• Singles
  • Single Parent Family
  • Couples/Family

Basic

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Five Star

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No excess $150 excess $250 excess $500 excess
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Dental*

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Basic Ancillary*

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Ancillary Plus*

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Five Star Extras*

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Our budget hospital cover - specifically for public hospitals. Basic Hospital Benefits is suitable for those who want to be covered just in case. It is designed for those who want full cover against the cost of shared room accommodation in public hospitals as a private patient with the choice of doctor or specialist. Even though default benefits are paid against the cost of private hospital treatment, this cover is not recommended for people wanting comprehensive private hospital cover.

Effective 1 April 2017

What you get:

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 government prescribed benefits 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. doctor’s service, pathology, radiology), Medicare pays 75% of the Medicare Benefits Schedule  (‘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 (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.

 

The most comprehensive hospital cover available. H4 Five Star Hospital Benefits gives you 100% cover Australia wide, offering you peace of mind with no excess, no co-payments, and no exclusions (other than comestic surgery). With 100% cover contracts with more than 425 private hospitals Australia wide, you can have peace of mind knowing that you will be fully covered.

Effective 1 April 2017

What you get:

Excess

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

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 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 your 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 with a maximum benefit per membership, 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 425 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 some day procedures at all private hospitals with the exception of the Mildura Private Hospital where members do no 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. doctor’s service, pathology, radiology), Medicare pays 75% of the Medicare Benefits Schedule  (‘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 difference between the Medicare Schedule fee and your doctor’s fee.

 

* Basic Ancillary can be taken with Dental or taken alone.

Why Ancillary cover? With our Basic Ancillary cover you’ll get great benefits on a whole range of healthcare services and treatments not covered by your hospital cover or by Medicare. We provide benefits for perscription glasses and contact lenses as well as physiotherapy to name a few. For a full list of services covered, and benefits paid, refer to the benefits table below.

Effective 1 April 2017

Our basic extras cover. Offers lower benefits and limits at a lower cost. Still covers a
great range of services that our members use. Can be combined with Dental or taken on its own.

SERVICE TYPE BENEFITS
PHYSIOTHERAPY/EXERCISE PHYSIOLOGY/OCCUPATIONAL THERAPY (2 month waiting period )
Limit per calendar year $390 per person
$780 per family
Initial Consultation $27
Subsequent Consultation $24
Group Therapy - sub limits apply $8
Group Therapy Sub Limit - Physiotherapy & Exercise Physiology $80
PODIATRY (2 month waiting period )
Limit per calendar year $390 per person
$780 per family
Initial Consultation $27
Subsequent Consultation $24
Foot Orthotics ( 12 month waiting period ) As per fund benefit schedule
DIETICIAN (2 month waiting period )
Limit per calendar year $390 per person
$780 per family
Initial Consultation $27
Subsequent Consultation $24
SPEECH THERAPY (2 month waiting period )
Limit per calendar year $390 per person
$780 per family
Initial Consultation $27
Subsequent Consultation $24
ORTHOPTIC (EYE THERAPY) (2 month waiting period )
Limit per calendar year $390 per person
$780 per family
Initial Consultation $27
Subsequent Consultation $24
CHIROPRACTIC/OSTEOPATHIC (2 month waiting period )
Limit per calendar year $390 per person
$780 per family
CHIROPRATIC (Combined with Osteopathic yearly limit)
Initial Consultation $22
Subsequent Consultation $21
OSTEOPATHIC (Combined with Chiropractic yearly limit)
Initial Consultation $27
Subsequent Consultation $24
DISTRICT VISITING NURSE (Excluding Midwifery Services) (2 month waiting period )
Limit per calendar year $350 per person
$700 per family
Per Visit $12
AMBULANCE (2 month waiting period )
Limit per calendar year Equal to benefit
Family Refund $70
Single Refund $35
GLASSES (12 month waiting period )
Limit per person per calendar year $165
Frames/Lenses/Contact Lenses $165
HEALTH AIDS/APPLIANCES
Limit per calendar year $600 per person
$1200 per family
(36 month waiting period)
Limit per person every 36 months
Blood Glucose Monitor $150
Blood Pressure Monitor $125
TENS Machine $125
Nebuliser $125
Constant Air Pressure Monitor (CPAP) $230
Limit per person every 60 months
Hearing Aid $450
(12 month waiting period)
Braces/Splints 65% up to $300 every 36 months
CAM Boot 65% up to $300 every 36 months
Artificial Limbs & Prosthesis 65% up to $300 every 24 months
Wigs** 65% up to $150 every 24 months
Crutches/Walking Frame 65% up to $25 every 24 months
Compression Garments** 65% up to $150 every 24 months
**Require an approval form before benefits payable. Mildura Health Fund benefit approval form is available from our office upon request or can be downloaded from Forms & Links. Health Aids & Appliances must be medically necessary and for the treatment of a specific condition.

* Ancillary Plus can be taken with Dental or taken alone.

Why Ancillary Plus cover? With our Ancillary Plus cover you’ll get great benefits on a whole range of healthcare services and treatments not covered by your hospital cover or by Medicare. We provide benefits for prescription glasses and contact lenses, physiotherapy and remedial massage to name a few. For a full list of services covered, and benefits paid, refer to the benefits table below.

Effective 1 April 2017

Our mid-range extras cover. Includes benefits for Natural Therapies and Clinical Pyschology. Can be combined with Dental for a more rounded extras cover.

SERVICE TYPE BENEFITS
PHYSIOTHERAPY/EXERCISE PHYSIOLOGY/OCCUPATIONAL THERAPY (2 month waiting period )
Limit per calendar year $540 per person
$1080 per family
Initial Consultation $36
Subsequent Consultation $32
Group Therapy - sub limits apply $9
Group Therapy Sub Limit - Physiotherapy & Exercise Physiology $90
PODIATRY (2 month waiting period )
Limit per calendar year $540 per person
$1080 per family
Initial Consultation $36
Subsequent Consultation $32
Foot Orthotics ( 12 month waiting period ) As per fund benefit schedule
DIETICIAN (2 month waiting period )
Limit per calendar year $540 per person
$1080 per family
Initial Consultation $36
Subsequent Consultation $32
SPEECH THERAPY (2 month waiting period )
Limit per calendar year $540 per person
$1080 per family
Initial Consultation $36
Subsequent Consultation $32
ORTHOPTIC (EYE THERAPY) (2 month waiting period )
Limit per calendar year $500 per person
$1000 per family
Initial Consultation $29
Subsequent Consultation $27
NATUROPATHY/REMEDIAL MASSAGE/ACUPUNCTURE/MYOTHERAPY (2 month waiting period )
Limit per calendar year $500 per person
$1,000 per family
Initial Consultation $29
Subsequent Consultation $27
CHIROPRACTIC/OSTEOPATHIC (2 month waiting period )
Limit per calendar year $540 per person
$1080 per family
CHIROPRATIC (Combined with Osteopathic yearly limit)
Initial Consultation $29
Subsequent Consultation $27
OSTEOPATHIC (Combined with Chiropractic yearly limit)
Initial Consultation $36
Subsequent Consultation $32
DISTRICT VISITING NURSE (Excluding Midwifery Services) (2 month waiting period )
Limit per calendar year $500 per person
$1000 per family
Per Visit $12
CLINICAL PSYCHOLOGY (2 month waiting period )
Limit per calendar year $540 per person
$1080 per family
Initial Consultation $45
Subsequent Consultation $40
Group Therapy $8
AMBULANCE (2 month waiting period )
Limit per calendar year Equal to benefit
Family Refund $80
Single Refund $40
GLASSES (12 month waiting period )
Limit per person per calendar year $220
Frames/Lenses/Contact Lenses $220
HEALTH AIDS/APPLIANCES
Limit per calendar year $1000 per person
$2000 per family
(36 month waiting period)
Limit per person every 36 months
Blood Glucose Monitor $200
Blood Pressure Monitor $150
TENS Machine $150
Nebuliser $150
Constant Air Pressure Monitor (CPAP) $400
Limit per person every 60 months
Hearing Aid $700
(12 month waiting period)
Braces/Splints 75% up to $500 every 36 months
CAM Boot 75% up to $500 every 36 months
Artificial Limbs & Prosthesis 75% up to $500 every 24 months
Wigs** 75% up to $250 every 24 months
Crutches/Walking Frame 75% up to $35 every 24 months
Compression Garments** 75% up to $250 every 24 months
**Require an approval form before benefits payable. Mildura Health Fund benefit approval form is available from our office upon request or can be downloaded from Forms & Links. Health Aids & Appliances must be medically necessary and for the treatment of a specific condition.

*Five Star Extras is our top comprehensive extras cover, including the highest ancillary and dental benefits.

Why Five Star Extras cover? With our Extras cover you’ll get great benefits on a whole range of healthcare services and treatments not covered by your hospital cover or by Medicare. As well as being able to claim for your regular dental check-up, we provide benefits for prescription glasses and contact lenses, physiotherapy and remedial massage to name a few. For a full list of services covered, and benefits paid, refer to the benefits table below.

Effective 1 April 2017

Our most comprehensive extras cover. This level of cover included Dental and offers the highest benefits and yearly limits of our extras and dental covers.

SERVICE TYPE BENEFITS
PHYSIOTHERAPY/EXERCISE PHYSIOLOGY/OCCUPATIONAL THERAPY (2 month waiting period )
Limit per calendar year $650 per person
$1,300 per family
Initial Consultation $50
Subsequent Consultation $45
Group Therapy - sub limits apply $10
Group Therapy Sub Limit - Physiotherapy & Exercise Physiology $100
PODIATRY (2 month waiting period )
Limit per calendar year $650 per person
$1,300 per family
Initial Consultation $42
Subsequent Consultation $38
Foot Orthotics ( 12 month waiting period ) As per fund benefit schedule
DIETICIAN (2 month waiting period )
Limit per calendar year $650 per person
$1,300 per family
Initial Consultation $42
Subsequent Consultation $38
SPEECH THERAPY (2 month waiting period )
Limit per calendar year $650 per person
$1,300 per family
Initial Consultation $50
Subsequent Consultation $45
ORTHOPTIC (EYE THERAPY) (2 month waiting period )
Limit per calendar year $650 per person
$1,300 per family
Initial Consultation $42
Subsequent Consultation $38
NATUROPATHY/REMEDIAL MASSAGE/ACUPUNCTURE/MYOTHERAPY (2 month waiting period )
Limit per calendar year $600 per person
$1,200 per family
Initial Consultation $36
Subsequent Consultation $34
CHIROPRACTIC/OSTEOPATHIC (2 month waiting period )
Limit per calendar year $600 per person
$1,200 per family
CHIROPRATIC (Combined with Osteopathic yearly limit)
Initial Consultation $36
Subsequent Consultation $34
OSTEOPATHIC (Combined with Chiropractic yearly limit)
Initial Consultation $50
Subsequent Consultation $45
DISTRICT VISITING NURSE (Excluding Midwifery Services) (2 month waiting period )
Limit per calendar year $600 per person
$1,200 per family
Per Visit $12
CLINICAL PSYCHOLOGY (2 month waiting period )
Limit per calendar year $650 per person
$1,300 per family
Initial Consultation $60
Subsequent Consultation $50
Group Therapy $10
AMBULANCE (2 month waiting period )
Limit per calendar year Equal to benefit
Family Refund $90
Single Refund $45
GLASSES (12 month waiting period )
Limit per person per calendar year $250
Frames/ Lenses/ Contact Lenses $250
PHARMACEUTICALS (2 month waiting period )
Limit per calendar year $200 per person
$400 per family
Benefit per non PBS prescription $25
Benefit payable for non PBS prescription after deducting co-payment. Amount equal to the current non-concessional PBS co-payment amount effective 1 January.
HEALTH AIDS/APPLIANCES
Limit per calendar year $1200 per person
$2400 per family
(36 month waiting period)
Limit per person every 36 months
Blood Glucose Monitor $260
Blood Pressure Monitor $200
TENS Machine $200
Nebuliser $200
Constant Air Pressure Monitor (CPAP) $520
Limit per person every 60 months
Hearing Aid $1,000
(12 month waiting period)
Braces/Splints 85% up to $600 every 36 months
CAM Boot 85% up to $600 every 36 months
Artificial Limbs & Prosthesis 85% up to $600 every 24 months
Wigs** 85% up to $300 every 24 months
Crutches/Walking Frame 85% up to $50 every 24 months
Compression Garments** 85% up to $300 every 24 months
**Require an approval form before benefits payable. Mildura Health Fund benefit approval form is available from our office upon request or can be downloaded from Forms & Links. Health Aids & Appliances must be medically necessary and for the treatment of a specific condition.
FIVE STAR HEALTH MANAGEMENT BENEFITS (6 month waiting period)
Limit per calendar year $150 per person
$300 per family
Benefit 70% of cost
Benefits for approved programs to manage or treat a specific health condition such as Pilates, Yoga, Mole Mapping, Bowel Cancer tests, Weight Management and Quit Smoking Programs. Please contact the Fund for details or see the detailed Five Star Health Management fact sheet in Forms & Links.
GENERAL AND MAJOR DENTAL (2 month waiting period)
Maximum benefit payable per person in first membership year (once 2 months waiting period completed) $360
Maximum benefit payable per person per calendar year once first membership year completed $1,200
Percentage benefit of fees as per Fund Dental Schedule, unless otherwise stated 85%
Preventative Dental  100%*
*100% of fee where service provided by a Super Dental provider. See the Preventative Dental section of our brochure for more information.
INLAY/ONLAY, CROWN AND BRIDGE (2 month waiting period)
Sublimit per person per calendar year (by membership year)
1st calendar year of membership $360
2nd calendar year of membership $480
3rd calendar year of membership $540
4th calendar year of membership $600
5th calendar year of membership $660
6th calendar year of membership $720
ORTHODONTICS (24 month waiting period)
Sublimit per person per calendar year $720
Lifetime limit per person $2,000
Benefit Examples
Items Waiting Periods Benefits Paid
General Dental Services
011 - Comprehensive oral examination 2 months $56.30
012 – Periodic oral examination $46.80
114 – Removal of calculus (first visit) $95.90
022 – Bitewing xray – first exposure $39.65
022 - Subsequent exposures (same day) $32.60
513 – Metallic restoration – three surfaces - direct $138.60
311 – Extraction – removal of tooth or part(s) thereof $118.65
323 – Surgical Extraction $221.00
Major Dental
Orthodontics
821 – Active removable appliance – per arch 24 months 50% with max. benefit of $462.90
831 – Full banding – per arch 50% with max. benefit of $396.75
Inlay, Onlay, Crown & Bridge
556 – Veneer – indirect 2 months 75% with max. benefit of $720.00
615 – Full Crown – veneered - indirect 50% with max. benefit of $720.00
Dentures
719 – Complete set of dentures 12 months $1,200.00
Inlay/onlay, crown and bridge and orthodontics are subject to the general and major dental calendar year limits.
Our orthodontics fact sheet can be found in Forms & Links.

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Your quote

Smart Starter $ 0.00
Total Extras $ 0.00
Total $ 0.00

*These quotes are effective from 1 April 2017 to 31 March 2018.

Note: Quote total amount is indicative only and may vary by .10 cents to the actual amount.

Determine your rebate

Your Age:

Under 65 65 - 69 70+

Rebate Tier:

Full rebate
Singles: <$90,000
Families: <$180,000
If you are unsure of your tier please contact the ATO or your financial advisor.
Tier 1
Singles: $90,000-$105,000
Families: $180,000-$210,000
If you are unsure of your tier please contact the ATO or your financial advisor.
Tier 2
Singles: $105,001-$140,000
Families: $210,001-$280,000
If you are unsure of your tier please contact the ATO or your financial advisor.
No rebate
Singles: >$140,001
Families: >$280,001
If you are unsure of your tier please contact the ATO or your financial advisor.
Your calculated rebate: 0%

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