(before any rebate, loading or discount)
Covers two adults & dependants (3 or more people, only 2 of whom are adults)
Available in Victoria
# 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 22, 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.
Employees and customers of Astute Financial
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).
| 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 $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
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.
Ambulance subscriptions are claimable up to an annual premium, where there is no state-based Ambulance scheme or levy.
This health insurer does not operate a preferred provider scheme.
| Note, for items marked with an asterisk *: Under Preventative Dental, we pay up to 60% of the average fee charged Australia wide up to the maximum benefit for each eligible service. This applies to examinations, x-rays, scale and clean and fissure sealing. If your dentist charges above the maximum benefit, or in excess of the average fee, a gap or out of pocket may apply. Annual limits, fund rules and waiting periods apply. | |||
|---|---|---|---|
| Treatment | Waiting period (months) | Benefit limits (per 12 months unless otherwise stated) | Examples of maximum benefits |
| General dental* | 2 | $750 per person | Periodic oral examination - 60% of charge Scale & clean - 60% of charge Fluoride treatment - 60% of charge Surgical tooth extraction - 60% of charge |
| Major dental | 12 | $500 per person (combined limit for major dental & endodontic - Sub-limits apply) | Full crown veneered - 60% of charge |
| Endodontic | 12 | Filling of one root canal - 60% of charge | |
| Optical | 6 | $200 per person | Single vision lenses & frames - $200.00 Multi-focal lenses & frames - $200.00 |
| Non PBS pharmaceuticals | 2 | $300 per person | Per eligible prescription - 60% of charge |
| Physiotherapy | 2 | $350 per person (combined limit for physiotherapy, ante-natal/post-natal classes, exercise physiology & eye therapy (orthoptics) - Sub-limits apply) | Initial visit - $53.00 Subsequent visit - $47.00 |
| Chiropractic | 2 | $350 per person (combined limit for chiropractic & osteopathy - Sub-limits apply) | Initial visit - $38.00 Subsequent visit - $27.00 |
| Podiatry | 2 | $200 per person | Initial visit - $40.00 Subsequent visit - $33.00 |
| Psychology | 12 | Benefits payable towards counselling services - Initial consultation $60/subsequent consultation $45 included in $400 Psychology Limit. | Initial visit - $110.00 Subsequent visit - $75.00 |
| Acupuncture | 2 | $300 per person (combined limit for acupuncture, remedial massage & chinese medicine - Sub-limits apply) | Initial visit - $32.00 Subsequent visit - $28.00 |
| Remedial massage | 2 | Initial visit - $32.00 Subsequent visit - $28.00 | |
| Audiology | 2 | $350 per person 1 service(s) every 1 year (combined limit for audiology, dietetics/dietary advice, home nursing & occupational therapy - Sub-limits apply) | Initial visit - 60% of charge |
| Ante-natal/Post-natal classes | 2 | Combined limit - see Physiotherapy | Initial visit - 60% of charge Subsequent visit - 60% of charge |
| Chinese medicine | 2 | Combined limit - see Acupuncture | Initial visit - $32.00 Subsequent visit - $28.00 |
| Dietetics/dietary advice | 2 | Combined limit - see Audiology | Initial visit - $40.00 Subsequent visit - $30.00 |
| Exercise physiology | 2 | Combined limit - see Physiotherapy | Initial visit - 60% of charge Subsequent visit - 60% of charge |
| Eye therapy (orthoptics) | 2 | Combined limit - see Physiotherapy | Initial visit - $43.00 Subsequent visit - $33.00 |
| Home nursing | 2 | Combined limit - see Audiology | Initial visit - $50.00 Subsequent visit - $50.00 |
| Occupational therapy | 2 | Combined limit - see Audiology | Initial visit - $55.00 Subsequent visit - $40.00 |
| Osteopathy | 2 | Combined limit - see Chiropractic | Initial visit - $43.00 Subsequent visit - $40.00 |
| Blood glucose monitors | Orthodontic |
| Hearing aids | Other treatments - check with your insurer |
Approved health management programs when Wellbeing Extras is taken with hospital cover. Benefits payable at 60% of fee charged, up to maximum benefit. Diabetes Education & Nutrition benefits included in Dietetics sub-limit.
Pensioner Concession Card and Healthcare Card holders are entitled to free clinically necessary ambulance transport. If you are not eligible for a concession and want to be covered, you can purchase insurance from a private health insurer or take out a subscription with the state ambulance service (https://www.ambulance.vic.gov.au/membership).
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.