Frequently Asked Questions

When changing your level of cover, the lower level of benefits apply for 12 months for pre-existing ailments and pregnancy (childbirth). Restricted Benefits may apply for specific services. If changing to another cover you may no longer receive Excess Bonuses or your Excess Bonuses may be cancelled, please contact us for details.

If you are changing from another Australian health fund to Australia you may receive Restricted Benefits for some services if specified on your cover with Australia. You will continue to be covered for all benefit entitlements on your new cover that you had on your old cover, as long as you transfer to Australia within 30 days of leaving the previous fund. This is referred to as 'continuity of cover'. Where your level of cover differs from your cover with your old fund, the lower level of benefits applies for pre-existing ailments in the first 12 months.

Some hospital covers offer an Excess Bonus feature, which entitles you to 1 excess-free overnight or same day hospital admission per calendar year on a single or single parent membership, and 2 excess-free overnight or same day hospital admission per calendar year on a family membership.

If you have hospital cover that offers the Excess Bonus feature and have also accumulated Excess Bonus dollars prior to 1 April 2007, you will be able to use your Excess Bonus dollars towards the payment of any excess on a dollar for dollar basis once you have used your excess-free hospital admission/s.

Australia offers some packaged covers, which combine hospital cover and extras cover. These include: Ultimate Health Cover*, Young Couples Choice, Young Singles Saver and Young Singles Choice.

• Accommodation fees for overnight or same-day stays
• Operating theatre, intensive care and labour ward fees
• Pharmaceuticals supplied to you while in hospital as part of your hospital treatment (covered by the Pharmaceutical Benefit Scheme)
• Allied services such as physiotherapy, occupational therapy and dietetics
• Surgically implanted Government-recognised No Gap prostheses

You are covered for the cost of any medical treatment up to the Government Schedule fee - this is the amount set by the Federal Government for each medical service covered by Medicare. Medicare pays 75% of the Schedule fee and Australia pays the remaining 25%. If your specialist charges more than the Schedule fee, there will be a `gap? for you to pay. However, our Ezyclaim system can help to eliminate or reduce the gap for you.

Australia hospital cover also allows you to choose your own hospital and doctor or specialist. And on top of your hospital cover you receive cover for ambulance services.*

Family Plus membership covers you, your partner and your single children under 25 years, even if they are not students and are living away from home.

We define an emergency as an event that is unplanned, non-routine, and in which you require immediate medical attention. You are not covered for transportation from a hospital to: your home, a nursing home, or another hospital (where the member has been admitted to the transferring [first] hospital). You are also not covered for transportation from your home, a nursing home or hospital for ongoing medical treatment, e.g. Chemotherapy or dialysis.

An ambulance subscription to your state ambulance service covers you for transportation and treatment by the ambulance service that is not restricted to emergency-only ambulance transport services and on-the-spot treatment.

Please note that benefits for ambulance subscriptions are not payable by Australia but the state ambulance service.

If you live in VIC, SA or NT you will receive cover for capped recognised emergency-only ambulance transport services or on-the-spot treatment.

If you live in NSW or ACT, you pay an ambulance levy as part of your hospital cover premium. This entitles you to recognised emergency-only ambulance services under the State Government ambulance transport schemes in every state except QLD and SA. When you receive an account for ambulance services in any state except QLD and SA, simply send it to us and we will endorse it for you to send back to the appropriate ambulance transport scheme. In QLD and SA you will receive cover for capped recognised emergency-only ambulance transport or on-the-spot treatment.

If you live in QLD or TAS you will receive full ambulance cover under your state ambulance service. If you fall outside of your state based arrangement, you will receive cover for recognised emergency-only ambulance transport or on-the-spot treatment.

If you live in WA you will receive full ambulance cover nationwide, including uncapped non-emergency transportation and on-the-spot treatment.

Cover for recognised emergency-only ambulance transport services or on-the-spot ambulance treatment on top of your hospital cover is is capped at one service for a single membership and two services for couple, single parent and family memberships each calendar year - unless you have Ambo Cover, in which case you are covered for unlimited emergency services.

We define an emergency as an event that is unplanned, non-routine, and in which you require immediate medical attention. You are not covered for transportation from a hospital to: your home, a nursing home, or another hospital (where the member has been admitted to the transferring [first] hospital). You are also not covered for transportation from the member?s home, a nursing home or hospital for ongoing medical treatment, e.g. Chemotherapy or dialysis.

If you do not have an ambulance subscription with your state ambulance service and need to make a claim for emergency ambulance services covered on top of your hospital cover, please complete and return to us the Particulars of Ambulance Transportation form [in addition to your claim form?].

There are some situations where you won't have to pay a Lifetime Health Cover loading, for example:

• You first took out private health insurance when you were under 31 and you have had private health insurance without any break (or any break less than 3 years) since you took it out);
• You had private hospital cover on 1 July 2000 and have maintained it since; or
• You were born before 1 July 1934.

You need to join before you turn 31 to avoid incurring a loading over and above your base insurance premium (2% for every year you are over 31, up to a maximum of 70%). For example, if you join at 30 you pay a lower annual premium when compared to joining at 50, as you will then have to pay a 40% loading. Once you've had hospital cover for 10 consecutive years, you won't have to pay the loading any longer.

So what does all this mean? The sooner you take out private health insurance, the less loading you will have to pay.

The amount of Rebate you are entitled to depends on your age. There are three levels of rebate:

• Under 65 years - 30% Government Rebate
• 65 to 69 years, or persons on a policy that also covers someone aged 65 to 69 - 35% Government Rebate
• 70 years or over, or persons on a policy that also covers someone aged 70 or over - 40% Government Rebate

• At least 30% off your premium - the Federal Government contributes 30%, 35% or 40% (depending on the age of the people covered on your policy) of your private health insurance premium, which effectively cuts the cost of your cover by, at the least, almost a third
• No Medicare Levy Surcharge - private health insurance may reduce the tax you have to pay. If you're single and earn more than $50,000 a year, or a couple with a combined annual income of over $100,000* and don't have private hospital cover you may have to pay the Government's 1% Medicare Levy Surcharge. That's on top of the normal 1.5% Medicare Levy imposed on all eligible tax payers
• Take out and maintain private hospital cover by age 31, without any break (or any break less than 3 years), and you may not have to pay the Government's Lifetime Health Cover loading on your premiums. Under the initiative, your age is determined by how old you are on 1 July before you join. If you're over 31, the sooner you take out private hospital cover, the less loading you pay

• Treatment at general and specialist practitioners
• Treatment at public hospitals
• A portion of the cost of medical treatment in private hospitals by surgeons, anaesthetists and other specialists

• If you go into a public hospital as a public patient, you are fully covered under Medicare. That's the good news. The not so good news is that you'll have little or no say over who treats you, or when
• If you go into a public hospital as a private patient, your Australia hospital cover will pay for some of the costs associated with your treatment. You get to choose your doctor but you'll still have little or no control over where or when you get treated

Private hospitals

If you go into a private hospital, Medicare will cover a portion of your medical treatment costs, but not your accommodation and theatre expenses. A way to cover yourself for those bills is with hospital cover offered by private health insurance.

Our hospital cover contributes to the portion of medical costs if you are admitted to any hospital within our network of Members First or Participating Private hospitals, or public hospitals in Australia:

• We cover you for the cost of medical treatment up to the Government Schedule Fee
• Medicare pays 75% of the Schedule Fee
• Australia pays the remaining 25%

Some doctors and specialists charge more than the Government Schedule Fee. The difference between the two is the "gap", which is normally up to you to pay, but if your doctor or specialist uses our Ezyclaim system, they agree with Australia to either charge you no gap or a maximum gap that is agreed with us. They also agree to bill us directly. So in most cases, there's no gap and no bill!

• Outpatient treatment, which is where you receive treatment at a private hospital but are not actually admitted to hospital
• Medical costs for surgical procedures performed in hospital by a dentist or podiatrist cannot be covered as they are not eligible for Medicare rebate
• Pharmaceuticals supplied on discharge from hospital, unless covered by your extras cover
• Services that can be claimed elsewhere such as via a compensation claim eg. Worker's Compensation or TAC
• All hospital covers have Restricted Benefits for cosmetic surgery and sterilisation reversal that will result in significant out-of-pocket costs

Your level of cover sets out the types of services covered. If it is not stated that a service is covered, then it is not covered by that level of cover.

Some levels of cover exclude specific services. This means you will not be covered for that particular service whilst on that level of cover. The types of services that may be excluded are:

• Pregnancy related services, including childbirth
• Heart and artery related services
• Psychiatric services
• Assisted reproductive services, including IVF
• Hip or knee replacements
• Rehabilitation services
• Cataract surgery

Some services have a waiting period. A waiting period starts from the date you join. During a waiting period you are not covered and will not receive any benefits for the types of treatment affected by the waiting period. Once the waiting period is over, you will receive the full benefits listed under your level of cover for that treatment type.

If you transfer to Australia from another health fund on an equivalent level of cover, we will honour all the waiting periods you have already served when we receive confirmation of your previous membership and level of cover, but you will need to join Australia within 30 days of leaving the other fund.

When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during waiting periods.

Waiting periods apply to all levels of cover. Please refer to the full policy details to determine the waiting periods that apply to your level of cover.

Recognised providers and Participating hospitals are providers and hospitals with which Australia has established agreements that help to minimise out-of-pocket expenses for its members.

At Participating hospitals, which includes most private hospitals and all public hospitals in Australia, you're covered for the following in-hospital services:

• Overnight and same day accommodation
• Operating theatre and intensive care fees
• Supplied pharmaceuticals that are approved by the Pharmaceutical Benefits Scheme and provided as part of your treatment
• Allied services such as physiotherapy, occupational therapy and dietetics
• No Gap prostheses that are surgically implanted and Government recognised

At Australia we understand that sometimes there's the odd bump in the road. If you are involuntarily retrenched or your position is made redundant, on some levels of hospital cover we will pay your health insurance premium (at the same level of cover) for up to 12 months, as long as you remain unemployed. The main conditions are:

• If you have a family membership, only the main income earner is eligible
• The main income earner must have been continuously employed for at least six months prior to being retrenched or made redundant
• You must have been enrolled in a level of hospital cover that includes 'unemployment cover'* for the preceding 12 months
• Payment of unemployment cover benefits are made quarterly provided you can supply a copy of either a Newstart Allowance Certificate or a Statutory Declaration confirming your continued unemployment every 3 months

• If your hospital cover has a waiting period, it means that you will not be covered and will not receive benefits for that treatment during the waiting period
• If your cover has an Exclusion on some services, you cannot claim for those services for as long as you are on that level of cover
• If your cover has a Restricted Benefit on a medical treatment or condition, you will only ever receive minimum default benefits set by the Government for that treatment or condition

• Aged over 30 and were aged under 65 on July 1st 1999 and are not currently covered by private hospital insurance

To reward members for their loyalty, Australia has a loyalty scheme on a number of cover options. This scheme rewards members with Excess Bonuses. Excess Bonuses are either excess-free hospital admissions or Excess Bonus dollars that are allocated to the member's account each year and can be used towards the payment of any hospital excesses. For more information, please refer to the 'What is an Excess Bonus' FAQ.

• 2 months for General Dental
• 12 months for Major Dental, root fillings, complex fillings, dental sleep apnoea devices and pre-existing ailments

If you wish to have the baby in a private hospital or as a private patient in a public hospital and your current policy does not cover pregnancy, you will need to change your level of hospital cover to a policy that covers pregnancy and serve the 12 month waiting period.

Please note that you will need to take out a family membership before your baby is born.

You can change your cover at any time by using the Change my cover form on the website or by contacting us.

Yes, you can request a Summary of Cover at any time. Simply contact us and ask one of our customer service consultants to send you one, or you can request a Summary of Cover online.

• Augmentation mammaplasty
• Liposuction
• Reduction of eyelids
• Meloplasty
• Laser sculpting of eyes

• Workers' Compensation
  
• Compulsory Third Party Insurance
  
• Common Law
  
• Sports Insurance
  
• Travel Insurance
  
• Litigation

Please note:

When changing your level of cover, the lower level of benefits apply for 12 months for pre-existing ailments and pregnancy (childbirth). Restricted Benefits may apply for specific services. If changing to another cover you may no longer receive Excess Bonuses or your Excess Bonuses may be cancelled, please contact us for details.

If you are changing from another Australian health fund to Australia you may receive Restricted Benefits for some services if specified on your cover with Australia. You will continue to be covered for all benefit entitlements on your new cover that you had on your old cover, as long as you transfer to Australia within 30 days of leaving the previous fund. This is referred to as 'continuity of cover'. Where your level of cover differs from your cover with your old fund, the lower level of benefits applies for pre-existing ailments in the first 12 months.

Please contact us on if you have any queries or require further information.

Some hospital covers offer the Excess Bonus feature, which entitles you to 1 excess-free overnight or same day hospital admission per calendar year on a single or single parent membership, and 2 excess-free overnight or same day hospital admission per calendar year on a family membership.

If you have hospital cover that offers the Excess Bonus feature and have also accumulated Excess Bonus dollars prior to 1 April 2007, you will be able to use your Excess Bonus dollars towards the payment of any excess on a dollar for dollar basis once you have used your excess-free hospital admission/s.

• Where you choose to be treated at a non-participating private hospital, you may not be fully covered.
• A person who is classified as a "nursing home type patient" (as defined in the Health Insurance Act) may receive limited benefits. In such cases patients are required by law to make a personal contribution towards their care.
• Cosmetic surgery and sterilisation reversal have restricted benefits based on the Medicare benefits payable.
• Benefits are not payable for outpatient treatment in a private hospital if you are not admitted to hospital.
• Medical costs for surgical procedures performed in hospital by a dentist or podiatrist or any other practicioner that is not eligible for the Medicare rebate.
• Benefits are not payable for pharmaceuticals supplied on discharge from hospital, unless covered under your extras benefits.
• Excess Bonuses cannot be used towards the cost of excesses when claims are made for services during a period of Lifetime Restricted Benefits.

A Waiting Period starts from the date you join health insurance. During a Waiting Period you are not covered and will not receive any benefits for the types of treatment affected by the Waiting Period. Once the Waiting Period is over, you will receive the full benefits listed under your level of cover for that treatment type.

All hospital covers have 12 month Waiting Periods for pre-existing ailments and pregnancy (childbirth), where applicable. If you transfer to from another health fund on an equivalent level of cover we will honour all the Waiting Periods you have already served for benefits on your new cover that you had on your old cover when we receive confirmation of your previous membership and level of cover, but you will need to join within one month of leaving the other fund.

Where your level of cover with Australia differs from your cover with your old fund, the lower level of benefits applies for pre-existing ailments in the first 12 months.

When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during Waiting Periods.

A Restricted Benefits period for a service is a period during which that service is only covered as a Restricted Benefit. During a Restricted Benefits period you will only be covered for the service with your choice of doctor for shared room accommodation in a public hospital. If you go to a private hospital for a service that has Restricted Benefits it is likely to result in large out-of-pocket expenses. Restricted Benefits are an amount set by the Government and are generally not enough to cover accommodation costs in a private hospital.

All hospital covers for Australian residents have Restricted Benefits for cosmetic surgery, sterilisation reversal, surgical podiatry and all services that do not attract a Medicare benefit.

Some hospital covers give Restricted Benefits for specific services for the duration of that cover.

Please check the full policy details to determine if any Restricted Benefits apply for specific services.

If a service is covered as a Restricted Benefit, this means you will be covered with your choice of doctor for shared room accommodation in a public hospital only. If you go to a private hospital for a specific service which has Restricted Benefits, it is likely to result in large out-of-pocket expenses. Restricted Benefits are an amount set by the Government and are generally not enough to cover accommodation costs in a private hospital.

All hospital covers for Australian residents have Restricted Benefits for cosmetic surgery, sterilisation reversal, surgical podiatry and all services that do not attract a Medicare benefit.

Some hospital covers give Restricted Benefits for specific services for the duration of that cover.

Please check the full policy details to determine if any Restricted Benefits apply for specific services.

Australia offers a range of quality health cover options at affordable prices, to suit any lifestyle and budget. So we can provide you with high quality cover at competitive rates, and the peace of mind you expect from private health insurance.

• Your accountant may ask you to get a Tax Statement so you can claim the Government Rebate. You are eligible for the Government Rebate if you have a Reciprocal Medicare card and extras cover.
• Your accountant may ask you to get a Tax Statement to exempt you from the Medicare Levy Surcharge (MLS). You are liable for the MLS if you are from a RHCA country, have a Reciprocal Medicare card, are working in Australia and earning over a certain amount.

Covers for Australian residents can provide you with a wide range of alternative options to suit your needs and if you join one on an equivalent level of cover to your overseas visitor cover, you will continue to be covered for benefits on all services you were entitled to under your overseas visitors cover. This applies as long as you transfer to a cover for Australian residents within 30 days of ceasing your overseas visitor cover.

If your level of cover with us is higher than the cover you had with your previous insurer, the lower level of benefits will apply until any waiting periods on the upgrade have been served. You may also need to serve waiting periods for any new benefits, services or treatments offered under your new cover with us.

If you chose a lower level of cover than you previously held, then the lower benefits of your new cover will apply immediately.

Please note that when changing health insurers, extras benefits paid by your previous insurer will be counted towards your yearly maximums in the first year of membership with us.

View your payment options.

If you do not have a Reciprocal Medicare card you are not eligible to claim the rebate.

All hospital covers have a 12 month waiting period for pre-existing ailments and pregnancy (childbirth), where applicable. If you transfer from another health insurer to an equivalent level of cover with our fund, we will honour all the waiting periods you have already served for benefits that you had on your old cover (as long as they are on your new level of cover with our fund). To confirm this, we require confirmation of your previous membership and level of cover in the form of a Clearance Certificate from the previous fund. To receive this continuity of cover, you will need to join our fund within one month of leaving your previous insurer.Where your level of cover with us differs from your cover with your old insurer, the lower level of benefits applies for pre-existing ailments in the first 12 months. When you upgrade to a higher level of cover, the benefits from your previous level of cover apply during Waiting Periods.

However, if your claim is in the first 12 months, not related to a pre-existing condition and you ensure the section on medical symptoms on your claim form is completed, we will usually not require a medical certificate

• 2 months for General Dental
• 12 months for Major Dental, root fillings, complex fillings, dental sleep apnoea devices and pre-existing ailments

For example:

• Workers' Compensation
• Compulsory Third Party Insurance
• Common Law
• Sports Insurance
• Travel Insurance
• Litigation

We reserve the right to recover any benefits paid in this regard.