This cover is suitable for admissions to public hospitals as a private patient, subject to the doctor’s admitting rights.

It is not recommended for members wanting private hospital accommodation.

Benefits in a Public Hospital

• Overnight & same day in-patient accommodation
You are fully covered for the cost of accommodation in a shared ward of a public hospital. Other services included:
– Intensive Care
– Theatre and Labour Ward
– In-hospital boarder accommodation benefit of
up to $120 per Membership year.

• Pharmaceuticals
In-patient medication used while in hospital is normally covered within hospital charges. However, high cost medication as listed in the exceptional drug list (EDL) requires the Hospital to obtain Fund approval prior to dispensing. The cost of Pharmacy medication taken home on discharge from the hospital is payable by the Member.

• Prostheses
At all private and public hospitals, cover for surgically implanted prostheses as listed in the Government Schedule. Gap costs may be incurred for some items.

• Emergency Ambulance Transport

• Medical Gap
The 25% difference between the Schedule Fee for medical services and the 75% Medicare benefit payable for in-hospital treatment.

• CPAP Machine benefit of up to $750 maximum.

Benefits are not payable for:

• Access Gap
• Theatre and Labour Ward in a private hospital

Important Conditions

In a Private Hospital the default benefit is payable for intensive care and hospital accommodation charges.
Default benefits are determined by the Federal Government each year.

• Waiting periods ranging from 2 to 24 months may apply to some services.
• If you have a Pre-existing Ailment or Condition, waiting periods must be served before benefits are payable.

We encourage our Members to contact us prior to hospitalisation to obtain accurate information about what benefits are payable according to their level of cover.

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