Hospital Cover
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Extras Cover
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EXCESS
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EXCESS
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PAYING
* Based on an Australian Government Rebate of {{quotePanel.value.rebatePercent}}%, {{quotePanel.value.lhcPercent}}% LHC loading, ${{quotePanel.value.excess}} excess for a {{quotePanel.value.coverType}} Extended in {{model.state}}.
Please note that the amount quoted will change on 1 April 2018 due to changes to the Australian Government Rebate on private health insurance.
Hospital Cover
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Extras Cover
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Yearly limits **
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** Sub-limits & benefit limits may apply.
Legend
Covered
Not Covered
Restricted
Restricted services
It’s important to understand what it means when a service is listed as ‘restricted’. Here is an overview of what we’ll pay for and what you you’ll have to pay for if going to hospital for treatment for a service that’s restricted:
In a public hospital:
- We pay – accommodation in a shared room (as long as the hospital doesn’t charge above the default rate set out by the Federal Government), and medical costs.
- You pay – any excess (if applicable), and any gap if your hospital charges above the default rate.
In a private hospital:
- We pay – accommodation in a shared room (at the default rate set out by the Federal Government), and medical costs.
- You pay – any excess (if applicable) and the balance of accommodation costs, plus any theatre costs. This could be costly, so ensure the hospital provides you with the potential costs upfront.
Either way, the hospital should let you know about any out-of-pocket expenses you’ll need to pay. This is called informed financial consent.
| Pre-existing condition | 12 months |
| Pregnancy & birth related services | 9 months |
| Psychiatric, rehabilitation & palliative care | 2 months |
| All other hospital services | 2 months |
| Emergency Ambulance transport | 1 day |
| Non-emergency ambulance transport | 1 day |
| General Dental, Body & Mind Therapies, Natural Therapies, Artificial aids | 2 months |
| Optical, Healthy Lifestyle | 6 months |
| Major Dental, Orthodontia, Medical Appliances, Hearing Aids | 12 months |
| Wheelchair purchase | 24 months |
| Emergency Ambulance transport | 1 day |
| A waiting period is a period of time you need to wait after taking out your cover before you can receive benefits for services or items covered. Benefits are not payable for services received over the course of a waiting period. |
| Waiting periods Like all health funds, waiting periods may apply when you take out your cover. You may have to wait if:
If you’ve cancelled your membership with another health fund, you’ll need to join us within 60 days to keep up your continuity of cover and not re-serve any applicable waiting periods. |
| A pre-existing condition is an illness, ailment or condition where the signs or symptoms of which, in the opinion of the Fund Medical Advisor or other relevant medical practitioner appointed by UniHealth, existed at any time during the six months before taking out private health insurance or transferring to a higher level of cover. This rule applies to: - new members to private health insurance - existing members who are upgrading their level of cover. A 12 month waiting period applies to all pre-existing conditions except psychiatric, palliative care and rehabilitation, which are covered by the normal two month waiting period. Pregnancy and birth has a 9 month waiting period. |
| Emergency Ambulance means an ambulance service that consists of transporting a seriously ill person to the nearest hospital by a State Government Ambulance Service or by a private ambulance service recognised by UniHealth in order to receive urgently needed treatment. This includes transportation from the scene of an accident or the scene of a medical event such as a heart attack or stroke, but does not include transportation to hospital for the routine management of an ongoing medical condition or transportation between hospitals. |
| A Recognised Provider is a qualified person who provides services that are eligible for benefits, recognised by UniHealth in a particular discipline, modality or calling as a provider for whose services, provided to an eligible member with cover for the provider’s services. |
| Benefits are limited to one service per patient, per provider, per day. If a provider performs more than one consultation, the treatment that attracts the higher benefit will be paid. Where multiple visits/services are performed on the same day at different times by the same provider, then the visit/service that attracts the higher benefit will be paid. |
| Increasing limits are calculated on years of continuous membership of UniHealth Top Extras cover. Other loyalty limits are not transferable. |
| Pharmaceuticals Benefit Scheme (PBS) pharmaceuticals are subsidised by Medicare and by law are not eligible for health fund benefits. Our Extras covers pay benefits towards non-PBS prescription only medication supplied to treat a medical condition. You pay a co-payment equal to the current non-concessional PBS co-payment amount. |
| All per person and per family limits are based on a calendar year from 1 January each year, unless otherwise stated. Family yearly limits are based on a set amount across all members of the family. |
| *Note: The level of cover you select may include waiting periods, exclusions, restrictions, limitations and excesses. Please see the Membership Guide for details. All brochures and forms should be read carefully and retained. Please see Hospital and Extras and our Membership Guide for further details. |
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