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.