Broader Health Cover

Since April 2007, private health funds have been able to cover a wide variety of clinically appropriate alternatives to hospital treatment. This can include treatment provided in your own home or in community healthcare clinics (known as hospital substitute treatment), as well as programs to manage or prevent chronic disease.

It is not mandatory for health funds to offer cover for these services. It is up to individual funds to decide what services they cover and the benefits payable. Participation in these programs may be subject to your level of cover and eligibility criteria. As with most services, the necessary arrangements need to be in place between the service provider and the health fund before benefits can be paid.

Hospital Substitute Treatment

Many health funds offer cover for treatment that allows patients the option, subject to a doctor's approval, to complete their hospital recovery in the comfort of their own home or in community healthcare clinics. Some of the most common examples include:

  • Wound care
  • IV therapy
  • Early discharge

Chronic Disease Management Programs

Many health funds offer their members access to a range of chronic disease management programs to manage and prevent chronic diseases and self management programs for healthier lifestyles. These may include:

  • Heart/cardiovascular health
  • Risk factors for chronic disease
  • Diabetes management/education
  • Mental health
  • Weight loss/management
  • Quit smoking
  • Asthma management
  • Back pain
  • Healthy lifestyle

How do I find out more?

Many funds offer benefits for at least one of these services, and are able to provide you with further information. Some funds may have included details of available broader health cover services in the "other features" box on the Standard Information Statements.

You should contact your fund to discuss what services or programs may be available to you.