Find out how Health Partners cover emergency and non-emergency services.
Health Partners is South Australia’s largest open health fund. With more than 80,000 members across the state, it covers a range of hospital and ancillary services as well as ambulance services.
Ambulance cover is important, especially in South Australia where most people will not be insured by any kind of state ambulance scheme. Instead, a state ambulance or St John’s ambulance membership can be purchased, or you can get equivalent cover through a health fund, which is often the more cost-effective option.
What kinds of ambulance cover does Health Partners offer?
Health Partners offers ambulance cover with both its hospital and extras plans. Whether you have full cover or emergency-only cover depends on the plan.
- Emergency ambulance cover is included in all Health Partners hospital and extras policies and packages.
- Full ambulance cover, including non-emergency ambulance transport and services, is included in the Gold and Gold Value hospital policies and the Family Essentials and Prime Living packages. It is not available through any Health Partners extras policies.
What’s emergency and non-emergency services are covered?
Emergency ambulance cover will only reimburse the cost of ambulance services that have been coded as an emergency by the attending ambulance personnel. Generally, this applies when an ambulance is called to provide critical care on the scene, or to urgently transport someone to hospital in order to receive emergency medical attention. As a general rule of thumb, if an ambulance has its lights and sirens on to transport a patient, it likely qualifies as an emergency.
When you have full ambulance cover with Health Partners, you are insured for emergency ambulance services as well as non-emergency services. These non-emergency services can include patient transport between hospitals, clinically necessary transport to hospital for the management of an ongoing condition.
Health Partners does not offer any standalone ambulance policies and only covers ambulance services in a limited way under its hospital and extras policies and packages.
What are the limitations?
- Extras: You are covered for one emergency ambulance service per person, per year. There is a maximum of two total ambulance claims per policy, per year.
- Hospital: You are covered for one ambulance service per person, per year, whether emergency or non-emergency.
- Packages: You are covered for one ambulance service per person, per year.
As such, the only way to claim more than one ambulance service per year with Health Partners is to hold both a hospital and an extras policy (not to be confused with a combined package) and to claim one service under your hospital cover and a second under your extras cover.
There is no cover for clinic-car type transport and there is a benefit limit of $20,000 per year for ambulance services. However, reaching this limit is unlikely (barring very special circumstances and air transport needs) as you can typically only claim one ambulance service per year. According to South Australia State Ambulance, the average cost of an emergency ambulance is $934, which is well beneath the $20,000 limit, but also a lot more than most people can comfortably afford to pay out of pocket.
As you can see, it’s important to be aware of the fine print in each plan and it pays to look at your policy in detail. Even though you might be covered for ambulance services with Health Partners, you can still incur thousands of dollars of out-of-pocket expenses if you have to use multiple ambulance services per year.
These limitations might also be viewed differently by someone who is considering upgrading to a higher level of ambulance cover. If you have reason to believe that you will require non-emergency ambulance transport, you will also generally be more likely to require emergency ambulance transport in the same year. If you have already used your single claim for a non-emergency ambulance, you might be left without cover in the event of an emergency later.
How can I find more complete cover?
For more complete cover with fewer restrictions, look for a health fund that doesn’t have these limits on ambulance services, choose an ambulance-only policy or take out a subscription with the state ambulance service.
As of 1 November 2016, South Australia’s state ambulance service rates are:
- Singles cover: $79.50 per year
- Family cover: $158.00 per year
- Single pensioner cover: $48.00 per year
- Family pensioner cover: $95.50 per year
Interstate ambulance cover plans cost an additional $15 per year for singles and $30 for families. South Australian state ambulance plans cover you for an unlimited number of emergency and non-emergency ambulance services per year when medically necessary, within the conditions of the plan.
Are there any exemptions from fees in South Australia?
Department of Veterans Affairs (DVA) Gold Card holders are covered for necessary ambulance transport by the DVA, while DVA White Card holders are covered for necessary ambulance transport, but only for conditions relevant to their card.
Unlike other states, there are no ambulance cost exemptions for pensioners or concession card holders in South Australia, other than lower-cost state ambulance subscriptions for pensioners. As such, all residents of South Australia, even those who are with Health Partners, may want to consider looking at additional ambulance cover options, being careful to check the terms and conditions.
Ambulance cover options to consider include:
- Health funds that provide effective ambulance cover as part of their hospital or extras plans or packages.
- A state ambulance subscription.
- Standalone ambulance cover options.