Hospital
| Service | Benefit | Co-payment by member |
|---|---|---|
Private hospital accomodation, including:
| 100% cover* with contracted private hospitals & day facilities in Australia. (Limited to 100 days per calendar year. Basic Hospital default accommodation rates apply thereafter.) | $100 per day |
Theatre fees, including:
| 100% cover* | $100 per day |
In-hospital medical services, including:
| 100% cover of the Medicare Benefits Schedule (MBS) Fee PLUS the Access Gap Cover Scheme is available to minimise any out-of-pocket gap costs. | |
Surgically implanted prosthesis | 100% cover for No-Gap Prosthesis List Items | |
* 100% cover applies to private hospitals when they are contracted with the fund through the Australian Health Service Alliance (AHSA). This does involve most licensed private hospitals and day facilities in Australia. To view the hospitals contracted with the fund, you can go to our website www.acahealth.com.au and use the Hospital Search.
Other Features
- Choose your own doctor and private hospital
- Access to the Federal Government Rebate as a reduced premium
- Exemption from the Medicare Levy Surcharge
- Exemption from Lifetime Health Cover penalties if joining before age 31
- Ambulance Cover for residents of NSW & ACT in these states (for other states the ambulance cover is available under the Ancillary Products)
Waiting Periods
- Accidents requiring hospital treatment, not related to a pre-existing condition – No waiting period
- Ambulance – No waiting period
- Obstetrics (pregnancy) – 12 Months
- Treatment relating to a pre-existing condition – 12 Months
- All other services – 2 Months
On joining hospital cover for the first time, waiting periods must be served before benefits will be paid. If you have upgraded your hospital cover, waiting periods will apply before the higher benefits will be paid.
What’s Not Covered?
- Surgeon’s fees for podiatric surgery
- Services for which Medicare pays no benefit e.g. cosmetic surgery & laser-eye surgery
- Services while a membership is in arrears
- Services incurred before waiting periods are served (including any service for a pre-existing condition)
- Services received as an outpatient, such as in the Emergency department or visit to your General Practitioner/ Specialist
- Services where there is an entitlement under compensation insurance
- Services claimed over 2 years after the service date
- Services provided in countries outside of Australia
Pre-Existing Conditions
If you are suffering from a medical condition, illness or ailment at the time of commencing or upgrading hospital cover there will be a 12-month waiting period before hospital benefits can be paid on claims relating to that condition.
A pre-existing condition is defined as an ailment or illness where, in the opinion of a medical practitioner appointed by the Fund, the signs or symptoms existed at any time during the six months before or on the day which a member joins private health insurance or upgrades to a higher level of cover.