Choose from three levels of hospital cover
health.com.au took on the ambitious task of redefining health insurance in Australia, with simple and straightforward options. For its hospital cover this takes the form of two simple policies with clear cover.
The hospital cover options
The available plans are:
- Entry Hospital: Hospital treatment, including accommodation as a private patient in a shared room in a public hospital only.
- Base Hospital: Effective private hospital insurance for people in good health, who mostly want “just in case” benefits. Covers all Medicare services except the specifically excluded procedures.
- High Hospital: With pregnancy benefits and all-around high-level cover, this option is geared towards people who need extra hospital cover for having a baby, or because they need cover for a wider range of health issues. Covers everything that Medicare does, and nothing it doesn’t.
|Base Hospital||High Hospital|
|Starting price per week||$20.89||$41.97|
|Excess||$500||$0, $250 or $500|
|Access Gap Cover Scheme|
|1-day waiting period accident cover|
|Emergency ambulance cover|
|Covers all Medicare services|
|Covers any non-Medicare services|
With High Hospital you are covered for the following treatments, but with Base Hospital you are not:
- Pregnancy-related services, including assisted reproductive services and sterilisation reversal
- Cardiothoracic heart and lung procedures
- Cataract and eye lens procedures
- Dialysis for chronic kidney failure
- Joint replacements, including prostheses
- Bariatric surgery, such as gastric banding and other obesity treatments
- Spinal surgery
- Insulin pumps
- Cochlear implants
Neither cover level will pay for any non-Medicare procedures, such as cosmetic or plastic surgery where it’s not medically necessary.
What are the additional benefits of health.com.au hospital cover?
Whether you opt for the basic or comprehensive cover, you get to use the Access Gap Cover Scheme. This is a procedure that doctors can choose to opt into, in order to remove or reduce your out-of-pocket gap expenses. Almost 9 out of 10 medical procedures under the Access Gap scheme will have no out-of-pocket costs.
As the name suggests, health.com.au is one of the few online-only health funds. If you like over-the-counter service it might not be the right choice, but if you’re happy doing it all online this may help keep premiums down and make claiming easier.
Being online-only also helps health.com.au offer a range of online functionality through its members portal, letting you make claims, check your limits and contact live chat services 24 hours a day, 7 days a week.
What are the limitations and waiting periods?
You are only able to access the restricted, minimum benefits for palliative care, rehabilitation and psychiatric treatment under the Base Hospital plan. Even with Top Hospital, benefits are still restricted for psychiatric treatment. For these you are limited to claiming the expense of public hospital treatments as a private patient.
Waiting periods also apply, where you cannot make claims. These are:
- 1 day: Accident and ambulance cover
- 2 months: All treatments not otherwise specified, psychiatric, rehabilitation and palliative care even when pre-existing
- 12 months: Pre-existing conditions, pregnancy-related services, major dental services and health appliances
How to make payments
You can set up a direct bank transfer, or pay your premiums by credit card to receive a 4% discount, or make payments online. You can choose whether to pay fortnightly, monthly or quarterly, and which day of each month you want to make the payments.
How to make claims
When you attend a public, or contract private hospital, it will simply send your bill directly to health.com.au and it will pay the hospital directly.
If you do receive a bill you can send it to health.com.au to get the claim paid.
For any separate expenses, such as assisting surgeon costs or anaesthetists, you can make claims through Medicare, which will generally liaise with health.com.au to get it paid up to the limits of your chosen cover.