Have you considered onemedifund as your health fund provider? Full review and comparison

onemedifund is an Australian private health fund that offers hospital, extras and combined policies to suit different needs and budgets. onemedifund aims to take the stress and confusion out of finding private health cover by making its policies as easy and straightforward to understand as possible.

Its cover options are designed to protect you against rising medical and health care costs but at the same time provide cover that is affordable.  So, compare onemedifund options and choose the right cover for you. does not currently have access to this health insurance brand. You may wish to compare options available on the health insurance homepage.

onemedifund levels of cover

This policy provides Australia-wide cover for accommodation and treatment as a private patient in a private or public hospital. It covers:

  • Theatre fees
  • Labour ward
  • Intensive care
  • Surgical prostheses
  • In-hospital psychiatric treatment
  • In-hospital rehab
  • Heart surgery
  • Major eye surgery
  • Hip and knee replacement
  • Obstetrics services, assisted reproductive services
  • Plastic and reconstructive services
  • Ambulance cover

No excess is payable when you are admitted to hospital and the fund has Access Gap Cover arrangements in place with more than 19,000 doctors around the country.

This policy offers the exact same level of cover as Private Plus No Excess but with the key difference that you will have to pay an excess when you are hospitalised. The maximum excess payable per year is $250 per single policy and $500 per family policy.

 If you need extras cover, you can choose onemedifund Extras Plus option

This comprehensive policy is competitively priced and offers cover for an extensive range of general treatments including:

  • No annual limits for general dental
  • Loyalty bonuses that can also be accessed on high-cost dental treatments after five years
  • Generous benefit limits for major dental, orthodontics, optical, pharmacy, physiotherapy, occupational therapy, chiropractic, naturopathy, homeopathy, podiatry, acupuncture, dietetics, home nursing, psychology and more
  • National ambulance cover is also included

This economically priced option covers the most common extras treatments and provides a guaranteed minimum benefit of 75 per cent of costs. It covers:

  • General dental
  • Optical
  • Pharmacy
  • Physio
  • Complementary therapies
  • Health management programs
  • National ambulance cover

If you’d like to create a combined policy simply mix and match your choice of hospital cover and extras cover from onemedifund.

Are there any additional benefits?

  • Eye-care discounts. onemedifund members can access a wide range of impressive eyecare discounts at providers like Laubman & Pank, Teachers Eyecare, Peoplecare Eyes & Teeth, OPSM and more
  • My Health Online. This online wellness portal provides members with an extensive selection of health tools to help them improve their wellbeing
  • My Health Risk Assessment. You can use this online tool to create a personalised health report and learn what you can do to improve your overall health
  • My Hospital @ Home. This program allows you to check out of hospital earlier by offering the treatment you need in the comfort and privacy of your home
  • Strive for Health. This program provides telephone and face-to-face support to help members manage chronic health conditions

General exclusions, limits and waiting periods


Just like any other private health fund, onemedifund will not pay your private health cover claim if:

  • It is for costs incurred before your waiting periods have been served
  • It is for a service for which Medicare does not pay a benefit, such as cosmetic surgery
  • It is for a service that is provided outside the Commonwealth of Australia
  • It is for services that are eligible to be claimed from other sources, such as workers’ compensation cover or third party insurance
  • It is for a service received more than 24 months ago
  • It is for doctors’ fees that are not part of a hospital admission
  • It is for outpatient services not included in onemedifund agreement with a hospital
  • It is for take-home drugs, high-cost drugs or other drugs that were not related to the reason for your admission to hospital
  • It is for prostheses not included on the Australian Government approved list
  • It is for ambulance subscriptions or for ambulance costs covered under Government legislation

Benefit limits

Are you aware of the benefit limits? For example, while Extras Plus members receive $275 cover per year for glasses, frames and contact lenses, this limit drops to $180 for Basic Extras members. Other benefits, such as orthodontics, may attract a lifetime cover limit, while certain dental procedure limits will rise after five years of membership to reward onemedifund members for their loyalty.

Waiting periods

Waiting periods apply to all private health funds in Australia. While there is no waiting period before you receive cover for emergency ambulance transportation and treatment following an accident, most benefits are not available until you have served a two-month waiting period. Other benefits such as obstetric, high-cost dentistry and treatment for pre-existing conditions, require you to sit out longer waiting periods.

Does onemedifund vary benefit payments by treatment?

The payment onemedifund members receive will differ depending on what medical service they claim for. The amount will increase proportionate to the seriousness of the condition and the procedure required to treat it.

The results of the Australian Medical Association's 2016 Private Health Insurance Report Card are displayed below, and allows you to view onemedifund's benefit payment amounts on 22 commonly claimed for treatments and compare them with Medicare (MBS).

Due to them being a member of the Australian Health Service Alliance (AHSA) onemedifund is listed under that organisations name in this chart:

Basal Cell Carcinoma or Squamous Cell Carcinoma removal from nose, eyelid, lip, ear, digit or genetalia$221.35$366.10
Breast, benign lesion surgical biopsy of excision$260.05$356.40
Carpal Tunnel Release$276.80$440.20
Cataract Surgery$760.55$1,239.70
Complicated Delivery (of baby)$1,629.35$1,855.90
Coronary Artery Bypass$2,200.00$3,783.30
Cytotoxic Chemotherapy$97.95$107.80
Femoral on Inguinal Hernia$464.50$909.70
Hip Replacement$1,317.80$2,214.50
Knee Replacement$2,047.60$2,563.40
Overnight investigation for sleep apnoea$588.00$682.20
Tonsils or Tonsils and Adenoid$295.70$513.90
Uncomplicated Delivery (of baby)$693.95$1,484.50
Vaginal Hysterectomy$674.70$1,066.20
Varicose Veins$109.80$164.80


I recognise most of these funds except for the AHSA, what is that?

The Australian Health Service Alliance is a management services organisation that represents a number of small to medium sized health insurance funds, allowing them to combine resources to deliver a higher quality of service to their members.

The funds represented by the ASHA are:

  • ACA Health Benefits Fund
  • Australian Unity Health Limited
  • CBHS Health Fund Limited
  • CUA Health Limited
  • Defence Health
  • GMF Health
  • Budget Direct Health Insurance
  • Frank Health Insurance
  • GU Health
  • HBF Health Ltd
  • Health Care Insurance Limited
  • Health Insurance Fund of Australia Limited
  • Health Partners
  • Navy Health
  • onemedifund
  • Peoplecare Health Insurance
  • Phoenix Health Fund
  • Police Health Limited
  • Queensland Country Health Fund Limited
  • Reserve Bank Health Society Ltd
  • rt health fund
  • Teachers Health Fund > UniHealth Insurance
  • Teachers Union Health
  • The Doctors' Health Fund Pty Ltd
  • Transport Health
  • Westfund

How much does onemedifund cost?

The following factors can influence the cost of your onemedifund premiums:

  • How much cover do you need? The higher the level of cover, the more you’ll have to pay for it
  • Are you after a combined policy? Whether you choose a standalone policy or combined cover.
  • At what age are you planning on getting cover? Failing to take out cover before your 31st birthday could see you being hit with a premium loading under the Lifetime Health Cover scheme
  • How much do you earn a year? How much you earn influences your eligibility for the Medicare Levy Surcharge and the Australian Government Rebate

onemedifund Health Insurance excess

As mentioned above, depending on the hospital cover option you choose you may need to pay an excess when you are admitted to hospital. The excess is the amount you contribute to the overall cost of your stay in hospital, and onemedifund Private Plus cover is available with a nil, $250 and $500 excess. If you choose the option with an excess, the following payment requirements apply:

  • $250 excess per person for an overnight stay in a private hospital
  • $125 excess per person when admitted to a day facility
  • $125 excess per person when admitted to a public hospital
  • Maximum excess per financial year: $250 for a single policy, $500 for a family policy

Making a Claim

Making an extras claim with onemedifund is easy. Around 30,000 extras providers around the country make it possible for onemedifund members to make an extras claim simply by swiping their onemedifund membership card. Where electronic claiming is not available you can lodge your claim online, or fill out and submit a claim form (along with your receipts) by post or email. When it comes to medical claims, most doctors will usually bill your health fund directly. If this doesn’t happen you can use electronic claiming through the government’s ECLIPSE system or submit a claim form via email or post. Hospital claims should be sent directly to onemedifund by your hospital.


Question: How do I work out which rebate tier applies to me for the Australian Government Rebate on Private Health Insurance?

  • Answer: Simply estimate the amount of your household income for the financial year and then find your age on the rebate tier table online - this will tell you which tier you fall under.

Question: Which benefits does onemedifund offer loyalty bonuses for?

  • Answer: onemedifund members who hold extras cover for five years can enjoy increased benefits for crowns and bridgework, dentures and orthodontic treatment.

Question: Does extras cover include protection against ambulance costs?

  • Answer: Yes, both Extras Plus and Basic Extras cover from onemedifund include nationwide ambulance cover.

Question: How can I find a healthcare provider?

  • <strong.Answer: onemedifund has arrangements in place with more than 500 private hospitals and 21,000 doctors around Australia. Use its easy online search facility to find your nearest hospital, doctor or other health care provider.

Question: I’m joining from another health fund - will I have to re-serve my waiting periods?

  • Answer: No, all private health funds in Australia must recognise the waiting periods you have already served on an equivalent or higher level of cover.

Question: Can I take out cover for my children?

  • Answer: Yes, onemedifund allows you to cover your dependent children on a family policy until they reach 18 years of age, or up until they reach the age of 25 if they’re studying full-time. If you’re looking for hospital cover, extras cover or a combined policy, consider the cover options available from onemedifund today. However, you should always make sure to compare private health insurance with the products available from a range of other health funds to help you make an informed decision on cover.
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