Hospital Cover

You can choose either of our Private Plus Hospital Cover options. The benefits payable are identical under each cover option, except for the level of excess that you agree to pay if hospitalised.

 

What is an excess?

Choosing an excess allows you to reduce your standard contribution rate. In these circumstances, if you are admitted to hospital, you agree to pay an amount up front towards the cost of your hospitalisation. 

For each Hospital product a per person excess applies together with an annual maximum each financial year (1 July – 30 June). 

As a special feature, the excess payable for day only treatment or for any public hospital admission, is only half of the standard per person excess.

If you do not have an excess with your Private Plus Hospital cover, the following is not applicable. If you do have an excess with your Private Plus Hospital cover, the following excess is payable when admitted to a hospital:

  • The most excess an individual contributor will pay in a financial year is $250
  • The most excess a family will pay in a financial year is $500
  • Excesses apply to hospital services only

 


As at 1 April 2017

Important information:

  • Waiting periods, including those for pre existing conditions, may apply.
  • After payment of your excess (if applicable), 100% cover is available for all public and more than 520 private hospitals across Australia. You may have out-of-pocket costs if you are admitted to a hospital that does not have an agreement with onemedifund. To find your nearest agreement hospital, visit www.onemedifund.com.au/providers.
  • Prostheses – we pay the benefit listed on the Government’s Prostheses List. If your doctor charges above that amount, you will have out-of-pocket costs.
  • We are unable to pay benefits for services that are not eligible for Medicare benefits.

 

What We Will Pay For

  • Public or Private Hospital bed - shared or private room (if available)
  • Same day patient fees
  • Theatre fees
  • Intensive care
  • Labour ward
  • In hospital psychiatric treatment
  • In hospital rehabilitation treatment
  • In hospital pharmacy
  • Surgical Prostheses
  • Ambulance Services

What We Won't Pay For

  • Services incurred before waiting periods have been served.
  • Any treatment for which Medicare does not pay a benefit, including cosmetic surgery.
  • Services that are provided outside the Commonwealth of Australia.
  • Services where an entitlement exists or may exist under any compensation, third party or other insurance.
  • A claim for a service that is submitted more than 24 months after the date of service.
  • Doctors’ fees (including GPs, specialists, radiology, pathology etc.) for services that are not part of a hospital admission. Services are not covered until the contributor is admitted to hospital (this includes visits to hospital Emergency departments and for diagnostic services).
  • Outpatient services other than where included in an agreement between the fund and the hospital.
  • Some high cost drugs or drugs that are not deemed to be related to the reason for your admission to hospital.
  • Prostheses items that are not included on the Commonwealth Government approved list.
  • Ambulance subscriptions or state based ambulance levies.
  • Ambulance costs that are covered under Government legislation or other compensable sources.