Healthy Choice Hospital Cover H4

Healthy Choice Hospital Cover offers comprehensive hospital cover at an economical price by excluding certain services and applying a co-payment.

Benefits

Overnight and same day in-patient accommodation. In intensive care, surgical or general wards, in a private room (where available and/or required) or a shared ward at contracted private hospitals. A daily co-payment of $100 applies to overnight accommodation capped at $500 per admission. A daily co-payment of $100 applies to all day stays / day procedures with the exception of all in-patient dental treatment.

• Theatre Fees*

• 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*
Cover for surgically implanted prostheses as listed in the Government Schedule. Gap costs may be incurred for some items.

• Rehabilitation*

• Physiotherapy* (while in hospital)

• Psychiatric Therapy (while in hospital)

• Emergency Ambulance Transport

• CPAP Machine benefit of up to $750 maximum.

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

• Access Gap*
Provides benefits for medical services charged in excess of the Schedule Fee, where the doctor chooses to participate.

*Subject to excluded surgery as listed below (section: 'The following services are EXCLUDED and do not attract any benefits').

The following services are EXCLUDED and do not attract any benefits:

• All joint replacements – knee, hip, shoulder, etc. – and related services such as rehabilitation. Surgery that does not involve a replacement joint is covered, e.g. knee reconstruction.
• Pregnancy related services – including fertility programs and IVF treatments, including vasectomy and sterilisation (including reversals).

Limited benefits are available for:

• A 12 month Benefit Limitation Period (BLP) applies to psychiatric, rehabilitation & cardiac inpatient medical treatment.
  BLP means that benefits are restricted to basic cover in the first 12 months of membership to new members or members upgrading their cover.

• Cosmetic Surgery or services not listed in the Medical Benefit Schedule (MBS)
  Limited benefits are available but due to the complexity of these procedures, please contact Transport Health before commencing treatment.

• Non-contracted private hospitals
  For details of benefits, contact Transport Health

Important Conditions

• 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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