Private Health Information Statement - Combined policy

Silver Plus Hospital 500 and Ancillary Lite

Monthly Premium

$366.83 #

(before any rebate, loading or discount)

Covers one adult & dependants (2 or more people, only one of whom is an adult)

Available in All States

# You may be entitled to an Australian Government rebate on the above premium. Your premium may also include a Lifetime Health Cover loading or an insurer discount. Check with your insurer for details.

This policy covers children and other dependants up to and including the age of 20, students up to and including the age of 24, as well as persons with a disability who qualify as a child or other dependant or student in these age ranges.

Membership of this insurer is restricted to Seventh-day Adventist Church employees, Local Church Officers and their families.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy does not provide accident cover or benefits for travel and accommodation (outside of hospital).

This policy includes cover for

Hospital Cover Legend
Back, neck and spineGastrointestinal endoscopyPain management with device
BloodGynaecologyPlastic and reconstructive surgery (medically necessary)
Bone, joint and muscleHeart and vascular systemPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
Brain and nervous systemHernia and appendixSkin
Breast surgery (medically necessary)Implantation of hearing devicesSleep studies
Chemotherapy, radiotherapy and immunotherapy for cancerJoint reconstructionsTonsils, adenoids and grommets
Dental surgeryKidney and bladderHospital psychiatric services
Diabetes management (excluding insulin pumps)Lung and chestPalliative care
Digestive systemMale reproductive systemRehabilitation
Ear, nose and throatMiscarriage and termination of pregnancy
Eye (not cataracts)Pain management

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesInsulin pumpsWeight loss surgery
CataractsJoint replacements
Dialysis for chronic kidney failurePregnancy and birth

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $500 per person per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 12 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product.

The Medical Costs Finder lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

$500 excess per person per annum. For NSW & ACT residents only, Hospital cover includes ambulance cover for emergency (unlimited with no waiting period) and call-out fees (paid for each attendance, including emergency treatment without transport to hospital) in that state or territory only. No ambulance cover for excluded services.

For further information about this policy see

https://acahealth.com.au/quote-details/?hospital=silver&extras=lite

General Treatment Cover

This health insurer does not operate a preferred provider scheme.

This policy includes General treatment (Extras) cover for

General treatment legend
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental9$700 per person
(combined limit for general dental, major dental, endodontic & other services - Sub-limits apply)
Periodic oral examination - $100.00
Scale & clean - $100.00
Fluoride treatment - $100.00
Major dental9Surgical tooth extraction - $168.00
Full crown veneered - $400.00
Endodontic9Filling of one root canal - $400.00
Optical4$200 per person
(combined limit for optical & other services)
Single vision lenses & frames - $200.00
Multi-focal lenses & frames - $200.00
Non PBS pharmaceuticals2$250 per personPer eligible prescription - $50.00
Physiotherapy2$300 per person
(combined limit for physiotherapy, chiropractic, podiatry, osteopathy & other services)
Initial visit - $37.50
Subsequent visit - $26.50
Chiropractic2Initial visit - $25.00
Subsequent visit - $25.00
Podiatry2Initial visit - $25.00
Subsequent visit - $25.00
Acupuncture2$100 per person
(combined limit for acupuncture & remedial massage)
Initial visit - $20.00
Subsequent visit - $20.00
Remedial massage2Initial visit - $20.00
Subsequent visit - $20.00
Osteopathy2Combined limit - see PhysiotherapyInitial visit - $25.00
Subsequent visit - $25.00

This policy does not include General treatment (Extras) cover for

General treatment legend
Blood glucose monitorsOrthodonticOther treatments - check with your insurer
Hearing aidsPsychology

For further information about this policy see

https://acahealth.com.au/quote-details/?hospital=silver&extras=lite

Ambulance cover

In All States this policy provides:

Emergency: Unlimited with no waiting period.

Call-out fees:  will be paid for each attendance, including emergency treatment without transport to hospital.

State schemes provide ambulance services for residents of Tasmania (https://www.health.tas.gov.au/ambulance/fees_and_accounts) and Queensland (https://www.ambulance.qld.gov.au/).

For further information about this policy see

https://acahealth.com.au/quote-details/?hospital=silver&extras=lite

Disclaimer

The information contained in this Private Health Information Statement was provided by the insurer and is intended as general information. It may not take into account your particular circumstances. For information please contact the insurer.

Covered

For information on what is covered under each category, see https://www.privatehealth.gov.au/categories

Restricted

Restricted categories partially cover your hospital costs as a private patient in a public hospital. You may incur significant expenses in a private room or private hospital.

Not Covered

These categories are not covered by this policy.