Have you considered onemedifund as your health fund? 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.
Find out more about Onemedifund
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.
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 funds 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
Hospital cover
The Private Plus Hospital cover plan delivers comprehensive hospital cover for all Medicare procedures. There are excess and a no-excess options, but other than this the cover itself is identical.
Excess option
This option has lower premiums, but you pay a set amount in the event of hospitalisation or day surgery. You only have to pay these amounts are payable only once a year per person, and up to twice a year per family.
- $125: For admission to a public hospital, or day surgery
- $250: For overnight admission to a private hospital
If you have no reason to expect hospitalisation, it may be worth choosing the excess plan in order to reduce your premiums. However, if you have reason to think a hospital stay may be imminent, the no-excess plan would help eliminate out-of-pocket expenses.
Extras cover
The Extras Plus plan exceeds many other comprehensive extras policies in several ways:
Dental benefits
- Periodontics and endodontics are covered under general dental. These are typically found under major dental. This enhances the basic plan too but is particularly effective with the Extras Plus plan, which carries unlimited general dental benefits.
- Separate limits for major dental procedures. There is no overarching major dental limit under these plans, which can let someone with advanced dental needs claim a considerable amount for important treatment.
Optical benefits
There are no sub-limits for glasses, frames or contact lenses under the optical cover, and you can claim 100% of the cost up to the annual limit. This means you’re more free to spend it as needed. For example, if you don’t wear contacts and don’t need new lenses you might be able to spend it all on a $275 set of frames without paying anything out of pocket.
In addition to this the Extras Plus policy lets you claim laser eye surgery, which is frequently unavailable.
The Basic Extras plan has similar optical benefits without sub-limits, but only up to $180 per year, and no laser eye surgery benefits.
Both plans also pay benefits towards health management programs, including:
- Approved programs for the treatment of diagnosed health conditions
- Approved screening services such as blood pressure or cholesterol testing, mammograms and hearing tests
Note that neither policy pays benefits towards health management programs, like gym memberships, which many other extras policies do.
Other benefits and features
onemedifund strives to provide complete, effective hospital insurance. There is a range of cover included in the Private Plus plan:
- All Medicare services: You are covered for all Medicare procedures, in both public and private hospitals.
- Ambulance: When medically necessary, 100% of the cost of air, land or sea ambulance services is covered.
- Access Gap Cover: Find out ahead of time whether you will have any out-of-pocket expenses, and how much of these will be covered by the Access Gap scheme.
- Hospital accommodation: You are covered for all public hospital accommodation in Australia, in both shared and private rooms where available. You are also covered in private hospitals with which onemedifund has a health insurance agreement.
- Labour ward, theatre and special care fees: The plan covers you for additional fees associated with special accommodation, such as labour ward, theatre, intensive care and neonatal care.
- Surgical prostheses: You are covered for prostheses listed on the government prostheses list, up to the minimum amount. For items over this amount, you will have out-of-pocket expenses.
- Dependents cover: Children and dependants are covered up to the age of 18 under a family plan, or 25 if they are a full-time student.
General exclusions, limits and waiting periods
Exclusions
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.
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 funds 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.
