Do you work in the emergency services? Find out how you can benefit from cover from Emergency Services Health.
Members of the police force have had their own specialised health fund for more than 80 years and now Australia’s emergency services personnel and volunteers have health cover they can call their own.
Emergency Services Health is a not-for-profit health fund designed to look after the health and wellbeing of Australia’s emergency services community.
Backed by Police Health, Emergency Services Health is a Members Own Health Fund with a focus on providing straightforward products and comprehensive cover.
Who’s covered by Emergency Services Health
Emergency Services Health is a not-for-profit health fund tailored to looking after the health care needs of Australia’s emergency services community. Run entirely to benefit members, it offers products that are easy to understand, provide a high level of cover and are available at an affordable price. Members are given the freedom to choose their preferred hospital, doctor and any other health care service provider, as long as that provider is recognised by Emergency Services Health.
As it is a restricted access health fund, an Emergency Services Health membership is only available to current or previous employees or volunteers in the following professions:
- Fire response and recovery sector. Employees/volunteers of a not-for-profit, commercial, or national, state or territory government fire department/service or association/union. Those who work for registered training organisations and/or specialist emergency service equipment suppliers in this sector are also eligible.
- Ambulance and medical response and recovery sector. Employees/volunteers of a not-for-profit, commercial, or national, state or territory government ambulance department, hospital service or association/union. People working in a medical, nursing or allied health capacity and registered with the Australian Health Practitioners Regulation Agency can also be covered, as can employees and volunteers of registered training organisations and/or specialist emergency service equipment suppliers.
- Water response and recovery sector. Employees/volunteers of a not-for-profit, commercial, or national, state or territory government life saving department/service or association/union. Employees and volunteers of registered training organisations and/or equipment suppliers in this sector are also covered.
- State emergency response and recovery sector. Employees/volunteers of a not-for-profit, commercial, or national, state or territory government emergency services department or association/union. Employees/volunteers of registered training organisations and/or specialist emergency service equipment suppliers in this sector are also covered.
What cover options are available?
With a focus on keeping cover as simple as possible, Emergency Services Health offers only three cover options: Lifelong Hospital, Lifelong Extras and Lifelong Combined, all of which provide top-level cover.
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 no excesses, no benefit limitation periods and no co-payments. Lifelong Hospital covers all treatments and procedures where Medicare pays a benefit. This means you’re covered for:
- Hospital accommodation
- Same-day hospitalisation and day surgery
- Intensive/coronary care accommodation
- Theatre fees/labour ward
- Drugs supplied
- Doctor’s fees for hospital treatment
- Hospital at home
- Emergency and non-emergency ambulance transport
- Surgical prostheses
Emergency Services Health Lifelong Extras provides cover for an extensive range of general health services, allowing you and your family to stay in top shape. The policy covers 80% of the cost of most extras services and you have the freedom to visit the recognised health provider of your choice. Annual and rollover maximum benefit limits apply. Lifelong Extras includes cover for the following general treatment options:
- General and major dental
- Exercise physiology
- Complementary therapies
- Occupational therapy
- Dietary services
This comprehensive policy brings together all the benefits of the Lifelong Hospital and Lifelong Extras policies, allowing you to combine them into one cover package with a reduced premium. In addition, this policy also provides benefits towards the cost of corrective laser eye surgery.
What exclusions, waiting periods and excesses are there?
Just like any other private health fund, there are certain circumstances and services for which Emergency Services Health will not pay a benefit. These include:
- Services received before you have served the relevant waiting period.
- Services received outside of Australia.
- Treatments for which Medicare does not pay a benefit, for example, cosmetic surgery.
- Services for which you may be entitled to any payment under compensation, sports club or third party insurance.
- A claim for a service received more than two years ago.
- Outpatient services, unless Emergency Services Health has an agreement in place with the hospital.
- Pharmaceuticals that are unrelated to the reason for hospitalisation, not covered under the agreement with the hospital or provided on discharge.
- Exceptional high-cost drugs.
- Prostheses not included on the Federal Government’s approved list.
- Personal and take-home items such as newspapers and toiletries.
- Treatment provided in a private hospital emergency department.
- Ambulance services covered by a state or territory ambulance scheme.
As well as this, benefits will be significantly reduced if you are in hospital for more than 35 consecutive days and not classified as an acute care patient.
Before you take out cover with Emergency Services Health, or any other private health fund, you should be aware that you’ll need to serve waiting periods before you are eligible to receive benefits. The following waiting periods apply to hospital cover:
- 2 months for all benefits, excluding accidents
- 12 months for obstetric treatment
- 12 months for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care
- 12 months for aids and appliances
Separate waiting periods also apply to extras cover as follows:
- 2 months for all benefits, excluding accidents
- 12 months for major dental, orthodontics, hearing aids, nebulisers, blood glucose and blood pressure monitors, other appliances, blood coagulation monitors and pre-existing conditions
- 12 months for Rollover Benefits and access to Rollover Maximum (24 months for major dental)
If you take out combined cover, you will also need to serve a three-year waiting period before you are eligible to receive any benefits for corrective laser eye surgery.
Finally, one of the key features of hospital cover from Emergency Services Health is that you will not have to pay any excess or co-payment when you are admitted to hospital. This means you will not have to contribute towards the cost of your hospital treatment.