When switching from another insurer, any waiting periods you have already served will be recognised so that you don’t have to serve them again. If your new health.com.au policy is an upgrade from your previous cover then you may have to wait before you can claim, but only for the services you didn’t have on your previous policy.
If you have never had private health insurance before you will need to serve some waiting periods before you can make a claim.
12 months – Pre-existing conditions
2 months – All services including psychiatric, rehabilitation, and palliative care, except the ones listed below
A pre-existing condition is an ailment, illness or condition where, in the opinion of an independent medical referee appointed by health.com.au (not your own doctor), the signs or symptoms of a condition existed and would have been evident to you or a medical practitioner during the six months before you first signed up for hospital cover or upgraded to a higher level of hospital cover. Pre-existing Conditions have a 12 month waiting period. The Australian Government have published this PDF, which you can download for more information.
When you visit your favourite healthcare professionals with Basic65, up to your annual cap, you’ll get 65% of their fee back every time you visit.
We will pay for medically necessary ambulance transport.
If you go into hospital, Basic65 cover you for things that are more likely to happen to younger people, like: accidents, removal of tonsils, adenoids, wisdom teeth and the appendix; arthroscopies and colonoscopies; shoulder and back surgery; and knee reconstructions.
Psychiatric, rehabilitation and surgical podiatry services are only covered to a minimum level. For these services coverage is only enough to be treated as a private patient in a public hospital, not a private hospital.
Basic65 will not cover you for pregnancy, heart related services, joint replacements, cataract removal nor some other treatments that fit and active people are less likely to use.
You can lower the cost of your premium by choosing a higher excess. We give you a choice of two excess amounts: $500 or $250. This cost will apply for each hospital admission, but there is an annual cap to limit your costs incurred to you. There is no excess with Extras or ambulance.
We have an agreement with nearly every private hospital in Australia. However, if you go to a hospital that we don’t have an agreement with you’re likely to have out of pocket expenses that are not covered by the policy.
Otherwise known as gap fees, these can be applied by hospitals and or medical practitioners (for their medical services).
Our Access Gap Cover scheme allows you to reduce or eliminate your out of pocket expenses. On a case by case basis medical practitioners can decide if they will participate in our scheme. Almost 9 out of 10 medical services under the Access Gap Cover scheme have no out of pocket expenses. If your medical practitioner chooses not to participate then health.com.au is only able, by law, to pay 25% of the Medicare Benefits Schedule (MBS) fee. Medicare pays 75% of the MBS fee. However medical practitioners are able to charge what they like. If your bill is more than the MBS fee you’ll have to pay the difference.
This is only a summary of the product’s features. View the Basic Features Guide for more information.
You should read this summary together with the health.com.au Policy Guide
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