ACA Health Fund Hospital Cover

Compare four hospital policies designed for Seventh-day Adventist officers, employees and their families

The ACA health fund is for the benefit of Seventh-day Adventist Church officers, employees and their families, with surplus profits finding their way back to you and your community. You can join if you are:

  • A Seventh-day Adventist Church employee or former employee
  • The partner, spouse or other family member of a church employee

Church employees are workers of incorporated companies affiliated with the Seventh-day Adventist Church in Australia. If you're eligible, see how the hospital cover with this member's health fund compares to other cover available.

finder.com.au does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.
Top 3 features
  1. Good for people who want to avoid fees. ACA offers several ways for you to avoid out-of-pocket costs, including an Access Gap scheme to help you avoid the gap and a Deluxe policy that eliminates co-pays.
  2. Good for someone that wants to belong to a not-for-profit fund where 100% of surplus profits are invested back into the products to make them better for members.
  3. Beware if you want mid-level police. A stock standard Bronze policy is the only mid-level policy they offer.

What ACA Hospital policies are available?

  • Basic Hospital. Covers all treatment categories on a restricted basis, meaning you must be treated as a private patient in a public hospital and you'll have to pay for your own theatre fees.
  • Bare Essentials Hospital. This offers all 21 categories of treatment required for the Bronze label, like joint reconstructions and pain management. It also offers full instead of restricted cover for palliative care.
  • Private Hospital. This offers full cover for all 38 clinical categories required for the Gold label. It includes cover for pregnancy, insulin pumps, kidney dialysis and more.
  • Deluxe Hospital. This is exactly the same as the Gold Private Hospital policy except that you do not have to pay a co-pay for your accommodation when you are treated.
Basic HospitalBare Essentials HospitalPrivate HospitalDeluxe Hospital
RehabilitationRestrictedRestricted
Hospital Psychiatric ServicesRestrictedRestricted
Palliative CareRestricted
Brain & Nervous SystemRestricted
Eye (not cataracts)Restricted
Ear, nose and throatRestricted
Tonsils, adenoids and grommetsRestricted
Bone, joint and muscleRestricted
Joint reconstructionsRestricted
Kidney and bladderRestricted
Male reproductive systemRestricted
Digestive systemRestricted
Hernia and appendixRestricted
Gastrointestinal endoscopyRestricted
GynaecologyRestricted
Miscarriage and termination of pregnancyRestricted
Chemo, radio and immunotherapy cancerRestricted
Pain managementRestricted
SkinRestricted
Breast surgery (mc)Restricted
Diabetes management (excl insulin pumps)Restricted
Heart and vascular systemRestricted
Lung and chestRestricted
BloodRestricted
Back, neck and spineRestricted
Plastic and reconstructive surgeryRestricted
Dental surgeryRestricted
Podiatric surgeryRestricted
Implantation of hearing devicesRestricted
CataractsRestricted
Joint replacementsRestricted
Dialysis for chronic kidney failureRestricted
Pregnancy and birthRestricted
Assisted reproductive servicesRestricted
Weight loss surgeryRestricted
Insulin pumpsRestricted
Pain management with deviceRestricted
Sleep studiesRestricted

Other benefits of ACA Extras Cover

Cover with ACA Health Fund delivers the following special benefits for members:

  • 100% cover policies with no limits.
  • It's not-for-profit, so 100% of surplus revenue gets invested back into the product in order to provide better value for the members.
  • Combine different levels of hospital and extras to find cover that's right for you.
  • Choose your own doctor and private hospital with deluxe or private level cover, or public hospitals with the basic plan.
  • Access the Federal Government Rebate to reduce your premium.
  • Ambulance cover in the ACT and NSW. For other states, ambulance cover is available with extras cover.
  • 30-day cooling off period after signing up if you change your mind.

In addition, you can choose a different membership level to enjoy benefits for yourself and the rest of your family.

  • Family membership gets cover for you and your partner.
  • The optional dependent extension can cover your children up to the age of 25.

How do the costs work?

There are usually some out-of-pocket costs associated with private care, but ACA offers several ways for you to avoid many of these.

A major out-of-pocket expense you can avoid is the doctor's gap fee. ACA has partnerships with more than 16,000 doctors who are part of ACA's Access Gap Cover scheme. If you choose one of these doctors, you can avoid this gap fee.

You can also eliminate your co-pay, which is the amount you pay per day for your accommodation and theatre fees, by going with the Gold Deluxe Hospital policy.

Waiting periods and limitations

Your waiting period for each treatment is as follows:

  • No waiting period.Ambulances (NSW and ACT) and accidents not related to pre-existing conditions.
  • 12 months.Pregnancy and pre-existing conditions.
  • 2 months.Everything else.

All cover levels have the following exclusions:

  • Surgeon's or podiatric surgery fees
  • Services for which Medicare pays no benefits, such as cosmetic procedures
  • Services that may otherwise be claimable under forms of compensation insurance
  • Services claimed more than two years after the procedure was performed
  • Outpatient services, such as GP visits that are not explicitly covered by the policy

It's important to remember that the Basic policy does not cover you for private hospital expenses.

How to make a claim

You can usually claim your hospital bills on the spot by providing your membership card. For doctors bills, specialist bills and other medical bills, the process differs based on whether or not the doctor takes part in ACA's Access Gap Cover scheme.

If they are part of the scheme, they can process your claim directly. If they are not, you'll have to take your bill to Medicare who will process the claim.

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