Restrictions & Exclusions

Restrictions and Exclusions

Some of our policies give you cover for the costs of most hospital admissions, apart from any excess or co-payment you agree to pay on your specific policy. Other policies restrict or exclude benefits for some treatments, in return for a lower premium.

 

Exclusions are what you agree not to be covered at all for these certain services when you picked your specific policy with health.com.au. These are the services that your policy will not pay for any of the costs of the service. If your policy has exclusions for particular conditions, you are not covered for treatment as a private patient in a public or private hospital for those conditions.

For example, if your policy excludes cardiac services and you go into hospital as a private patient for cardiac surgery, we unfortunately will not pay any benefits towards your hospital and medical costs.

 

Restrictions are what  you agree to receive only limited benefits for certain services. In other words these are services that your policy only partly covers. If your policy has restrictions for some conditions, you will be covered for treatment for those conditions, but only to a very limited extent.

For example, if your policy restricts rehabilitation, you will be covered for this as a private patient in a public hospital. However, if you go into hospital as a private patient in a private hospital, we unfortunately  will not pay any benefits towards the theatre fees and only a small benefit towards your accommodation fee. This means you may face considerable out-of-pocket costs.