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 |
|
(as from 01/07/2019) |
| Private Room, Public or Private Hospital |
|
|
| 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
|
$0, $150, $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 exlusions: This level of cover has no restrictions on services covered. You will be fully covered in a shared or private room in both public and private hospital or private day facility.
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 |
H4 |
Nil |
Nil |
Nil |
| Five Star Gold $150 Excess |
F1 |
$150 |
$150 |
$300 |
| 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 |
*Effective 1 July 2019
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 default benefit rate as declared by the Department of Health (DoH). If you are admitted to a private hospital or day facility, and hold the Basic Plus cover, you may have large out of pocket expenses to pay.
Treatment that is not covered by Medicare will not be covered by your hospital cover.
Cosmetic surgery is specifically excluded if there is not a Medicare benefit.
Benefits are payable for 365 days of the year provided all relevant documentation is received from the hospital. In the case of long term ‘nursing home type’ patients, a daily co-payment will apply, in accordance with the fees set by DoH. 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.