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Hospital Cover with Excess Level 5

Cover that can save you money

By choosing to pay an excess of $500 a year, you can reduce your premium and still enjoy full cover for your hospital expenses at any participating private hospital or public hospital in our extensive, Australia-wide network.

Basically, you'll pay $500 for overnight or same day hospital admissions, capped at $500 for single memberships and $1000 for single parent or family memberships each calendar year. Plus, if you become unemployed, we'll pay your health insurance premium (at the same level of cover) for up to 12 months (conditions apply).

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What is covered?

Hospital expenses
Medical expenses
Excess per year

Additional features and benefits

Ambulance services
Unemployment cover
Baby Care
You could 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
Cover for extras like dental and optical

Waiting periods & price

What are the waiting periods?
What does it cost?

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 (PBS) and provided to you 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 and that remain in-situ upon discharge from the hospital
Cover for 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 Medicare Benefits 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 HBA's 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.
Excess per year
Your excess
$500 excess for overnight or same-day hospital admissions applies.

The amount of excess payable is capped at $500 for singles and $1000 for single parents and families each calendar year.
   
Ambulance services
Emergency ambulance services
On top of your hospital cover you will receive cover for recognised emergency-only ambulance transport services 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 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.
Unemployment cover
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
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.
Wellbeing services
Parent and Baby Wellbeing - You will receive access to a range of valuable services for parents with new babies, including consultation and support, identification of depression and anxiety and follow-up support if needed. These services are provided as part or your hospital cover. It's part of our commitment to ensuring the best possible care for you and your family.
You could reduce your tax
You may not have to pay the 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 $73,000 or couples and families with combined taxable incomes greater than $146,000 (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.
   
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 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
  • Laser eye correction surgery
  • Medical costs for surgical procedures performed in hospital by a dentist. However some Dental costs can be covered by our extensive range of Extras Covers
  • For cosmetic surgery that is not clinically necessary and where benefits are not paid by Medicare
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 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.
Cover for extras like dental and optical Hospital cover does not include out of hospital services not covered by Medicare such as physiotherapy, dental and optical. To be covered for these health services, take out one of HBA's extras covers.
   
Hospital Waiting Period
Initial waiting period 2 Months
Palliative care 2 Months
Psychiatric and rehabilitation 2 Months
Pregnancy (childbirth) 1 Year
Pre-existing ailments, illnesses or conditions for hospital services 1 Year
   
Cover Price
Single $21.90  per week
Couple $43.85  per week
Single Parent $37.30  per week
Family $43.85  per week
Family Plus $52.05  per week
   

Prices are for stated memberships only.
Prices include the 30% Federal Government Rebate and do not include any Lifetime Health Cover loading that may apply.
 
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