If you need to travel a long way from home and stay overnight to receive specialist medical treatment, private health insurance can help cover the cost.
When you’re suffering from an illness or injury, sometimes it’s not possible to access the medical treatment you need close to home – especially if you live in a remote area. If this is the case, you may need to travel to the nearest city or regional centre where the treatment you need is available. However, this can be an expensive exercise, as travel and accommodation costs can quickly add up.
The good news is that if you have private health insurance cover, your policy may provide cover for your medical-related travel and accommodation costs. Let’s take a closer look at which policies provide protection and what costs are covered.
What costs are actually covered?
Many private health funds in Australia pay a benefit for travel and accommodation costs when you need to travel a long distance from home to receive medical or hospital treatment. Travel benefits are designed to cover the expenses you incur to get to the place of treatment, including petrol costs if travelling by car, or train, bus or airfares if using other forms of transport.
Accommodation benefits are designed to cover the cost of accommodation near to the place of treatment for the patient and a carer or attendant. This refers to accommodation in a hotel or motel (not hospital), and can help you afford the cost of staying overnight and accessing the medical or hospital treatment you need. While some funds will require your carer to also be a member in order to cover their accommodation costs, other funds will also cover your carer’s accommodation expenses even if they are not a member.
The exact level of cover provided varies depending on the health fund and the individual policy you choose, but limits will apply. This could be one overall limit for both travel and accommodation benefits, or separate limits for each individual benefit.
When are these travel and accommodation costs covered?
Private health funds cover medical-related travel and accommodation costs when the following conditions are met:
- The medical or hospital treatment must be medically necessary.
- The treatment must not be available locally.
- The total return trip distance must exceed a specified limit, usually 200km.
It’s also worth pointing out that your health fund may impose limits on when it will cover accommodation costs. For example, cover may only be available for one overnight stay, while other policies may provide cover for accommodation one night before and one night after the treatment. Check the details of your policy for more information.
Is cover provided by hospital or extras policies?
Travel and accommodation benefits are included as part of extras health insurance cover. However, this feature is not included on all policies, so you’ll need to select high-level extras cover if you want to access travel and accommodation benefits. Check with your health fund for details of which of its products include this cover feature.
How do I lodge a claim for travel and accommodation costs?
Your health insurance fund will most likely provide you with a special claim form you can fill out to lodge a claim for travel and accommodation costs. Although these forms may vary slightly between funds, you will usually have to provide the following information:
- Your full name
- Your membership number
- Your address and contact details
- The type of transport (e.g. car, bus, train)
- The date(s) of travel
- Your destination and the distance travelled
- The cost of travel (including receipts where required)
- The name of the medical specialist or hospital that you travelled to in order to receive treatment
- The name of the doctor that certified travel (your GP will need to sign a declaration that it was necessary for you to travel to receive specialist medical or hospital treatment because that treatment was not available locally)
- If claiming for accommodation costs, you will also need to provide details about the length of your stay, the hotel or motel where you stayed, and the cost of your accommodation
When aren’t you covered?
It’s also important to be aware that there are situations and expenses for which your health fund will not provide any cover. These include:
- Overseas travel and accommodation – health insurance can only cover health care expenses incurred in Australia
- If no referral is provided by your GP or treating doctor
- If the medical or hospital treatment you need is available locally
- If you do not provide receipts (for petrol, travel and accommodation costs etc) to back up your claim
- If the total distance of your return trip is less than a specified limit, usually 200km
- If your claim is for hospital accommodation costs (this cover is provided by a separate part of your health insurance hospital cover policy)