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SERVICES EXPLAINED
Benefit included
Benefit excluded
Restricted benefit
Partially included
Budget-friendly hospital cover for commonly used services.
The services covered will change from 1 April. See the product sheet below to learn more.
Affordable hospital cover for a large range of services.
HOSPITAL SERVICES BY CATEGORY
Fully covered for unlimited urgent ambulance transport by road only (excludes air transport). Ambulance services are not free or not covered by Medicare in most Australian states (Queensland and Tasmania exempt).
Fully covered for accommodation in a private or shared room at an HBF Member Plus private hospital. On included services only.
Covered for treatment of the tonsils, adenoids and insertion or removal of grommets. For example, a tonsillectomy.
Covered for joint reconstruction surgery and associated treatments. For example, surgery for a knee reconstruction (ACL repair) or shoulder reconstruction (rotator cuff tears).
Covered for the investigation and treatment of a hernia or appendicitis. For example, surgery to repair a hernia.
Covered for hospital treatment involving teeth and gum surgery. For example, wisdom teeth removal and dental implant surgery.
Covered for the investigation and treatment of the female reproductive system. For example, treatment for endometriosis, polycistic ovaries and female sterilisation. Female sterility reversal is excluded on Bronze Hospital Plus.
Covered for in-hospital psychiatric care. For example, treatment for mental health disorders such as depression, anxiety, trauma and grief.
Covered for inpatient rehabilitation services at a hospital or day facility. For example, physical therapy to restore physical strength after surgery.
Covered for end of life care, which aims to provide the best quality of life possible. For example, pain alleviation and management.
Covered for the investigation and treatment of conditions affecting the ear, nose, or throat, and related areas of the head and neck. For example, a damaged ear drum or sinus surgery.
Covered for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. For example, a colonoscopy or gastroscopy.
Covered for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. For example, chemotherapy for breast cancer.
Covered for any service where Medicare pays a benefit, so long as the service is not excluded on your product. For example, medically necessary investigative scopes, tests and/or examinations performed after you are admitted to hospital.
Covered for in-hospital treatment of the heart for a range of conditions. For example, heart attacks, chest pain, stroke, heart rhythm problems, and congenital heart defects.
Covered for the investigation and treatment of conditions affecting the feet and/or ankles, provided by a registered podiatric surgeon. For example, in-grown toenails and bunions.
Covered for the implantation of a cochlear implant, which is a type of surgically inserted hearing device.
Covered for sterility reversal, which involves a surgical procedure that attempts to restore fertility. For example, a vasectomy reversal.
Covered for the supply and replacement of an insulin pump for the treatment of diabetes.
Covered for surgery to remove a cataract and replace with an artificial lens.
Covered for partial or total joint replacement surgery, which involves the removal of some or all of a damaged or diseased joint. For example, knee replacement surgery.
Covered for maternity and birth-related services, which help women expecting a baby access in-patient care prior to and during birth, and up to 6 weeks after the birth.
Covered for IVF and other Assisted Reproductive Services (ARS) when received as an inpatient. For example, retrieval of eggs or sperm, or Gamete Intra-Fallopian Transfer (GIFT).
Covered for surgical weight loss procedures, also known as gastric banding or sleeve gastrectomy.
Covered for in-hospital dialysis, which involves the removal of excess fluids and waste products from the body for people experiencing kidney failure.
Waiting period
Basic Hospital Plus
HOSPITAL TREATMENTS
Bronze Hospital Plus
Silver Hospital
Silver Hospital Plus
Gold Hospital
Choose from 5 Extras products, which cover you for everyday health care services that Medicare generally doesn't.
Hospital insurance, also known as hospital cover, helps cover costs when you go to hospital for surgery and other types of medical treatment.
It helps cover the cost of doctors’ and anaesthetists’ fees, as well as other hospital costs like accommodation, prostheses and theatre fees.
With hospital insurance, you can go to a private hospital for treatment, choose your own specialist and time of treatment, and gain access to a private room (so long as it’s covered on your policy and there’s one available).
Hospital insurance helps cover the cost of ‘inpatient’ services—these are treatments you receive when you’re formally admitted to hospital for care, e.g. for surgery.
The specific hospital procedures and services you’re covered for (e.g. chemotherapy, a colonoscopy, tonsil removal, knee reconstructions etc.) depends on the level of hospital cover you choose.
Generally, as your level of hospital cover goes up, so does the number of included services.
Your hospital insurance cannot cover ‘outpatient’ services—these are treatments you receive when you haven’t been formally admitted to hospital, for example, tests and examinations (like x-rays and blood tests). In most cases, Medicare will help cover these services.
Depending on your level of cover, you may also have exclusions and/or restrictions. If a service is excluded, it’s not covered at all. Restricted services receive the minimum default benefit, which generally means a large out-of-pocket.
Your hospital costs will either be fully or partially covered depending on the type of agreement your health fund has with your specialists and hospital.
With HBF, when you’re admitted to hospital for treatment you will get 100% back for the cost of your hospital accommodation and specialists so long as you choose providers that have ‘no-gap’ (otherwise known as ‘fully covered’) agreements with your health fund.
Just be aware of out-of-pocket costs, which can include excess or co-payments, as well any outpatient services.
When you buy hospital insurance for the first time, if you’ve not had it for a long time, or you upgrade to include a new service or procedure, there will generally be a waiting period you need to serve before you can claim.
Waiting periods for hospital insurance generally fall into two buckets: 12 months for maternity and pre-existing conditions and 2 months for most other procedures and services.
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