About Private Health Cover

Private health cover can be confusing so we have put together some 'how do I?' question and answers for you.

How do I....


Important information about private health cover

  • Private health cover is designed to complement Medicare, not replace it. Private health cover contributes towards the cost of public and private hospital treatment and health services not covered by Medicare. Click here for a table outlining who pays for various medical services. For a comprehensive outline of exactly what you’re covered for, please refer to your cover description under forms and brochures.
  • Lifetime Health Cover Loading: The Lifetime Health Cover loading will increase the standard rate for hospital cover by 2% for each year that you are over the age of 31 as at the date that you take out a hospital cover.
  • Medicare Levy Surcharge: If you take any onemedifund hospital product, you will avoid the Medicare Levy Surcharge. This levy is between 1% and 1.5% of your taxable income, depending on your income. Note: For the 2016/17 financial year the MLS income threshold for singles is $90,000 and $180,000 for couples and families.
  • Private Health Insurance Rebate: The Australian Government Rebate on Private Health Insurance aims to reduce the cost of health cover for Australians. The rebate is income tested and the amount of rebate you are entitled to receive is based on your age and household income for Medicate Levy Surcharge purposes.
  • Medicare Benefits Schedule & Access Gap: If you have private health cover and are admitted to hospital as a private patient, Medicare pays a benefit of 75% of the MBS and the remaining 25% is paid by onemedifund. If a doctor raises a charge that is above the MBS, this amount is known as a ‘medical gap’. onemedifund has arrangements with more than 21,000 doctors Australia wide where additional benefits are payable by the fund to reduce or eliminate ‘medical gaps’ faced by contributors. This scheme is known as ‘Access Gap’.
  • Waiting Periods, Pre-Existing Conditions & Continuity of Cover: Waiting periods are established to protect all contributors by encouraging people to maintain their health cover. A waiting period is a length of time applied to each new health cover and also applies when cover is upgraded. During this period, benefits are not payable.
  • Excess Options: onemedifund have 2 different levels of excess you can choose to have when you take out our private hospital or combination covers.
  • Co-payments: NHBA has contracts in place with most hospitals throughout Australia. As a result, contributors of NHBA are not required to contribute a co-payment sum for a hospital admission in the majority of cases unless an excess applies to their level of cover. (Note: some hospital admissions for nursing home type patients will attract a co-payment.)

onemedifund is the way to go if you want to access private health services, eliminate the Medicare Levy Surcharge, obtain any government rebate off your private health cover and reduce the impact of the Lifetime Health Cover Loading.