Mildura Health Fund Hospital Cover Policy Review

With 2 hospital cover options available, Mildura Health aim to keep things simple and straightforward for customers.

Operating since 1929, Mildura Health Fund is a not-for-profit regional health insurance fund that exists to serve and support its members with private health care.

With over 90 years experience in the industry, Mildura Health feel it's important to keep things simple. They offer two levels of cover: the essentials (Basic Plus) and a comprehensive package (Five Star Gold).

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Top 3 features
  1. Good for single children who remain covered up to the age of 21 and 24 if they are a full time student.
  2. Not-for-profit organisation.
  3. The youth discount is available to those aged between 18 and 29 when you take out a Five Star Gold level of cover.

What hospital policies are available?

  • Basic Plus Benefits. This is Mildura Health's most basic level of cover. Ideal for young and healthy singles and couples, it gives you public hospital cover for all Medicare services as well as shared room accommodation as a private patient in a public hospital and lets you pick your own provider. If you are admitted to a private hospital, it will very likely result in large out of pocket expenses.
  • Five Star Gold Benefits. A very comprehensive cover option, Five Star Gold gives you 100% cover throughout Australia for all 38 clinical categories required for a gold rating. You can also choose between five different excess options, from $0 - $750.

Restricted cover means you will be covered in a shared ward in a public hospital only:

CoverBasic PlusFive Star Gold
Excess option$750$0, $150, $250, $500, $750
RehabilitationRestricted
Hospital psychiatric servicesRestricted
Palliative careRestricted
Brain and nervous systemRestricted
Eye (not cataracts)Restricted
Ear, nose and throatRestricted
Tonsils, adenoids and grommetsRestricted
Bone, joint and muscleRestricted
Joint reconstructionsRestricted
Kidney and bladderRestricted
Male reproductive systemRestricted
Digestive systemRestricted
Hernia and appendixRestricted
Gastrointestinal endoscopyRestricted
GynaecologyRestricted
Miscarriage and termination of pregnancyRestricted
Chemotherapy, radiotherapy and immunotherapy for cancerRestricted
Pain managementRestricted
SkinRestricted
Breast surgery (medically necessary)Restricted
Diabetes management (excluding insulin pumps)Restricted
Heart and vascular systemRestricted
Lung and ChestRestricted
BloodRestricted
Back, neck and spineRestricted
Plastic and reconstructive surgery (medically necessary)Restricted
Dental surgeryRestricted
Podiatric surgery (provided by an accredited podiatric surgeon)Restricted
Implantation of hearing devicesRestricted
CataractsRestricted
Joint replacementsRestricted
Dialysis for chronic kidney failureRestricted
Pregnancy and birthRestricted
Assisted reproductive servicesRestricted
Weight loss surgeryRestricted
Insulin pumpsRestricted
Pain management with deviceRestricted
Sleep studiesRestricted

Other benefits of Hospital Cover

Mildura Health have a range of perks and benefits when you take out hospital cover including:

  • A range of excess options with Five Star Gold: $0, $150, $250, $500 and $750. The higher the excess, the lower the premiums.
  • As long as your child is single, they can remain covered under a family plan until age 21, or 24 if they're a full-time student.
  • There is a 2.5% discount on premiums when you pay with direct debit.
  • Mildura Health has no gap medical agreements with many medical specialists who work at Mildura Health Private Hospital (MHPH).

How do the costs work?

If you have to go to hospital, you'll be charged separately for any medical fees by your medical practitioner. These fees will be on top of your accommodation and theatre fees.

You will receive 100% of the Medicare Benefit Schedule (MBS) fee plus the Fund Benefit for in-patient services. If your medical specialist charges more than the MBS fee, Mildura Health will pay a benefit towards this amount, also known as the gap.

If your doctor has an agreement in place with Mildura Health, they will simply send the bill straight to them. If not, you can send the bill to Mildura for claiming.

You should always try and contact Mildura Health Fund prior to any planned hospitalisation with the MBS item number and inform them of how much your doctor plans to charge. That way, they can make sure you are covered and warn you of any out of pocket expenses.

Waiting periods and limitations

If you transfer from another fund where you have already served the waiting period, then Mildura Health Fund will cover you straight away on a similar level of cover. However, if you are moving to a higher level of cover, you will serve the waiting periods for the services you previously did not hold. These waiting periods apply:

  • Immediate: Newborns, accidental injury
  • 2 months: General illness, rehabilitation, psychiatric services, and palliative care
  • 12 months: Pre-existing conditions, pregnancy, and birth-related services

How to make a claim

Submitting a claim is very straightforward. If you can't process a claim by card, you can download the Mildura Health Fund app off of the iTunes App store or Google play for free. This lets you enter your fund details and take a photo of your invoice. You can also fill out a claim's form. All you need to do is attach the proper documentation and email or mail it to Mildura Health Fund.

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