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Doctors’ Health Fund Hospital Cover

Review the 3 hospital cover options Doctors' Health Fund offers medical professionals and find cover tailored to your needs.

Doctors’ Health Fund is a private health fund that covers medical professionals, students and families. Unsurprisingly, it delivers an exceptional level of hospital cover. You can join if you are one of the following:

  • A registered medical practitioner
  • A registered health practitioner in a specified category
  • A person studying to become a medical or health practitioner
  • An overseas doctor who is registered for the AMC exams
  • An employee of a medical or health practitioner, or an employee of an incorporated medical or health practitioner practice
  • Employed in any role by a federal or state Australian Medical Association (AMA) or by an associated or subsidiary organisation
  • An officer, employee or contractor of Avant Insurance Limited or Avant Law Pty Limited
  • An eligible family member of any of the above

To quality for this category, you must be a registered health practitioner in any of the following areas:

  • Medical radiation (diagnostic radiographer, medical imaging technologist, radiographer, nuclear medicine scientist, nuclear medicine technologist or radiation therapist)
  • Optometry
  • Dental (dentist, dental therapist, dental hygienist, dental prosthetist or oral health therapist)
  • Occupational therapy
  • Physiotherapy
  • Psychology

These include the following:

  • Spouse or partner (including former spouses or partners)
  • Dependent children
  • Adult children, including those of a spouse or partner
  • Parents
  • Siblings, including those of a spouse or partner
  • Nieces and nephews
  • Grandchildren, including those of a spouse or partner does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

Doctors’ Health Fund hospital cover plans

There are three standalone hospital plans:

  • Smart Starter. This is the most affordable level and it focuses on the essentials. It covers private hospital, private patient and day facility accommodation, including access gap cover. This level has a range of restricted benefits and exclusions.
  • Prime Choice. This is mid-level cover and covers private hospital, private patient and private day facility accommodation. It covers all Medicare services, as well as PBS and non-PBS medications, and includes access gap cover.
  • Top Cover. This is a unique high-level policy that pays up to the AMA fees list instead of in line with Medicare benefits. There are no exclusions, restrictions or excess on any service where Medicare pays a benefit. You’re also covered under the gap scheme regardless of whether your doctor opts in.

The cover

Smart StarterPrime ChoiceTop Cover
Gap CoverAccess GapAccess GapAMA Gap
Excess options$500$0 or $500None
No waiting period accident cover
  • yes
  • yes
  • yes
Ambulance cover (emergency, patient transfer and attendance on scene)
  • yes
  • yes
  • yes
Pregnancy related (including assisted reproductive services, sterilisation and reversal, and labour ward costs)
  • no
  • yes
  • yes
Theatre services and costs
  • yes
  • yes
  • yes
Hip and knee replacements and revisions
  • no
  • yes
  • yes
Cataract and glaucoma
  • no
  • yes
  • yes
Cardiothoracic surgeryRestricted
  • yes
  • yes
Dialysis for chronic renal failureRestricted
  • yes
  • yes
Gastric banding and obesity surgery
  • no
  • yes
  • yes
Hearing loss related
  • no
  • yes
  • yes
Diabetes related
  • no
  • yes
  • yes
Spinal surgery not related to an accident
  • no
  • yes
  • yes
All other Medicare services
  • yes
  • yes
  • yes
Non-Medicare services
  • no

The limitations and exclusions of each

Each type of cover has different limitations and restrictions. In all cases, you are only fully covered at contract hospitals.

Smart Starter

The only exclusions are those specified in the table above. Restricted benefits limit you to cover as a private patient in a public hospital, and apply to the following:

  • Cardiothoracic surgery.
  • Dialysis for chronic renal failure.
  • Rehab services following cardiothoracic surgery, hip and knee replacements and revisions and psychiatric treatment.
  • With psychiatric treatment, you are entitled to up to 10 days per annum in a private hospital.

The $500 excess is the annual maximum for singles cover, while a $500 excess per hospital visit also applies to couples and family policies, up to $1,000 per annum.

Prime Choice

There are no excluded services, but benefit restrictions apply to non-Medicare services, such as purely cosmetic surgery. You may only claim the accommodation costs and not the medical expenses.

Top Cover

As with Prime Choice no exclusions apply, but you are restricted to only accommodation benefits for non-Medicare services.

The applicable waiting periods are as follows:

  • None for accidents
  • 12 months for pre-existing conditions and obstetrics
  • 2 months for everything else, even pre-existing condition-related palliative care, rehabilitation and psychiatric treatment

Waiting periods already served with other funds will transfer over as will the balance of waiting periods yet to be completed unless the service wasn’t covered under your old policy or was covered to a lesser extent.

4 benefits to joining the Doctors’ Health Fund

  1. The two most outstanding features of the Doctors’ Health Fund are that the Top level policy pays up to Australian Medical Association benefits, and that even with the most basic policy, you are not limited to the MBS gap and still get access gap cover. In addition, the policies also cover you for stays at contract day facilities.
  2. According to the private health insurance administrative council, the access gap scheme has a record of paying benefits on over 92% of medical services, with almost 88% having no out-of-pocket expenses at all, significantly outperforming large private health funds.
  3. The unique Top Cover policy exceeds this and doesn’t require you to find a practitioner that participates in the access gap scheme. Benefits are paid to either cover the bill or up to the AMA List fees. Simply request that the doctor submit the bill directly to Doctors’ Health Fund instead of Medicare.
  4. As an added bonus, you can also get quick access to expert specialists over the phone through Doctors’ Health Fund to better manage your health and your treatments.

Andrew Munro

Andrew writes for, comparing products, writing guides, sniffing out deals and looking for new ways to help people get the most out of their money.

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