, during which reduced benefits are paid. Full benefits are restored after the Benefit Limitation Period is ended.
Excess Waiver Some funds may waive the excess in certain circumstances such as for day procedures, dependents or if you are admitted to hospital due to an accident. Waivers vary between products and funds so always check the policy description for full details.

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