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What are the benefits of Hospital Cover?
Our five Hospital Cover products are designed to help singles, couples, single parents and families meet the cost of private treatment in a hospital, avoid public hospital waiting lists and choose the specialist that treats you, when and where.
Yes, before you can make a claim, a waiting period may apply. These vary from 1 day to 12 months depending on the treatment you’re claiming for.
However, if you’re switching to AAMI Health Insurance from another health fund, not only is it easy but you won’t have to restart waiting periods you’ve already served with your old fund when you sign up for the same level of cover with us.
Yes. A waiting period of 12 months will apply before you can claim for treatment.
A condition is considered pre-existing if you’ve experienced symptoms at any time up to 6 months before joining this health fund or upgrading your cover. A medical practitioner will determine if a condition is pre-existing after reviewing information from your doctor.
Age-based discounts are available to eligible customers on select AAMI Health Insurance Hospital covers. Age-based discounts are calculated as 2% for each year that a person is under 30, up to a maximum of 10% for a person aged 18 to 25. Providing you remain on an eligible hospital cover, you will keep this discount until you turn 41, when it will start reducing at a rate of 2% per year.
Cancer treatment in hospital: It is important to be aware that health insurance will only cover the portion of costs that relate to an admission to hospital. Specialist fees outside of hospital or other outpatient fees in relation to chemotherapy or radiotherapy aren’t covered.
High cost drugs are sometimes requested for the Treatment of some cancers. Typically high-cost drugs are for newer Treatments that are not recognised by the Pharmaceutical Benefit Scheme (PBS) because the PBS considers them to be still under clinical trial and therefore experimental Treatments. Health insurance will not Cover high cost drugs for the same reasons (or may only Cover a small portion of the cost). It is the responsibility of the treating doctor, and Hospital, to inform Patients about the potential for large out-of-pockets as a result of high cost drugs.
Customers without full cover for Psychiatric Treatment are able to use a one-off waiver to upgrade their cover and have immediate access to applicable in-hospital mental health services. This waiver is only available to customers who have held hospital cover for at least the previous two months and have a valid referral from a consulting psychiatrist. To find out more, call us on 13 22 44.
Benefit Limitation Period - Minimum Benefits Payable (BLP - MBP) means that unless you're transferring from a Complying Health Insurance Product (see Policy Booklet), there will be significant out-of-pocket costs if you go to hospital for this treatment in the first 12 months of your policy. After serving the 2 month Waiting Period, your benefit will be limited to "Minimum Benefits Payable" for the following 10 months. After this period of time you are entitled to the full benefit claimable for the treatment.
Minimum Benefits Payable (MBP) means that we will pay the minimum amount of benefits that we are required to pay under the Private Health Insurance Act, to or on behalf of a customer for hospital treatment under a Hospital cover. If you’re attending a Private Hospital for these services, there will be significant out-of-pocket costs. If a treatment important to you is listed as MBP, we recommend you consider a higher level of cover.
INCL - Hospital Treatment provided by a registered Podiatric Surgeon is limited to cover for accommodation and prosthetic devices. No benefits are payable for Podiatric Surgeon fees, medical specialist fees (e.g. Anaesthetist) or theatre costs. Refer to the Policy Booklet for more information.
A hospital excess is a charge that applies when you, or someone on your policy, are admitted to hospital. Depending on the Hospital Cover you have this will be $250 or $500. It only applies once per person, per calendar year, and is paid directly to the hospital before your admission. There’s no hospital excess for dependent children under 21.
Some hospitals charge additional fees for care and treatment associated with your stay. These may include:
- private hospital emergency or out-patient fees
- admission or booking fees charged by a specialist or the hospital
- private room accommodation for a same day procedure
Call us on 13 22 44 before choosing a hospital to find out what charges may apply.
Any service listed as excluded on a customer’s policy is not covered. This includes:
- procedures within waiting periods
- cosmetic surgery
If you require additional or specialised nursing care, extra charges may apply. Examples of such care include:
- services provided exclusively or primarily for the care or treatment of a mentally disabled person who is not a private patient in a hospital
- services rendered in a nursing home
- respite care
You may be liable for extra charges if you require:
- autologous blood collection and storage
- drugs that aren’t available under the Pharmaceuticals Benefits Scheme (PBS)
- oral contraceptives
- procedures performed in a doctor’s surgery
Services that aren’t directly related to your treatment and care. These include:
- beauty services
- phone calls
- TV hire
- car parking
- luxury rooms
- take-home items e.g. crutches
Services, drugs or disposable items which may be used in a hospital but that are not recognised by Medicare. These are considered experimental and are not covered e.g. some items associated with robotic surgery.