Emergency Services Health Hospital Cover Insurance

Providing comprehensive Gold Hospital cover, Emergency Services Health gives first responders peace of mind.

Not-for-profit fund Emergency Services Health offers insurance for the emergency services community, focusing on straightforward products and comprehensive cover. Their Gold Hospital cover ensures you are never caught short. It's designed to offer value for money, effective cover and access to important health services for life.

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 top tier hospital cover.
  2. Good for emergency services workers and their families.
  3. Beware if you're looking for lower level, budget cover.

What Emergency Services Hospital cover options are available?

If you work for emergency services, you know better than most that the unexpected can happen at any time. Emergency Services Health provides just one comprehensive option, called Gold Hospital. This hospital-only product provides cover for treatment in any private or public hospital or day surgery around Australia. Its aim is to give you and your family freedom of choice in health care, with the following features;

  • No excess or co-payment. You can be admitted to hospital with no costs whatsoever.
  • No exclusions. Many other hospital plans have specific exclusions, which are Medicare services that aren't covered. This plan has no such exclusions.
  • No provider network. Most health plans will only cover you when you go to a hospital that's a member of their network. Emergency Services Health doesn't have a network, and covers you at all hospitals. In the unlikely event of a specific hospital no longer being recognised, you will be informed directly if it's likely to affect you.
  • Comprehensive ambulance cover. This includes emergency transport, clinically required non-emergency transport and treatment not requiring transport.

It also includes the following treatments;

  • General hospital costs
  • Theatre fees/labour ward
  • Drugs supplied
  • Doctor's fees (for hospital treatment)
  • Hospital at home
  • Additional health care services
  • Travel and accommodation
  • Surgical Prosthesis

Other benefits of Emergency Services Health Hospital Cover

Emergency Services Health's Refer A Mate offer encourages you to tell your friends and family about your cover and if a mate signs up, you can both reap rewards.

When you refer an eligible person to join the fund with any one of the three cover options, you'll both receive a $50 gift card. Just make sure the new member quotes the promo code 'REFER' when signing up.

How do the costs work?

There are a few costs you might have to fork out for, including;

  • Any services before waiting periods have been served.
  • A claim for a service submitted more than two years after the date of service.
  • Treatment for which Medicare does not pay a benefit, such as cosmetic surgery.
  • Outpatient services.

Waiting periods and limitations

There's a handful of conditions to be aware of. Importantly, you cannot claim during the waiting periods. Where you're switching to Emergency Services Health from a different health fund, any waiting periods already served on the same types of cover will be recognised, provided you're not switching from a lower level of cover.

Waiting periods apply to:

  • Pre-existing conditions. 12-month waiting period, with the exception of palliative care, psychiatric treatments and rehabilitation, which have only a 2-month waiting period.
  • Pregnancy and obstetrics. 12 months. You will need to get cover well in advance if you are planning to use your health insurance for pregnancy related expenses.
  • Health aids and appliances. 12 months. Health aids and appliances have a 12-month waiting period applied.
  • Accidents. No waiting period. You are covered for accidents that result in hospitalisation as soon as your cover is finalised.
  • Everything else. A 2-month waiting period applies to all services that don't fall into one of the above groups.

On more condition relates to hospital stays beyond 35 consecutive days. If this occurs for you, make sure the insurer receives an acute care certificate to confirm extensive treatment is necessary. If they don't receive this, benefits will stop being paid and out-of-pocket expenses will start piling up. Hospitals will typically arrange for an acute care certificate when necessary, and send it in on your behalf.

How to make a claim

Hospital claims usually go directly to Emergency Services Health from the hospital and a claim payment is sent back to the hospital, so you don't have to worry about making a claim.

In case of other service claims that can't be made on the spot, you can fill out a claim form send it with the relevant accounts and receipts via one of four ways;

  • Email (myclaim@eshealth.com.au) with your membership number in the subject line
  • Email mail to Emergency Services Health, Reply Paid 84966, Halifax St SA 5000.
  • Fax to 1300 151 152.
  • Upload to the Emergency Services Health Mobile Claiming App.
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