Uncomplicated private hospital insurance that covers the essentials.
Private hospital insurance is designed to offer peace of mind and freedom of choice when you are required to visit hospital for medical issues that are not usually covered by Medicare. Health.com.au Base Hospital insurance covers you for a multitude of essential hospital procedures and treatments.
Health.com.au is a private health fund that specialises in offering simple-to-understand health insurance policies to suit a range of requirements and budgets, so if you require more coverage than what is offered by Base Hospital their higher range Simple Essentials 60 and Extras 50 might be of interest to you.
What am I covered for?
Under this policy your hospital expenses will be covered if you require treatment or surgery for any of these medical issues:
- Treatment for accidents
- Tonsil removal
- Wisdom teeth removal
- Knee and shoulder reconstruction surgery
- Appendix removal
- Adenoid removal
- Dental surgery
- Achilles tendon surgery
- Recognised Medicare services
- Australia-wide emergency ambulance transport
Restrictions apply to these treatments which means benefits payable for these services are only enough for you to be treated as a private patient in a shared ward of a public hospital, not in private hospital:
- Rehabilitation services
- Psychiatric services
- Podiatric surgery
Whats not covered?
The following services and treatments are not covered under this policy:
- Cardiothoracic surgery (treatments and procedures related to the heart and lungs)
- Pregnancy services (assisted reproductive services, sterility reversal, labour and delivery)
- Cataract and eye lens procedures
- Dialysis for chronic kidney failure
- Joint replacement, including spine and prostheses
- Bariatric surgery (includes lap bands and gastric bypass surgery)
- Spinal surgery
- Insulin pumps
- Cochlear implants
- Services excluded by Medicare (includes cosmetic surgery, most dental care and surgery deemed medically unnecessary)
- Outpatient services (includes hospital substitute treatments)
- Some same-day procedures that do not require hospitalisation
- Ancillary health services (such as optical and physiotherapy)
- Personal items purchased while hospitalised
- Prostheses not listed on the Commonwealth Government’s Prostheses Schedule
Making a claim
- If you need to make a hospital claim on your Base Hospital policy, simply present your Health.com.au Claims Card when you are admitted to hospital. They will then settle the claim directly with the hospital and let you know once the bill has been paid.
- It’s also worth noting that each medical practitioner involved in your care may charge additional fees on top of the fees charged by your hospital. If your doctor uses Health.com.au’s Access Gap Cover Scheme, you won’t have to make a claim as the doctor's bill will be sent straight to your private health fund. If the doctor is not a part of the scheme, you will need to take your claim to Medicare.
Do I have to pay any excess?
Base Hospital is available with an excess of $500, which is the amount you must pay to contribute to the cost of your admission to hospital. This excess is charged on a per hospital admission basis, but there is an annual cap in place to limit the costs you incur.
What are the waiting times on claims?
- 1 day: Accidents, emergency ambulance transport
- 2 months: All other services except those listed below
- 12 months: Pre-existing conditions
Who's eligible for this policy?
You must be aged 16 years or older to take out any of Health.com.au's policies. Persons under 16 are deemed to be a dependants who should fall under a family or single parent family policy.
There are a few other eligibility requirements that must also be met to qualify for cover, including:
- Not having a private hospital insurance policy with another health fund.
- Having your policy reflect your Australian state of residence.
- Meeting Medicare’s residency and eligibility requirements.