Outpatient Pharmacy
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Outpatient Pharmacy
We'll cover you for selected pharmacy items prescribed as a hospital out-patient. You'll receive 90% of the balance per script item, up to a maximum of $500 per person per calendar year, after you pay the Pharmaceutical Benefit Scheme patient co-payment fee. This is provided the item's usage is approved by the Therapeutic Goods Administration (TGA).
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Special Partner Benefits
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Special Partner Benefits
We'll help cover the costs for your partner, immediate family member, carer or next of kin should they need to stay in hospital with you. They will be covered for $60 per night for accommodation in hospital and up to $30 a day for hospital meals, capped at $1000 per person, per year.
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Ambulance services
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Full ambulance cover
On top of your hospital cover you will receive full cover for ambulance transportation services or on-the-spot treatment anywhere in Australia.
If you do not have an ambulance subscription with your state ambulance service and need to make a claim for ambulance services covered on top of your hospital cover, please complete and return to us the Particulars of Ambulance Transportation form.
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Repatriation
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Cover for repatriation
We will pay benefits for you, and an accompanying family member, for medical repatriation if you are terminally ill or suffer a substantial life-altering illness or injury to your home country, when this is deemed necessary by your medical practitioner and in consultation with HBA. We will also pay benefits for the cost of returning your body to your home country.
Please note that you must contact HBA before repatriation will be organised. The decision to repatriate will only be made between HBA and the treating doctor.
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Full costs at non-participating private hospitals
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If you choose to be treated at a private hospital that is not in our Participating private hospital network, you may incur large out-of-pocket expenses. To get the most value from your cover, we recommend you use a Participating hospital.
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During a Waiting Period
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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.
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Restricted Benefits
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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.
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.
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Exclusions
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Some covers exclude specific services. This means you will not be covered for that specified service or treatment whilst on that level of cover.
For the duration of this cover you will not receive cover for:
- Any treatment outside of Australia
- Expenses relating to medical examinations, X-rays, inoculations or vaccinations or other treatments related to acquiring a visa or permanent residency
- Assisted reproductive services (including IVF)
- Services not covered by Medicare
- Cosmetic surgery (that is not clinically necessary and where benefits are not payable by Medicare)
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Services and situations not covered by health funds
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There are some hospital services that are generally not covered under a health fund's hospital cover:
- 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.
- Benefits are not payable where compensation, damages or benefits may be claimed from another source (eg. Workers' Compensation, Compulsory Third Party Insurance, Common Law Damages, Government Programs/Agencies, Travel Insurance, Sports Insurance etc) in relation to a condition, injury or ailment. We reserve the right to recover any benefits paid in this regard.
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