(before any rebate, loading or discount)
Covers 2 adults (and no-one else)
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 exempts you from the Medicare Levy Surcharge.
This policy does not provide accident cover or benefits for travel and accommodation (outside of hospital).
| Back, neck and spine | Eye (not cataracts) | Male reproductive system |
| Blood | Gastrointestinal endoscopy | Miscarriage and termination of pregnancy |
| Bone, joint and muscle | Gynaecology | Pain management |
| Brain and nervous system | Heart and vascular system | Pain management with device |
| Breast surgery (medically necessary) | Hernia and appendix | Palliative care |
| Cataracts | Hospital psychiatric services | Plastic and reconstructive surgery (medically necessary) |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Implantation of hearing devices | Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) |
| Dental surgery | Insulin pumps | Rehabilitation |
| Diabetes management (excluding insulin pumps) | Joint reconstructions | Skin |
| Dialysis for chronic kidney failure | Joint replacements | Sleep studies |
| Digestive system | Kidney and bladder | Tonsils, adenoids and grommets |
| Ear, nose and throat | Lung and chest | Weight loss surgery |
| Assisted reproductive services | Pregnancy 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.
Excess: You will have to pay an excess of $250 per 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.
Covers fund approved hospital-substitution & chronic disease management services. Rates discounted for premiums paid by direct debit.
This health insurer does not operate a preferred provider scheme.
| Note, for items marked with an asterisk *: Non PBS Pharmaceuticals must be a private Schedule 4 or Schedule 8 and dispensed via a provider in private practice. | |||
|---|---|---|---|
| Treatment | Waiting period (months) | Benefit limits (per 12 months unless otherwise stated) | Examples of maximum benefits |
| General dental | 2 | $1,000 per person up to $2,000 per policy (combined limit for general dental & other services) | Periodic oral examination - 100% of charge Scale & clean - 100% of charge Fluoride treatment - 100% of charge |
| Major dental | 12 | $1,000 per person up to $2,000 per policy (combined limit for major dental & endodontic) | Surgical tooth extraction - 75% of charge Full crown veneered - 75% of charge |
| Endodontic | 12 | Filling of one root canal - 75% of charge | |
| Orthodontic | 12 | $700 per person $3,200 lifetime limit | Braces for upper & lower teeth, including removal plus fitting of retainer - 75% of charge |
| Optical | 6 | $250 per person | Single vision lenses & frames - 100% of charge Multi-focal lenses & frames - 100% of charge |
| Non PBS pharmaceuticals* | 2 | $400 per person up to $40 per service up to $800 per policy (combined limit for non pbs pharmaceuticals & vaccinations - Sub-limits apply) | Per eligible prescription - 100% of charge |
| Physiotherapy | 2 | $600 per person up to $1,200 per policy (combined limit for physiotherapy, exercise physiology & other services - Sub-limits apply) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Chiropractic | 2 | $400 per person up to $800 per policy (combined limit for chiropractic, osteopathy & other services - Sub-limits apply) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Podiatry | 2 | $400 per person up to $800 per policy (combined limit for podiatry & other services - Sub-limits apply) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Psychology | 2 | $400 per person up to $800 per policy (Sub-limits apply) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Acupuncture | 2 | $400 per person up to $800 per policy (combined limit for acupuncture & remedial massage) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Remedial massage | 2 | Initial visit - 75% of charge Subsequent visit - 75% of charge | |
| Hearing aids | 12 | $600 per person up to $1,200 per policy (combined limit for hearing aids, blood glucose monitors & other services) | Hearing aid - 75% of charge |
| Blood glucose monitors | 12 | Per monitor - 75% of charge | |
| Audiology | 2 | $400 per person up to $800 per policy | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Dietetics/dietary advice | 2 | $400 per person up to $800 per policy | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Exercise physiology | 2 | Combined limit - see Physiotherapy | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Eye therapy (orthoptics) | 2 | $400 per person up to $800 per policy (combined limit for eye therapy (orthoptics) & speech therapy) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Occupational therapy | 2 | $400 per person up to $800 per policy | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Orthotics (podiatric orthoses) | 12 | $400 per person up to $800 per policy | Orthotics supply & fit - 75% of charge |
| Osteopathy | 2 | Combined limit - see Chiropractic | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Speech therapy | 2 | Combined limit - see Eye therapy (orthoptics) | Initial visit - 75% of charge Subsequent visit - 75% of charge |
| Vaccinations | 2 | Combined limit - see Non PBS pharmaceuticals | Per service - 100% of charge |
| Other treatments - check with your insurer |
100% back up to $600 per person/$1200 per membership per year for preventative dental, all other dental benefits pay 75% of the cost. Rates discounted for direct debit.
In South Australia 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.
Benefits for emergency transportations are available on hospital and selected eligible extras covers. To avoid unexpected out of pockets, we strongly recommend taking out a subscription to be covered Australia wide, regardless of your health insurance. If you have eligible extras cover, provide us with the subscription receipt to receive a benefit up to 100% of the subscription cost.
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.