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What am I covered for, & what am I not covered for?
What am I covered for, & what am I not covered for?

Find out what you are covered for and not covered for

John Connor avatar
Written by John Connor
Updated over a week ago

What does Hospital Cover include?

Hospital Cover provides benefits towards services you receive when you are admitted into hospital as an in-patient for treatment, such as:

  • Day surgery

  • Overnight accommodation

  • Theatre fees

  • Intensive care unit

  • Medicare recognised procedures

  • Private room [where available]

  • Specialist Surgeons, Anaesthetists and Assisting or Attending Doctors fees

  • In – Hospital Pharmacy

  • In – Hospital Pathology

  • In – Hospital medical supplies

You are covered as a private patient in a private hospital, or as a private patient in a public hospital – where you elect to be treated as a private patient. The choice is yours.

Where you elect to be covered as a private patient in a public hospital, you will be eligible for accommodation benefits paid at a shared ward rate. This means should you be given a private room, you may end up with out of pocket expenses.

What treatments are covered under your membership will depend on the level of cover you have selected, so you should always refer to your individual cover information sheet to find out what you are specifically covered for. We recommend contacting us prior to a hospital admission so we can confirm your eligibility for benefits.

Is there anything that my Hospital Cover won’t cover?

Private Hospital Cover can only provide benefits towards services received when you are admitted into hospital, or where the fund has arrangements with providers for services such as Chronic Disease Management and Obstetric programs. There are some services that your hospital cover does not provide benefits for:

  • Treatment received while not admitted into hospital – i.e. outpatient services, GP and Specialists visits,

  • Treatment received in the Emergency Department of a hospital, including emergency department facility fees,

  • Treatment that does not have a Medicare item number,

  • Services rendered in conjunction with a hospital stay where an Extras item number is raised – for example, where you are admitted into hospital for dental surgery (ie. wisdom teeth removal) and a dental item number is billed. The hospital stay and any medical and theatre items will be paid under Hospital Cover, but a relevant level of Extras cover is required to receive any benefit on the Dental items billed, and

  • Pharmaceuticals and medications provided on discharge from hospital.

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