Compare Hospital Cover
Compare our hospital covers to find the option that best suits your circumstances using the table below:
| HOSPITAL COVER |
FIVE STAR GOLD |
BASIC PLUS |
| Choice of Doctor |
|
|
| Choice of Hospital |
|
|
| Excess options available |
|
|
| Private Room, Public* or Private Hospital |
*out of pocket costs could apply |
|
| Shared Room, Public or Private Hospital |
|
out of pocket costs could apply |
| Theatre Fees |
|
|
| Gap Medical Benefits |
|
|
| Prosthesis |
|
|
Clinical categories
Hospital services/treatments are classified by Clinical Category in order to make it easier for you to know
exactly what you are covered for, and what you are not covered for, should you be admitted to hospital.
The table below is provided for your information:
| COVER |
FIVE STAR GOLD |
BASIC PLUS |
| EXCESS OPTION |
$250, $500, $750 |
$750 |
| Rehabilitation |
|
R |
| Hospital psychiatric services |
|
R |
| Palliative care |
|
R |
| Brain and nervous system |
|
R |
| Eye (not cataracts) |
|
R |
| Ear, nose and throat |
|
R |
| Tonsils, adenoids and grommets |
|
R |
| Bone, joint and muscle |
|
R |
| Joint reconstructions |
|
R |
| Kidney and bladder |
|
R |
| Male reproductive system |
|
R |
| Digestive system |
|
R |
| Hernia and appendix |
|
R |
| Gastrointestinal endoscopy |
|
R |
| Gynaecology |
|
R |
| Miscarriage and termination of pregnancy |
|
R |
| Chemotherapy, radiotherapy and immunotherapy for cancer |
|
R |
| Pain management |
|
R |
| Skin |
|
R |
| Breast surgery (medically necessary) |
|
R |
| Diabetes management (excluding insulin pumps) |
|
R |
| Heart and vascular system |
|
R |
| Lung and Chest |
|
R |
| Blood |
|
R |
| Back, neck and spine |
|
R |
| Plastic and reconstructive surgery (medically necessary) |
|
R |
| Dental surgery |
|
R |
| Podiatric surgery* (provided by an accredited podiatric surgeon – limited benefits) |
|
R |
| Implantation of hearing devices |
|
R |
| Cataracts |
|
R |
| Joint replacements |
|
R |
| Dialysis for chronic kidney failure |
|
R |
| Pregnancy and birth |
|
R |
| Assisted reproductive services |
|
R |
| Weight loss surgery |
|
R |
| Insulin pumps |
|
R |
| Pain management with device |
|
R |
| Sleep studies |
|
R |
*Limited benefits apply – contact the Fund for information.
No restrictions or exclusions: This level of cover has no restrictions on
services covered. You will be fully covered in a shared or private room in a private hospital or private day facility. For private room accommodation in a public hospital the Fund will pay an additional benefit of $80 above the shared ward accommodation rate.
R - Restricted benefits: You will be covered in a shared ward in a public hospital only. If you are
admitted to a private hospital or private day facility to be treated, it is likely to result in large out of
pocket expenses. Some specialists may not operate in a public hospital, please take this into consideration
when choosing your hospital cover.
Excess
You can choose to pay an excess amount upfront if you go into a public hospital, private hospital or private
day facility. It is that easy!
The higher your excess amount, the less you pay in your regular premiums. Just decide the excess amount that
suits your individual circumstances and you are on your way to lower premiums.
Your excess is only payable should you be admitted to a private hospital or private day facility, or a public
hospital as a private patient. For singles, couples and family type covers, the per person excess is only
payable once per calendar year, 1 January to 31 December, to the maximums shown in the table below, irrespective
of the length of stay or the number of admissions that year.
Excess amounts applicable per cover are outlined below:
| COVER |
PRODUCT
CODE |
EXCESS
AMOUNT |
MAXIMUM YEARLY EXCESS |
| SINGLE |
COUPLE / FAMILY |
| Five Star Gold $250 Excess |
F2 |
$250 |
$250 |
$500 |
| Five Star Gold $500 Excess |
F3 |
$500 |
$500 |
$1,000 |
| Five Star Gold $750 Excess |
F4 |
$750 |
$750 |
$1,500 |
| Basic Plus $750 |
H1 |
$750 |
$750 |
$1,500 |
Important Information
Benefits are payable for treatment received in a recognised hospital or facility in Australia only.
Benefits will not be payable unless all applicable waiting periods have been completed.
Restricted benefits will be payable at the Minimum Benefit Payable (MBP), this is the minimum benefit the Private Health Insurance Act requires health funds to pay for treatment under a hospital cover. If you hold the Basic Plus cover and are admitted to a private hospital or day facility, benefits will be payable at the MBP which may leave you with large out of pocket expenses to pay.
Treatment where no Medicare benefit is payable will not be covered by your hospital cover. However, limited benefits are payable towards the cost of hospital inpatient treatment for Podiatric surgery provided by an accredited podiatric surgeon depending on level of hospital cover. Cosmetic surgery is specifically excluded where there is no Medicare benefit payable.
Benefits are payable for 365 days of the year provided your doctor certifies your need for ongoing acute care. If after 35 days, you doctor doesn’t provide certification you will be classified as a long term ‘nursing home type’ patient. We will cover you for the minimum benefit amount as determined by the Department of Health (DoH) leaving you with a daily co-payment to pay. Depending on your length of stay your co-payment amount may be significant.
Gap Medical benefits are payable on all inpatient services where there is a Medicare benefit. If you, or your family, are being admitted to hospital always contact us first to confirm your cover.
Download our ‘Going to Hospital’ brochure here.