Young Couples Choice

Hospital and extras cover to save you money

Young Couples Choice is a hospital and extras package created especially for young couples. It's a good level of cover that is suitable for young people, but to keep the premiums low, we've kept it kid-free... that means no pricey pregnancy-related benefits. And because Young Couples Choice is made for couples, it costs less than taking out two single covers.

What is covered?

Hospital expenses

Medical expenses

Co-payment

Additional features and benefits

Ambulance services

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

Waiting periods & price

What are the restrictions or exclusions?

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 (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. To keep premiums low there is a co-payment and some services are excluded, as listed under the waiting periods. If you don?t need cover for these services, this cover could be for you! 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.
Co-payment	Your co-payment $50 a day for overnight or same-day hospital admissions Capped at $250 for any one hospital stay (including same-day treatment)

Additional features and benefits

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.

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.

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 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 Assisted reproductive services (including IVF) Cataracts Heart and artery Hip and knee replacement Laser eye correction surgery Pregnancy 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.

Are there any restrictions or exclusions?

Hospital	Waiting Period
Psychiatric treatment	Restricted benefits apply for the duration of cover
Rehabilitation	Restricted benefits apply for the duration of cover
Cataract surgery	Excluded service
Hip or knee replacement	Excluded service
Pregnancy (childbirth)	Excluded service
Heart or artery-related services	Excluded service
Assisted reproductive services (including IVF)	Excluded service

What are the waiting periods?

Hospital	Waiting Period
Initial waiting period	2 Months
Palliative care	2 Months
Psychiatric and rehabilitation	2 Months
Pre-existing ailments, illnesses or conditions for hospital services	1 Year

What does it cost?

Cover	Price
Single	$18.70 per week
Couple	$35.45 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. Waiting periods will apply for services not previously covered or fully completed. 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.