What am I covered for?
When checking your hospital cover, anything that doesn’t appear in the ‘exclusions’ list is covered under your insurance. For example, take a look at the list of exclusions on our Base Hospital cover below:
Exclusions on Base Hospital
- Pregnancy related services (Assisted reproductive services, sterility reversal, labour and delivery)
- Cardiothoracic related services (Heart and lungs)
- Cataract and eye lens procedures
- Dialysis Chronic kidney failure
- Joint replacements (Including prostheses)
- Bariatric surgery (Lapband, gastric bypass)
- Spinal surgery
- Insulin pumps
- Cochlear implants
- Services Medicare doesn’t cover including for non-medically necessary surgery eg cosmetic surgery
Anything appearing in the list is not covered under this cover. Of course, as you move to higher levels of cover, the list of exclusions becomes smaller.
If you’re looking to have a procedure done in private hospital that is an exclusion on your current level of cover, health.com.au cannot cover any part of the admission, including the theatre and the actual accommodation itself.
My procedure/surgery isn't listed as an exclusion. Heavens above! What happens next?
You’ll need to pay your excess to the hospital in order to be covered for your stay, and time spent in theatre. You’re also covered for the scheduled fees (a retail price set by the government) for the main surgical item numbers, the anaesthetist, and the assistant (if applicable). Any out of pockets above the scheduled fee are set by the individual professionals themselves, and you’ll need to consult them prior to your admission as to what these will be, and when they'll need to be paid.
What is a restriction?
Anything listed as a restriction on your cover means heath.com.au can pay default benefits towards your stay. Default benefits (commonly referred to as shared room rates) differ from state to state. They’re usually the equivalent to the public shared ward rates. For example, take a look at the list of restrictions on our Base Hospital cover below:
Restrictions on Base Hospital
- Psychiatric services
- Podiatric surgery
If you’re heading into hospital for a service that is restricted on your cover, make sure to consult your hospital beforehand to find out how much out of pocket you’ll need to pay towards the accommodation for your admission.