Q: What is the Medicare Levy Surcharge?

A:

The Medicare Levy Surcharge (MLS) encourages high income earners to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public system.

Where high-income earners do not take out private health insurance, they are charged an additional 1% on their taxable income on top of the usual 1.5% Medicare Levy.

For more information, click here.

Q: How does Access Gap Cover reduce my out-of-pocket expenses?

A:

In the past, large out-of-pocket expenses were often part of any hospital stay for people with private health insurance. To help improve this, ACA Health offers you the Access Gap Cover Scheme as part of our hospital cover.

Medical (doctor/specialist) services provided to hospital in-patients are charged separately from hospital accommodation/theatre fee charges. Medicare pays 75% of the Medicare Schedule Fee and ACA Health pays the remaining 25%.

Some doctors/specialists charge an amount above the Medicare Schedule Fee. These costs are generally referred to as out-of-pocket expenses, and in the past, health funds were unable to pay benefits on these amounts.

Now, out-of-pocket doctor/specialist expenses for hospital patients can be eliminated completely or dramatically reduced with our ‘Access Gap Cover’ payment and billing scheme.

Doctors/specialists who choose to participate in the ‘Access Gap Cove’ scheme agree to charge for services with either no out-of-pocket expenses or a predetermined amount, which is capped. In return, ACA Health can pay the doctor above the Medicare Schedule Fee.

ACA Health has “Access Gap Cover” arrangements with over 11,000 Doctors Australia wide, established on our members’ behalf by the Australian Health Service Alliance (AHSA). You can find out which doctors are using the scheme by logging into your Member Portal and clicking the “Find a doctor” button at the bottom of the page (click here to login). Not all doctors in the scheme have agreed to have their names listed, so keep this in mind when you are looking.

Finally, your doctor will usually lodge your claim for you − making the whole process even easier.

Please note: ACA Health is unable to provide recommendations on health care providers, hence the search function is not intended as a list of ‘preferred providers’.

Q: What is the Australian Government rebate and what does it mean for me?

A:

The Federal Government provides a rebate on health insurance to all Australians eligible for Medicare who are members of a registered health fund, in recognition of the contribution that those with private health insurance are making to their own health care costs.

This rebate is now age and income tested. This rebate is available on all ACA Health hospital and extras products.

Please visit the Private Health Website to check if a rebate applies to your age and income level.

As a member of ACA Health Benefits Fund you can choose the rebate claiming method that best suits you. You need to decide whether you want to receive the reduced premium or if you want to have it reimbursed at tax time, if you are eligible for the rebate.

You can receive the rebate as either:

  • A premium reduction through ACA Health; or
  • A refundable tax rebate in your annual tax return

Q: What is Lifetime Health Cover and how does it affect me?

A:

Lifetime Health Cover is a Government initiative that rewards those who take out and maintain hospital cover at a younger age with lower premiums throughout their life (compared to someone who joins later in life).

To lock in the lowest premiums for life under Lifetime Health Cover, a person needs to take out hospital cover with a registered fund before the first July 1 following their 31st birthday. After 31, the younger you join, the lower your premiums will be.

Under Lifetime Health Cover, health funds are required to charge people who were not members of a hospital cover prior to 1 July 2000, 2% extra on top of the normal premiums for every year they are aged over 30 when they first take out hospital cover.

For more information on Lifetime Health Cover, please contact us or refer to the government website.

Q: How do I find out what my gap will be before I go into hospital?

A:

Depending on your level of hospital cover, there may be some out-of-pocket expenses (‘gap’) for your hospital accommodation. Call ACA Health on 1300 368 390 to confirm your cover and inquire about any gaps that you may have to pay.

If you are having a procedure performed in hospital, you can ask your surgeon to provide you with a quote first. This information will inform you of any out-of-pocket expenses that you may incur for your surgeon’s fees as well as any other associate doctors/specialists fees for your procedure.

Q: Am I covered for cosmetic surgery with Deluxe Hospital cover?

A:

Cosmetic Surgery is not unconditionally covered under any of ACA Health’s hospital or extras products. Prior approval for this type of service must be obtained from the Fund committee and must be recommended by a Registered Medical Practitioner.

Q: Will I have to pay out-of-pocket expenses for Surgically Implanted Prosthesis?

A:

These include pacemakers, defibrillators, joint replacements and other devices that are surgically implanted during a stay in hospital. There are often a number of different choices available with any particular prosthesis, which can vary in cost and benefits.

The Department of Health and Aging has set a Prosthesis List with the majority as ‘No Gap’ which means you do not need to pay any out-of-pocket expenses. You and your surgeon will be able to choose a prosthesis for every Medicare procedure from the prosthesis list that will be fully covered by ACA Health.

In the situation where a more expensive prostheses is available for your surgery, and you elect to use one of these, you will have to pay the gap amount.

Before you have any surgery, check with ACA Health that you will be covered under your current policy.

Q: Do I have cover for treatment anywhere in Australia?

A:

Yes. ACA Health is a National fund and will pay benefits for treatments and services administered anywhere in Australia.