(before any rebate, loading or discount)
Covers two adults & dependants (3 or more people, only 2 of whom are adults)
Available in South Australia
Closed to new members
# You may be entitled to an Australian Government rebate on the above premium. Your premium may also include a Lifetime Health Cover loading, an age-based discount 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 31, 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 Medical and allied health professionals, their families, medical students and AMA employees.
This policy exempts you from the Medicare Levy Surcharge.
This policy provides accident cover and benefits for travel or accommodation (outside of hospital) - check with your insurer for details.
| Assisted reproductive services | Eye (not cataracts) | Miscarriage and termination of pregnancy |
| Back, neck and spine | Gastrointestinal endoscopy | Pain management |
| Blood | Gynaecology | Pain management with device |
| Bone, joint and muscle | Heart and vascular system | Palliative care |
| Brain and nervous system | Hernia and appendix | Plastic and reconstructive surgery (medically necessary) |
| Breast surgery (medically necessary) | Hospital psychiatric services | Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) |
| Cataracts | Implantation of hearing devices | Pregnancy and birth |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Insulin pumps | Rehabilitation |
| Dental surgery | Joint reconstructions | Skin |
| Diabetes management (excluding insulin pumps) | Joint replacements | Sleep studies |
| Dialysis for chronic kidney failure | Kidney and bladder | Tonsils, adenoids and grommets |
| Digestive system | Lung and chest | Weight loss surgery |
| Ear, nose and throat | Male reproductive system |
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.
Excess: You will have to pay an excess on admission. This is limited to a maximum of $250 per person and $500 per policy per year.
Co-payments: No co-payments
Waiting periods:
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.
This cover is categorised as Gold as it includes cover for the full range of inpatient services eligible for Medicare benefits, meaning there are no exclusions and restrictions. Prime Choice Gold is ideal for families who are looking for comprehensive hospital cover.
This health insurer does not operate a preferred provider scheme.
| Note, for items marked with an asterisk *: Orthodontic services accrue to a lifetime limit of $1,600 at $320 per year of membership. $500 optical limit every 2 years. Individual and group physiotherapy and hydrotherapy claimable under physiotherapy. Class physiotherapy and acupuncture claimable through health management when prescribed by your medical practitioner. | |||
|---|---|---|---|
| Treatment | Waiting period (months) | Benefit limits (per 12 months unless otherwise stated) | Examples of maximum benefits |
| General dental | 2 | $1,600 per person (combined limit for general dental, major dental, endodontic & orthodontic) $1,600 lifetime limit for Orthodontic | Periodic oral examination - 100% of charge Scale & clean - 100% of charge Fluoride treatment - 100% of charge Surgical tooth extraction - $153.00 |
| Major dental | 12 | Full crown veneered - $765.00 | |
| Endodontic | 12 | Filling of one root canal - $131.75 | |
| Orthodontic* | 12 | Braces for upper & lower teeth, including removal plus fitting of retainer - 100% of charge | |
| Optical* | 2 | $500 per person | Single vision lenses & frames - 100% of charge Multi-focal lenses & frames - 100% of charge |
| Non PBS pharmaceuticals | 2 | $300 per person (combined limit for non pbs pharmaceuticals & vaccinations - Sub-limits apply) | Per eligible prescription - 85% of charge |
| Physiotherapy* | 2 | $900 per person (combined limit for physiotherapy, podiatry, psychology, remedial massage, ante-natal/post-natal classes, dietetics/dietary advice, exercise physiology, eye therapy (orthoptics), occupational therapy, orthotics (podiatric orthoses), speech therapy & other services - Sub-limits apply) | Initial visit - $50.00 Subsequent visit - $35.00 |
| Podiatry | 2 | Initial visit - $50.00 Subsequent visit - $35.00 | |
| Psychology | 2 | Initial visit - $100.00 Subsequent visit - $100.00 | |
| Acupuncture* | 2 | $200 per person up to $400 per policy (combined limit for acupuncture, health management / healthy lifestyle & other services) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Remedial massage | 2 | Combined limit - see Physiotherapy | Initial visit - $40.00 Subsequent visit - $30.00 |
| Hearing aids | 24 | $800 per person 1 appliance(s) every 5 years | Hearing aid - $400.00 |
| Blood glucose monitors | 12 | $500 per person up to $250 per service 1 appliance(s) every 2 years (combined limit for blood glucose monitors & other services - Sub-limits apply) | Per monitor - 75% of charge |
| Ante-natal/Post-natal classes | 2 | Combined limit - see Physiotherapy | Initial visit - $50.00 Subsequent visit - $30.00 |
| Dietetics/dietary advice | 2 | Combined limit - see Physiotherapy | Initial visit - $50.00 Subsequent visit - $35.00 |
| Exercise physiology | 2 | Combined limit - see Physiotherapy | Initial visit - $30.00 Subsequent visit - $30.00 |
| Eye therapy (orthoptics) | 2 | Combined limit - see Physiotherapy | Initial visit - $50.00 Subsequent visit - $35.00 |
| Health management / Healthy lifestyle | 2 | Combined limit - see Acupuncture | Health management - 75% of charge |
| Occupational therapy | 2 | Combined limit - see Physiotherapy | Initial visit - $50.00 Subsequent visit - $40.00 |
| Orthotics (podiatric orthoses) | 12 | Combined limit - see Physiotherapy | Orthotics supply & fit - $150.00 |
| Speech therapy | 2 | Combined limit - see Physiotherapy | Initial visit - $50.00 Subsequent visit - $40.00 |
| Vaccinations | 2 | Combined limit - see Non PBS pharmaceuticals | Per service - 85% of charge |
| Major dental paid at fixed benefits per item. Combined annual limit of $900 for physiotherapy, exercise physiology, dietetics, occupational therapy, speech therapy, podiatry, massage and more (sub-limits of $700 for mental health and $500 for other therapies). Group physiotherapy and hydrotherapy $20 per session. Benefit of $400 each for one left and one right hearing aid every 5 years. Pharmacy benefits paid at 85% of charge above the PBS co-payment to a maximum of $40 per prescription (sub-limit applies for weight loss medications). | |||
| Chiropractic | Other treatments - check with your insurer |
Superior mid-range extras cover with substantial benefits including major dental and high-level optical cover. 100% back for 2 dental checkups per year (fixed benefits thereafter) at the provider of your choice. No sub-limits on optical benefits – use the full $500 limit on contact lenses or frames fitted with prescription lenses. Claim up to $700 per year (as part of the $900 overall limit for therapies) for mental health services. Health management includes services such as acupuncture, weight loss classes and class physiotherapy for the treatment of a specific diagnosed condition.
In South Australia this policy provides:
Emergency: Unlimited with a waiting period of 1 day.
Non-emergency: Unlimited transport with a waiting period of 1 day, or 1 day for pre-existing conditions.
Call-out fees: will be paid for each attendance, including emergency treatment without transport to hospital.
National cover for emergency and medically necessary ambulance transportation costs except where there is an entitlement to Benefits under a State Government ambulance transport scheme or any other source.
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.
For information on what is covered under each category, see https://www.privatehealth.gov.au/categories
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.
These categories are not covered by this policy.