Looking for hospital cover? Transport Health is a not-for-profit fund that offers a number of policies that cover hospital treatment.
Transport Health was established in 1888 as a very select health fund for Melbourne Tramway workers, but as demand grew it started to encompass all areas of Australia’s transport industry. In 2014 it opened its doors to all Australians eligible for health insurance, which has resulted in a 50% growth in membership.
See what this unique health fund’s hospital cover offers.
Top 3 features
- Good for people who want a basic policy that covers all clinical categories of treatment and not just the three required by the Australian government.
- Good for people who want a provider with a wide network of agreement hospitals where they can save on out-of-pocket expenses.
- Beware if you want a mid-range policy as there is really only one to choose from.
Contents of this review
- Affordable without skimping on cover. Transport Health's Basic Plus Public Hospital policy allows you to choose your own doctor, avoid waiting lists and access a near-full range of Medicare procedures at a low cost.
- Comprehensive option available. At the other end of the spectrum, Top Hospital covers the full range of Medicare procedures in agreement private hospitals and day facilities, and lets you adjust your premiums by choosing between an excess, a co-payment and no excess or co-payment plans.
- Access Gap Cover. Available in the Healthy Choice and Top Hospital policies, Access Gap Cover reduces or eliminates any out-of-pocket expenses you may incur, providing the doctors or practitioner who treats you participates scheme. If they are a "no-gap" doctor there won't be any extra costs, if they are "known-gap" you’ll know how much it will be ahead of time.
- Membership benefits. With the focus being on affordable healthcare alone, additional member bonuses are limited. However, you can still get a considerable 30% discount on QBE travel insurance as a Transport Health member.
Transport Health offers four levels of hospital cover, each offering emergency ambulance cover on top of the hospital treatments.
- Basic Plus Public Hospital. Low-cost policy that offers cover for all 38 clinical categories on a restricted basis, many more than the three required by the Australian government.
- Bronze Plus Healthy Choice Hospital. Mid-level policy that covers more than the Australian government requires of a Bronze policy. It covers pain management (including with device), joint reconstructions, back treatments, insulin pumps and more.
- Silver Plus Select Hospital with Excess. This fully covers all clinical categories available in the Australian medical system except for in-hospital psychiatry, which is covered on a restricted basis. This version of the Silver Plus Select Hospital policy comes with with a one-off excess of $500 per hospital visit (no matter how many nights you stay). Excess is capped at $500 per year.
- Silver Plus Select Hospital with Daily Excess. This is exactly the same as the policy above but instead of a one-off $500 excess, the excess is $100 per night. Excess is capped at $500 per year.
- Gold Top Hospital. Highest level of cover, covering all 38 clinical categories required of a Gold policy.
Full breakdown of what's covered and excluded by these policies
- Minimum benefits, public hospital only
|Details||Basic Plus Public Hospital||Bronze Plus Healthy Choice Hospital||Silver Plus Select Hospital with Daily Excess||Silver Plus Select Hospital with Excess||Gold Top Hospital|
|Starting Cost||$22.41 per week||$26.72 per week||$40.37 per week||$42.65 per week||$46.68 per week|
|Excess/Co-payment||None||$100 co-payment||$100 co-payment||$500 co-payment||None|
|Hospital psychiatric services|
|Brain and nervous system|
|Eye (not cataracts)|
|Ear, nose and throat|
|Tonsils, adenoids, grommets|
|Bone, joint and muscles|
|Kidney and bladder|
|Male reproductive system|
|Hernia and appendix|
|Miscarriage and termination of pregnancy|
|Chemotherapy, radiotherapy, and immunology for cancer|
|Breast surgery (medically necessary)|
|Diabetes management (excluding insulin pumps)|
|Lung and Chest|
|Heart and vascular system|
|Back, neck and spine|
|Plastic and reconstructive surgery (medically necessary)|
|Podiatric surgery (provided by a registered podiatric surgeon)|
|Implantation of hearing devices|
|Dialysis for chronic kidney disease|
|Pregnancy and birth|
|Assisted reproductive services|
|Weight loss surgery|
|Pain management with device|
Available with the Healthy Choice and Top Hospital policies, these enable you to reduce your premium cost in exchange for paying an up-front fee when you go to hospital. An excess is a single payment while a co-payment is a per night fee. Circumstances where you might opt for an excess or co-payment on your policy include the following:
- If you have ongoing health issues this can be a useful way of tailoring your plan to reduce the cost.
- If you have health issues that make it likely you’ll attend hospital each year it might be a good idea to pick the no-excess or co-payment plan, at the cost of higher premiums.
- If you’re likely to experience hospitalisations lasting several days an excess is likely to be cheaper.
- If odds are that you’ll be faced with multiple brief hospitalisations per year, an excess may be the most cost-effective option.
It’s important to be aware of the limits of each Transport Health hospital policy. Some of these are restrictions that only pay minimum benefits for specific services, while other exclude certain treatments completely. You are also required to wait a certain period of time before you are able to lodge a claim. These waiting periods vary depending on what you are claiming for.
Hospital cover limitations
- Top Hospital. The Top level plan does not include any specific exclusions and lets you access the full range of Medicare procedures at both public and agreement private hospitals as desired.
- Healthy Choice Hospital. For the procedures specified as exclusions you cannot claim any private health insurance benefits, whether in a public or private hospital. For these exclusions, you can still attend a public hospital as a public patient, but will need to contend with applicable waiting periods and will not be able to choose your doctor.
- Public Hospital. This policy excludes you from attending private hospitals or facilities without incurring considerable out-of-pocket expenses. The exceptions are hospitalisation resulting from an accident, and when getting government-approved prostheses where you are covered up to the specified amount for approved items.
Hospital cover waiting periods
- None: Emergency ambulance and accidents.
- 2 months: All conditions not otherwise specified, and pre-existing psychiatric, rehabilitation and palliative care.
- 12 months: Pre-existing conditions, pregnancy or fertility related services.
Hospital costs are typically billed directly to the fund, and you won’t need to worry about claiming. Instead, you can simply pay any applicable excess or co-payment on discharge.
Medical practitioners may bill their services separately, where you can make claims through Medicare by completing a two-way Medicare form. Where practitioners participate in the Access Gap Scheme, and you have mid or top level cover, they'll bill Transport Health directly. You'll only need to pay for any applicable gap, and can pay the provider directly.
Health fund premiums are payable in advance for the upcoming period. You can choose to pay weekly, fortnightly or monthly, and can select from the following payment options:
- Direct debit: Regular direct debits from your account or credit card. You can also choose to direct debit quarterly, yearly or half yearly in addition to the usual options.
- Pay by phone: Call 1300 806 808 to make a credit card payment over the phone.
- BPAY: Use your financial institution's BPAY facility.
- Mail: Make payments by cheque, money order or credit card. You cannot pay premiums by sending cash in the mail.
- Online: Log in to the member’s area of the Transport Health website to make credit card payments.