Ultimate Health Cover

The most comprehensive private health cover available

Designed for those wanting the very best in private health insurance, Ultimate Health Cover is a comprehensive package of hospital and extras.

When you choose Ultimate Health Cover, you'll get top cover for an extensive range of services and the highest extras benefits (up to 100%) and annual maximums.

What is covered?

Hospital expenses

Medical expenses

Gap Bonus per year

Heart scan

Laser eye surgery

Additional features and benefits

Ambulance services

Health subscription refund

Unemployment cover

Baby Care

Medical advice line

Reduce your tax

What is not covered?

Full costs at non-participating private hospitals

During a Waiting Period

Restricted Benefits

Exclusions

Services and situations not covered by health funds

Waiting periods & price

What are the waiting periods?

What does it cost?

What is covered?

Hospital expenses

Cover for your hospital expenses

If you are admitted to a Members First, Participating Private hospital or public hospital, you will receive full cover for hospital expenses, for as long as you are in hospital.

Hospital expenses are the hospital's charges for in-hospital services, which include:

Accommodation fees for overnight or same-day stays
Operating theatre and intensive care fees
Supplied pharmaceuticals approved by the Pharmaceutical Benefits Scheme (PSB) and provided as part of your in-hospital treatment
Allied services such as physiotherapy, occupational therapy and dietetics
No Gap prostheses that are surgically implanted and Government-recognised

Cover for prostheses

You are also covered for surgically implanted Government-recognised No Gap prostheses. If your doctor chooses a No Gap prosthesis, you will not have any out-of-pocket expense where the prosthesis item is implanted as part of the hospital treatment covered. If the prosthesis item used is listed as a Gap prosthesis you will have to pay any gap charged by the hospital. You can ask your specialist to choose a No Gap prosthesis as there is one available for every surgical requirement.

Medical expenses

Cover for your medical expenses

Medical expenses are the costs charged by a doctor, surgeon, anaesthetist or other specialist for treatment given to you in hospital. We cover you for the cost of medically necessary treatment given to you while you are in hospital, up to the Government Schedule fee.

For in-patient hospitalisation, Medicare pays 75% of the Schedule fee and HBA pays the remaining 25%. If your specialist charges more than the Schedule fee, there will be a 'gap, but our Ezyclaim system can help cover or reduce the gap for you.

Cover for the 'gap'

Ezyclaim is a direct billing system your specialist can use to eliminate or reduce the gap. An Ezyclaim specialist bills us directly. So in most cases, you don't pay any out-of-pocket expenses, or even receive a bill. And if there is a gap, you will be told about the amount before your treatment. Simply ask your specialist about Ezyclaim.

Gap Bonus per year

Gap bonus per year

We give you a $200 gap bonus when you join and another $200 bonus for each calendar year you're a member.

Heart scan

100% cover for standard heart scans. Limited to one per person every three years.

Laser eye surgery

Laser eye correction

100% cover for laser eye correction surgery by a HBA approved provider using a microkeratome.

Laser eye correction surgery using Lasik or Intralase will attract a higher fee and out of pocket expenses.

Lensectomy is classified as a cosmetic vision correction procedure and not covered.

Additional features and benefits

Ambulance services

Emergency ambulance services

If you live in NSW or ACT and you have hospital cover, 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. 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.

The NSW and ACT State Government ambulance transport schemes do not cover ambulance services in QLD and SA. In these states, on top of your hospital cover you will receive cover for recognised emergency-only ambulance transport or on-the-spot treatment. This is capped at one service for a single membership and two services for couple, single parent and family memberships each calendar year.

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, dialysis.

If you do not have an ambulance subscription with your state ambulance service or have fallen outside of a state based arrangement 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.

Health subscription refund

Your subscription refunds

50% refund on a subscription to the Arthritis Foundation, Asthma Foundation and Diabetes Australia.

Unemployment 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.

Unemployment cover conditions

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 your retrenchment or redundancy
You must have been enrolled in one of these covers for the preceding 12 months: Ultimate Health Cover, Top Hospital Cover, Hospital Cover with Excess Bonus Plus, Hospital Cover with Excess Bonus, Hospital Cover with Excess - Level 5 and Hospital Cover with Excess
Payments 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

Baby Care

Baby Care is about taking care of the very youngest member of your family. It is available if your child is born onto the membership on or after 1 April 2006. Special benefits for parents include:

Excess-free hospital visits
If you are on a cover where this feature is stated, we will waive the excess you would pay for your child's overnight or same-day hospital admission up to their third birthday as long as you have had any membership with us for at least two months.
Bonus book offer
If you have cover where this feature is stated, and you're expecting your first baby, you will receive a special gift of two free parent-friendly books - the pre-natal book What to expect when you're expecting when you tell us you are having a baby and Toddler Taming following your child's first birthday. These gifts can be collected from any HBA branch.

Medical advice line

Access to a free medical advice line staffed by medically qualified professionals - 24 hours a day, seven days a week, toll-free from anywhere in Australia.

Reduce your tax

No Medicare Levy Surcharge

Covers you against paying an extra 1% tax known as the Medicare Levy Surcharge. This tax is payable by singles earning more than $50,000 or couples and families with combined taxable incomes greater than $100,000 (the family income threshold increases by $1,500 for each additional child after the first one) who do not have an appropriate level of private hospital cover.

What is not covered?

Full costs at non-participating private hospitals

If you choose to be treated at a private hospital that is not in our Participating Private Hospital network, you may incur out-of-pocket expenses. To get the most value from your cover, we recommend you use a Participating Hospital.

During 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. All hospital covers have 12 month waiting periods for pre-existing conditions and pregnancy (childbirth), where applicable.

If you transfer to HBA 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 within one month 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.

Restricted Benefits

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. If Restricted Benefits apply for other treatments under this level of cover, they will be listed below.

Exclusions

Some covers exclude specific services. This means you will not be covered for that specified service or treatment whilst on that level of cover. HBA only pays for services that Medicare covers. Medicare does not cover some health screening services and services that are not medically necessary.

For the duration of your cover, you will not receive cover for:

Any treatment outside of Australia

Services and situations not covered by health funds

There are some hospital services that are generally not covered under a health fund's hospital cover:

If you are not admitted to hospital (including emergency room treatment) you are considered an outpatient and you will not be covered.
A person who has been in hospital for more than 35 days and 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.
Medical expenses for surgical procedures performed in hospital by a dentist, surgical podiatrist or any other practitioner that is not eligible for the Medicare rebate, such as sterilisation reversal and cosmetic surgery.
Benefits are not payable for pharmaceuticals supplied on discharge from hospital, unless covered under your extras benefits.
HBA benefits are not payable where compensation, damages or benefits may be claimed from another source (eg. Workers's Compensation, Compulsory Third Party Insurance, Common Law Damages, Government Programs/Agencies, Travel Insurance, Sports Insurance etc) in relation to a condition, injury or ailment. HBA reserves the right to recover any benefits paid in this regard.

What are the waiting periods?
	Waiting Period
Palliative care	2 Months
Psychiatric and rehabilitation	2 Months
Pregnancy (childbirth)	1 Year
Heart scan	1 Year
Pre-existing ailments, illnesses or conditions for hospital services	1 Year
Laser eye correction surgery	3 Years

What does it cost?
Cover	Price
Single	$41.75 per week
Couples	$83.55 per week
Single Parent	$78.85 per week
Family	$83.55 per week
Family Plus	$110.25 per week

Members transferring from other funds will have the total value of benefits paid for a service by any previous fund in the current calendar year deducted from their Annual Maximum for that same service with us. Prices are for stated memberships only. Prices include the 30% Government Rebate and do not include any Lifetime Health Cover loading that may apply.