(before any rebate, loading or discount)
Covers only one person
Available in Western Australia
# 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.
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).
| Blood | Gastrointestinal endoscopy | Pain management |
| Bone, joint and muscle | Gynaecology | Pain management with device |
| Brain and nervous system | Hernia and appendix | Palliative care |
| Breast surgery (medically necessary) | Implantation of hearing devices | Plastic and reconstructive surgery (medically necessary) |
| Chemotherapy, radiotherapy and immunotherapy for cancer | Insulin pumps | Rehabilitation |
| Dental surgery | Joint reconstructions | Skin |
| Diabetes management (excluding insulin pumps) | Kidney and bladder | Sleep studies |
| Digestive system | Lung and chest | Tonsils, adenoids and grommets |
| Ear, nose and throat | Male reproductive system | Hospital psychiatric services |
| Eye (not cataracts) | Miscarriage and termination of pregnancy |
| Assisted reproductive services | Dialysis for chronic kidney failure | Podiatric surgery (provided by a registered podiatric surgeon – limited benefits) |
| Back, neck and spine | Heart and vascular system | Pregnancy and birth |
| Cataracts | Joint replacements | Weight loss surgery |
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 $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.
Half excess applies to day surgery up to maximum product excess. 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 100% of your dentist's regular fee up to a maximum benefit per 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 their regular fee, a gap or out of pocket may apply. Regular fee refers to the average fee your dentist charges to all patients of his or her practice for each eligible service. | |||
|---|---|---|---|
| Treatment | Waiting period (months) | Benefit limits (per 12 months unless otherwise stated) | Examples of maximum benefits |
| General dental* | 2 | $1,000 per policy | Periodic oral examination - 100% of charge Scale & clean - 100% of charge Fluoride treatment - $36.00 Surgical tooth extraction - $180.00 |
| Major dental | 12 | $1,500 per policy (combined limit for major dental & endodontic - Sub-limits apply) | Full crown veneered - $810.00 |
| Endodontic | 12 | Filling of one root canal - $180.00 | |
| Orthodontic | 12 | $1,000 per policy $2,800 lifetime limit | Braces for upper & lower teeth, including removal plus fitting of retainer - 100% of charge |
| Optical | 6 | $300 per policy | Single vision lenses & frames - $300.00 Multi-focal lenses & frames - $300.00 |
| Non PBS pharmaceuticals | 2 | $600 per policy | Per eligible prescription - $70.00 |
| Physiotherapy | 2 | $850 per policy (combined limit for physiotherapy, ante-natal/post-natal classes & exercise physiology - Sub-limits apply) | Initial visit - $57.00 Subsequent visit - $49.00 |
| Chiropractic | 2 | Combined limit of $500 per person for chiropractic/osteopathy, acupuncture and other services. $400 sub-limit applies per person, per service. | Initial visit - $41.00 Subsequent visit - $30.00 |
| Podiatry | 2 | $1,000 per policy (combined limit for podiatry, dietetics/dietary advice, eye therapy (orthoptics), occupational therapy & speech therapy - Sub-limits apply) | Initial visit - $47.00 Subsequent visit - $38.00 |
| Psychology | 12 | Benefits payable towards counselling services - Initial consultation $80/subsequent consultation $70 included in $600 Psychology Limit | Initial visit - $145.00 Subsequent visit - $110.00 |
| Acupuncture | 2 | Combined limit - see Chiropractic | Initial visit - $35.00 Subsequent visit - $30.00 |
| Remedial massage | 2 | Combined limit - see Chiropractic | Initial visit - $35.00 Subsequent visit - $30.00 |
| Hearing aids | 36 | 2 appliance(s) every 5 years | Hearing aid - $1,000.00 |
| Blood glucose monitors | 12 | Overall limit of $1000 per person applies to Health Appliances & Aids**. $200 sub-limit applies to foot orthotics. | Per monitor - $200.00 |
| Audiology | 2 | 2 service(s) every 1 year | Initial visit - $50.00 Subsequent visit - $40.00 |
| Ante-natal/Post-natal classes | 2 | Combined limit - see Physiotherapy | Initial visit - $49.00 Subsequent visit - $49.00 |
| Chinese medicine | 2 | Combined limit - see Chiropractic | Initial visit - $32.00 Subsequent visit - $28.00 |
| Dietetics/dietary advice | 2 | Combined limit - see Podiatry | Initial visit - $75.00 Subsequent visit - $45.00 |
| Exercise physiology | 2 | Combined limit - see Physiotherapy | Initial visit - $53.00 Subsequent visit - $40.00 |
| Eye therapy (orthoptics) | 2 | Combined limit - see Podiatry | Initial visit - $65.00 Subsequent visit - $38.00 |
| Home nursing | 2 | $500 per policy | Initial visit - $50.00 Subsequent visit - $50.00 |
| Occupational therapy | 2 | Combined limit - see Podiatry | Initial visit - $80.00 Subsequent visit - $55.00 |
| Orthotics (podiatric orthoses) | 2 | Combined limit - see Blood glucose monitors | Orthotics supply & fit - 90% of charge |
| Osteopathy | 2 | Combined limit - see Chiropractic | Initial visit - $57.00 Subsequent visit - $45.00 |
| Speech therapy | 2 | Combined limit - see Podiatry | Initial visit - $120.00 Subsequent visit - $67.00 |
| Other treatments - check with your insurer |
Orthodontic limit included in annual Major Dental limit. Diabetes Education & Nutrition benefits included in Dietetics sub-limit. Approved health management programs when Extras Protect is taken with hospital cover. Member rewards apply after 5 years continuous membership. **Limits apply to individual Health Appliances & Aids.
Aged Pensioner concession holders are entitled to free ambulance transport services. If you are not eligible for a concession and want to be covered, you can purchase insurance from a private health fund or a subscription through the state ambulance service.
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.