Basic Plus hospital cover will give you shared room accommodation in a public hospital with your
choice of doctor. It is designed to provide 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 the Minimum Benefit Payable is paid against the cost of private hospital treatment, this cover
is not recommended for people wanting comprehensive private hospital cover.
Effective 1 April 2021
What you're covered for:
Basic Plus gives you shared ward accommodation in public hospitals across Australia with your
choice of doctor. Should you be admitted to a private hospital or day facility, restricted
benefits only will be payable leaving you with sometimes large out of pocket costs.
Excess
An excess of $750 will apply to this
level of cover.
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.
Waiting Periods
- None for accidents
- 2 months for general illness
- 12 months for pre-existing conditions
- 12 months for pregnancy and birth
- 2 months for psychiatric, rehabilitation and palliative care
Detailed information can be found here.
Restrictions
Hospital treatment provided in a private hospital or day facility will be restricted to the Minimum Benefit Payable (MBP).
Exclusions
None
Co-payments
None
What are my options if I am admitted to a public hospital?
When you are admitted to a public hospital, you can to choose whether to be treated as a public
patient or as a private patient. If you choose to be a public patient, you will be treated by a
doctor appointed by the hospital and not be charged for your care.
You can choose to be treated as a private patient in a public hospital to have your choice of
treating doctor, or to have a private room. However, this may not necessarily guarantee the
doctor of your choosing or that a private room will be available, nor does it guarantee a higher
level of care.
There is no difference in the level of care you receive at a public hospital if you elect to be a
private patient, you may however be charged some out-of-pocket costs.
What else is covered?
Gap Medical Benefits
When you are admitted to hospital you will be charged separately for medical fees by your doctor,
medical specialist, surgeon, anaesthetist, radiologist or pathologist.
These fees will be in addition to your accommodation and theatre fees, and are always negotiable
between you and your health care provider. You will receive 100% of the Medicare Benefit
Schedule (MBS) fee, the Medicare benefit, plus the Fund Benefit for inpatient services. Detailed
information can be found here.
No gap medical Benefits at MHPH
Mildura Health Fund has no gap medical agreements with a number of medical specialists, doctors and surgeons who operate at Mildura Health Private Hospital (MHPH). The current list of no gap medical providers can be found here.
Prostheses
A prosthesis is a surgically implanted medical device or artificial body part, such as a hip or
knee joints or a cardiac pacemaker.
Other costs you may incur
Depending on the procedure you are having whilst an inpatient in hospital, your doctor may need
to use high cost items that are not normally covered.
Our top, comprehensive cover gives you 100% cover Australia wide with or without an excess
option, no restrictions or exclusions. We have contracts with more than 435 private hospitals
Australia wide, to give you peace of mind knowing that you will be covered.
Effective 1 April 2021
What you're covered for:
If you would prefer to pay a lower premium and still have the most comprehensive cover, our Five
Star Gold cover has a choice of five different excess amounts that you can choose to
pay.
It is the same top cover with no exclusions but with a known upfront excess amount to pay. The
higher the excess, the lower the premium.
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.
Youth Discount
The Youth Discount is available to persons aged 18 to 29 inclusive who join a Five Star Gold
level of cover.
Waiting Periods
- None for accidents
- 2 months for general illness
- 12 months for pre-existing conditions
- 12 months for pregnancy and birth
- 2 months for psychiatric, rehabilitation and palliative care
Detailed information can be found here.
What else is covered?
Gap Medical Benefits
When you are admitted to hospital you will be charged separately for medical fees by your doctor,
medical specialist, surgeon, anaesthetist, radiologist or pathologist.
These fees will be in addition to your accommodation and theatre fees, and are always
negotiable between you and your health care provider. You will receive 100% of the
Medicare Benefit Schedule (MBS) fee, the Medicare benefit, plus the Fund Benefit for
inpatient services. Detailed information can be found here.
No gap medical Benefits at MHPH
Mildura Health Fund has no gap medical agreements with a number of medical specialists, doctors and surgeons who operate at Mildura Health Private Hospital (MHPH). The current list of no gap medical providers can be found here.
Prostheses
A prosthesis is a surgically implanted medical device or artificial body part, such as a
hip or knee joints or a cardiac pacemaker.
Other costs you may incur
Depending on the procedure you are having whilst an inpatient in hospital, your doctor
may need to use high cost items that are not normally covered.
| DENTAL BENEFIT TABLE |
DENTAL |
| SERVICE |
BENEFIT |
SUB-LIMIT* |
FIRST YEAR MEMBERSHIP |
LIFETIME LIMIT |
CALENDAR YEAR LIMIT |
| General & Major Dental |
Preventative Dental |
100% * |
|
$350 Maximum benefit payable per person |
|
$1,000 Maximum benefit payable per person once first year is
completed |
|
General & Major Dental |
70% ** |
|
Inlay/Onlay, Crown & Bridge |
As per dental schedule |
1st calendar year of membership $350 |
|
|
2nd calendar year of membership $450 |
|
|
3rd calendar year of membership $500 |
|
|
4th calendar year of membership $550 |
|
|
5th calendar year of membership $600 |
|
|
6th calendar year of membership $650 |
|
Orthodontics |
50% up to $600 |
$600 Per person per calendar year |
$1,500 Per person |
| DENTAL BENEFIT TABLE |
DENTAL EXTRAS |
| SERVICE |
BENEFIT |
| Preventative Treatment |
Periodical oral examination |
$47.55 |
|
Emergency consultation |
$31.15 |
|
X-Ray |
$41.95 |
|
Scale & Clean |
$101.55 |
|
Fluoride Treatment |
$42.40 |
| General & Major Dental |
Surgical Extraction |
$168.85 |
|
Filling - Adhesive one surface |
$91.50 |
|
Filling of one root canal |
$164.90 |
|
Full crown veneer |
$650 |
|
Full denture |
$1,000 |
* Sub-limits apply to these services. Group benefits not payable for Occupational Therapy.
^ Health Aids and Appliances must be medically necessary and for the treatment of specific conditions.
+ Conditions apply, sport and pregnancy related garments are excluded. Contact the Fund for further information.
All benefits subject to waiting periods and benefit limitation periods.
* Sub-limits apply to these services. Group benefits not payable for Occupational Therapy.
^ Health Aids and Appliances must be medically necessary and for the treatment of specific conditions.
+ Conditions apply, sport and pregnancy related garments are excluded. Contact the Fund for further information.
All benefits subject to waiting periods and benefit limitation periods.
* Sub-limits apply to these services. Group benefits not payable for Occupational Therapy.
^ Health Aids and Appliances must be medically necessary and for the treatment of specific conditions.
+ Conditions apply, sport and pregnancy related garments are excluded. Contact the Fund for further information.
All benefits subject to waiting periods and benefit limitation periods.
Dental Benefits
| DENTAL BENEFITS TABLE |
FIVE STAR EXTRAS |
| SERVICE |
BENEFIT |
SUB-LIMIT* |
FIRST YEAR MEMBERSHIP |
LIFETIME LIMIT |
CALENDAR YEAR LIMIT |
| General & Major Dental |
Preventative Dental |
100% * |
|
$390 Maximum benefit payable per person |
|
$1,400 Maximum benefit payable per person once first year is
completed |
|
General & Major Dental |
85% ** |
|
Inlay/Onlay, Crown & Bridge |
As per dental schedule |
1st calendar year of membership $390 |
|
|
2nd calendar year of membership $510 |
|
|
3rd calendar year of membership $570 |
|
|
4th calendar year of membership $630 |
|
|
5th calendar year of membership $690 |
|
|
6th calendar year of membership $750 |
|
Orthodontics |
50% up to $800 |
$800 Per person per calendar year |
$2,400 Per person |
| DENTAL BENEFIT TABLE |
FIVE STAR EXTRAS |
| SERVICE |
BENEFIT |
| Preventative Treatment |
Periodical oral examination |
$47.55 |
|
Emergency consultation |
$31.15 |
|
X-Ray |
$41.95 |
|
Scale & Clean |
$101.55 |
|
Fluoride Treatment |
$42.40 |
| General & Major Dental |
Surgical Extraction |
$204.80 |
|
Filling - Adhesive one surface |
$110.95 |
|
Filling of one root canal |
$200.00 |
|
Full crown veneer |
$750 |
|
Full denture |
$1,400 |