Excess

You have a choice of: No excess, $150, $250 or $500 excess.

If you want to pay a lower premium and still have the most comprehensive cover, an Excess cover is what you need. You agree to pay an upfront excess amount if you are admitted to a public or a private hospital, once this excess has been met you will be fully covered.

It is that easy!

Just decide the excess amount that suits your individual circumstances and you are on you way to lower premiums. Your excess is only payable should you be admitted to a private hospital, or a day surgery, or to a public hospital as a private patient.

For both singles and families, the excess per person is only payable once per calendar year to the maximums shown in the table below, irrespective of the length of stay or number of admissions in that year.

Co-payments

None

Waiting Periods

- None for accidents

- 12 months for pre-existing conditions

- 12 months for elective surgery

- 12 months for obstetric services

- 12 months for assisted reproductive services (including IVF)

- 2 months for psychiatric, rehabilitation and palliative care (whether or not for a pre-existing condition), and all other treatments

Benefit Limitation Period

- 24 months for psychiatric admissions

Exclusions

Hospital treatment for which Medicare pays no benefit eg most cosmetic surgery

Benefit restrictions

None

Accommodation

Benefits equal to 100% of shared or private room and additional costs (e.g. theatre, intensive care unit, high dependency unit) in over 435 contracted private hospitals throughout Australia. A full list of private and day hospital facilities is available here.

In the event that you are admitted to a private hospital we don’t have a contract with, default benefits will be payable. Always contact us first in this situation, as we may be able to negotiate with the hospital on your behalf.

Default benefits are equivalent to the amount payable for a shared ward in a public hospital by a private patient. These benefits are set and periodically reviewed by the government. Any difference between the default government prescribed benefit and the hospital charge will result in out-of-pocket costs.

During the benefit limitation period, default benefits only will be payable after the 2 month waiting period has been served. Psychiatric admissions are subject to a 24 month benefit limitation period.

Once the waiting period and benefit limitation period has been served, you will be entitled to the full benefit applicable to your level of cover.

NOTE: The excess is payable for all overnight admissions in all private hospitals. The excess is also payable for same day procedures at all private hospitals with the exception of the Mildura Health Private Hospital where members do not pay an excess.

Hospital services

All costs are covered for theatre services while you are an in-patient.

Medical services

For all medical services provided while an inpatient in hospital (e.g. doctors’ services, pathology and radiology), Medicare pays 75% of the Medicare Benefits Scheme (‘MBS’) fee and Mildura Health Fund pays the remaining 25%. Because some doctors charge fees above the MBS fee, you may incur out-of-pocket expenses. These can vary and may be significant. This is what’s referred to as a ‘gap’. (see Gap Medical Benefits).

Prostheses

Covers 100% of the minimum cost specified for government approved prostheses.

What you can expect to pay if you go to hospital

The excess if you opted for an excess cover. For personal items such as newspapers and television hire. The gap between the Medicare Schedule fee and your doctor’s fee.

Excess

None

Co-payments

None

Waiting Periods

- None for accidents

- 12 months for pre-existing conditions

- 12 months elective surgery

- 12 months for obstetric services

- 12 months for assisted reproductive services (including IVF)

- 2 months for psychiatric, rehabilitation and palliative care (whether or not for a pre-existing condition), and all other treatments

Exclusions

Hospital treatment for which Medicare pays no benefit eg most cosmetic surgery

Benefit restrictions

None

Accommodation

Benefits equal to 100% of day procedure and shared room fees in all public hospitals throughout Australia. Private hospital treatment, including Mildura Health Private Hospital, will attract default benefits.

Default benefits are the minimum level of hospital benefits payable to all public hospitals and non-contracted hospitals. These benefits are set and periodically reviewed by the government. Any difference between the default government prescribed benefit and the hospital charge will result in out-of-pocket costs.

NOTE: Your costs are covered by Mildura Health Fund for shared room accommodation in a public hospital. But your costs are not covered by Mildura Health Fund for a private room in a public hospital, or any private hospital in Australia.

Hospital services

All costs are covered for theatre services while you are an in-patient.

Medical services

For all medical services provided while an inpatient in hospital (e.g. doctors' services, pathology and
radiology), Medicare pays 75% of the Medicare Benefits Scheme (‘MBS’) fee and Mildura Health Fund pays the remaining 25%. Because some doctors charge fees above the MBS fee, you may incur out-of-pocket expenses. These can vary and may be significant. This is what’s referred to as a ‘gap’. (see Gap Medical Benefits).

Prostheses

Covers 100% of the minimum cost specified for government approved prostheses.

What you can expect to pay if you go to hospital

For personal items such as newspapers and television hire. The gap between the Medicare Schedule fee and your doctor’s fee.