Private Health Information Statement - Combined policy

TOP ADVANCED SHARED HOSPITAL GOLD & MULTICOVER

Monthly Premium

$1,006.20 #

(before any rebate, loading or discount)

Covers two adults & dependants, including non-student dependants (3 or more people, only 2 of whom are adults)

Available in NSW & ACT

Closed to new members

# 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.

This policy covers children, students up to and including the age of 30 and non-students up to and including the age of 30, as well as persons with a disability who qualify as a child, student or non-student in these age ranges.

Hospital cover

This policy exempts you from the Medicare Levy Surcharge.

This policy provides accident cover and benefits for travel or accommodation (outside of hospital) - check with your insurer for details.

This policy includes cover for

Hospital Cover Legend
Assisted reproductive servicesEye (not cataracts)Miscarriage and termination of pregnancy
Back, neck and spineGastrointestinal endoscopyPain management
BloodGynaecologyPain management with device
Bone, joint and muscleHeart and vascular systemPalliative care
Brain and nervous systemHernia and appendixPlastic and reconstructive surgery (medically necessary)
Breast surgery (medically necessary)Hospital psychiatric servicesPodiatric surgery (provided by a registered podiatric surgeon – limited benefits)
CataractsImplantation of hearing devicesPregnancy and birth
Chemotherapy, radiotherapy and immunotherapy for cancerInsulin pumpsRehabilitation
Dental surgeryJoint reconstructionsSkin
Diabetes management (excluding insulin pumps)Joint replacementsSleep studies
Dialysis for chronic kidney failureKidney and bladderTonsils, adenoids and grommets
Digestive systemLung and chestWeight loss surgery
Ear, nose and throatMale reproductive system

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.

The following payments may also apply for hospital admissions

Excess: No excess

Co-payments: Every time you go to hospital you will have to pay:

  • $0 (zero) per day for a shared room for overnight admissions
  • $50 per day for a private room for overnight admissions
  • No co-payment for day surgery (no overnight stay)
  • The maximum co-payment is $500 per year

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 12 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments

Gap Cover

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.

General Treatment Cover

Our nationwide network of No-Gap participating providers gives you access to comprehensive extras cover at an affordable price. Find out more See https://www.hcf.com.au/locations/find-a-participating-provider.

This policy includes General treatment (Extras) cover for

General treatment legend
Note, for items marked with an asterisk *: A higher psychology benefit ($75) may apply after Medicare Mental Health Treatment Plan is used up for the remainder of the calendar year. Sub-limits may apply. See fund rules for more information.
TreatmentWaiting period (months)Benefit limits (per 12 months unless otherwise stated)Examples of maximum benefits
General dental*2$550 per person
(Sub-limits apply)
Periodic oral examination - $34.00
Scale & clean - $69.00
Fluoride treatment - $27.00
Major dental*12$2,220 per person
(combined limit for major dental, endodontic & other services - Sub-limits apply)
Surgical tooth extraction - $182.00
Full crown veneered - $580.00
Endodontic*12Filling of one root canal - $164.00
Orthodontic*12$440 per person
$2,640 lifetime limit
Braces for upper & lower teeth, including removal plus fitting of retainer - $440.00
Optical2$220 per personSingle vision lenses & frames - 100% of charge
Multi-focal lenses & frames - 100% of charge
Non PBS pharmaceuticals2$600 per person
(combined limit for non pbs pharmaceuticals & vaccinations)
Per eligible prescription - $50.00
Physiotherapy*2$600 per personInitial visit - $46.00
Subsequent visit - $36.00
Chiropractic*2$600 per person
(combined limit for chiropractic, exercise physiology & osteopathy - Sub-limits apply)
Initial visit - $35.00
Subsequent visit - $28.00
Podiatry2$200 per personInitial visit - $35.00
Subsequent visit - $27.00
Psychology*2$300 per personInitial visit - $44.00
Subsequent visit - $44.00
Acupuncture2$200 per person
(combined limit for acupuncture & chinese medicine)
Initial visit - $32.00
Subsequent visit - $25.00
Remedial massage2$200 per personInitial visit - $32.00
Subsequent visit - $25.00
Hearing aids*12$600 per person
1 appliance(s) every 3 years
Hearing aid - $600.00
Blood glucose monitors*12$500 per person
1 appliance(s) every 3 years
(combined limit for blood glucose monitors & other services)
Per monitor - $150.00
Audiology2$500 per person
(combined limit for audiology & speech therapy - Sub-limits apply)
Initial visit - $52.00
Subsequent visit - $35.00
Chinese medicine2Combined limit - see AcupunctureInitial visit - $32.00
Subsequent visit - $25.00
Dietetics/dietary advice2$300 per personInitial visit - $50.00
Subsequent visit - $40.00
Exercise physiology2Combined limit - see ChiropracticInitial visit - $32.00
Subsequent visit - $30.00
Health management / Healthy lifestyle2$150 per person up to $300 per policyHealth management - $150.00
Occupational therapy2$500 per personInitial visit - $62.00
Subsequent visit - $40.00
Osteopathy2Combined limit - see ChiropracticInitial visit - $40.00
Subsequent visit - $30.00
Speech therapy2Combined limit - see AudiologyInitial visit - $60.00
Subsequent visit - $40.00
Vaccinations2Combined limit - see Non PBS pharmaceuticalsPer service - $50.00
General dental includes dental check-ups with service limits not in annual limit. Endodontic, periodontic, oral surgery & occlusal treatment - combined limit of $500. Dentures - $800 every 3 yrs. Includes mental health services (psychology, HCF-approved counselling, accredited mental health social worker and HCF-approved online cognitive behavioural therapy courses).

This policy does not include General treatment (Extras) cover for

General treatment legend
Other treatments - check with your insurer

Other features of this general treatment cover

A higher psychology benefit ($75) may apply after Medicare Mental Health Treatment Plan is used up for the remainder of the calendar year.

Ambulance cover

In NSW & ACT this policy provides:

Emergency: Unlimited with a waiting period of 1 day.

Call-out fees:  will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover

Cover for unlimited air, land and sea emergency ambulance trips and treatment by paramedics in Australia for services provided by recognised Ambulance Service Providers. Benefits are not payable when covered by another third party or other funding arrangement, such as a State government scheme. See fund rules for more information.

For further information about this policy see

https://www.hcf.com.au/faqs/faqs-cover#what-is-ambulance-cover

Disclaimer

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.

Covered

For information on what is covered under each category, see https://www.privatehealth.gov.au/categories

Restricted

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.

Not Covered

These categories are not covered by this policy.