Private Health Information Statement - Combined policy

Smart Essentials (Silver Plus)

Monthly Premium

$542.10 #

(before any rebate, loading or discount)

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

Available in Tasmania

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 or an insurer discount. Check with your insurer for details.

This policy covers children, students up to and including the age of 30 and non-students up to and including the age of 30, as well as persons with a disability who qualify as a child, student or non-student in these age ranges.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy provides accident cover - check with your insurer for details.

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

This policy includes cover for

Hospital Cover Legend
Back, neck and spineGastrointestinal endoscopyPain management
BloodGynaecologyPain management with device
Bone, joint and muscleHeart and vascular systemPalliative care
Brain and nervous systemHernia and appendixPlastic and reconstructive surgery (medically necessary)
Breast surgery (medically necessary)Implantation of hearing devicesPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
Chemotherapy, radiotherapy and immunotherapy for cancerInsulin pumpsRehabilitation
Dental surgeryJoint reconstructionsSkin
Diabetes management (excluding insulin pumps)Kidney and bladderSleep studies
Digestive systemLung and chestTonsils, adenoids and grommets
Ear, nose and throatMale reproductive systemWeight loss surgery
Eye (not cataracts)Miscarriage and termination of pregnancyHospital psychiatric services

This policy does not include cover for

Hospital Cover Legend
Assisted reproductive servicesDialysis for chronic kidney failurePregnancy and birth
CataractsJoint replacements

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 of $500 per admission. This is limited to a maximum of $500 per person and $1000 per policy per year.

Excess payments do not apply to hospital admissions for dependants or day surgery.

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
  • 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

Additional Benefits of the cover include: Hospital Care at Home & Rehabilitation at Home. There are Preventative Health Services and Health Support Programs available on this cover, waiting periods may apply. Please refer to the product Fact Sheet or contact Australian Unity for further details.

General Treatment Cover

Our network optical providers offer discounts on some optical purchases. Contact Australian Unity for more details.

This policy includes General treatment (Extras) cover for

General treatment legend
Note, for items marked with an asterisk *: 1)2)3) Dental limits increase for the first five years of continuous membership. Family limits are shared between all people on a membership. A per-person sub-limit applies for Major Dental ($700 per-person, up to $1400 per family). Full denture replacement is limited to once every three years. Surgical teeth extractions and gum disease treatment are included under Endodontics (12-month waiting period). No waiting period for preventative dental and selected diagnostic services. 4) $40 for a Chiropractic x-ray, limit to 1 x-ray per person per-calendar year. 5)Remedial massage sub-limit of $125 per person, $250 per family. 6) Travel Vaccinations only.
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental*2$1,500 per policy
(combined limit for general dental, major dental, endodontic & other services - Sub-limits apply)
Periodic oral examination - $30.00
Scale & clean - $44.00
Fluoride treatment - $21.00
Surgical tooth extraction - $105.00
Major dental*12Full crown veneered - 70% of charge
Endodontic*12Filling of one root canal - $95.00
Optical6$200 per personSingle vision lenses & frames - $200.00
Multi-focal lenses & frames - $200.00
Non PBS pharmaceuticals2$150 per person up to $300 per policy
(combined limit for non pbs pharmaceuticals & vaccinations)
Per eligible prescription - $50.00
Physiotherapy2$350 per person up to $700 per policy
(combined limit for physiotherapy, exercise physiology & other services)
Initial visit - $40.00
Subsequent visit - $40.00
Chiropractic*2$350 per person up to $700 per policy
(combined limit for chiropractic & osteopathy)
Initial visit - $40.00
Subsequent visit - $40.00
Podiatry2$250 per person up to $500 per policy
(combined limit for podiatry & orthotics (podiatric orthoses))
Initial visit - $40.00
Subsequent visit - $40.00
Psychology2$200 per person up to $400 per policy
(combined limit for psychology & dietetics/dietary advice)
Initial visit - $40.00
Subsequent visit - $40.00
Acupuncture2$350 per person up to $700 per policy
(combined limit for acupuncture & remedial massage - Sub-limits apply)
Initial visit - $40.00
Subsequent visit - $40.00
Remedial massage*2Initial visit - $40.00
Subsequent visit - $40.00
Dietetics/dietary advice2Combined limit - see PsychologyInitial visit - $40.00
Subsequent visit - $40.00
Exercise physiology2Combined limit - see PhysiotherapyInitial visit - $40.00
Subsequent visit - $40.00
Orthotics (podiatric orthoses)12Combined limit - see PodiatryOrthotics supply & fit - 70% of charge
Osteopathy2Combined limit - see ChiropracticInitial visit - $40.00
Subsequent visit - $40.00
Vaccinations*0Combined limit - see Non PBS pharmaceuticalsPer service - 100% of charge
Annual benefit limits apply per calendar year. Myotherapy, $40 per consultation, Combined maximum of $350 per person ($700 per family), (combined limit - see Physiotherapy limit) 2 month waiting period. Orthotic benefits are for supply only. Braces, Splints and Garments - up to 70% of the cost, maximum $250 per person up to $500 per policy (combined limit - see Podiatry) 12 month waiting period.

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

General treatment legend
Blood glucose monitorsOrthodontic
Hearing aidsOther treatments - check with your insurer

Other features of this general treatment cover

Please refer to the product Fact Sheet or contact Australian Unity for further details.

Ambulance cover

Ambulance cover is provided by the State government for residents of Tasmania. This may include cover whilst interstate, except for South Australia and Queensland where no cover applies. In other states please check with Ambulance Tasmania - https://www.health.tas.gov.au/ambulance/fees_and_accounts.

Other features of this ambulance cover

Some authorities provide certain ambulance services at no cost to eligible residents. Refer to your local ambulance provider for more information. Australian Unity won't pay a Benefit if you're eligible to claim from, or are covered by, another source. Australian Unity doesn't pay a benefit towards ambulance subscription services. If you’re not covered, this cover includes emergency ambulance to hospital, if transport is coded and invoiced as emergency transport by a state/territory ambulance service/authority. Call-out fees where you're not taken to hospital are limited to 2 ambulance attendances per person per calendar year. This cover doesn't include non-emergency ambulance transportation

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.