Our goal is to keep premiums affordable, while still offering you great cover. That’s why we’re making a few changes to Basic and Standard Hospital cover from 28 September 2015
|Service||Basic Hospital||Standard Hospital|
Treatment for injuries sustained in an accident, as well as ongoing treatment.
|If you have an accident, you’ll be covered for services that are normally excluded or restricted.||
There are new claiming conditions. Find out more in the below FAQs.
Weight loss surgery
Surgery to help people lose weight, including gastric banding or gastric bypass surgery, as well as surgery to reverse these procedures.
No longer covered.
Weight loss surgery, is a complex procedure, recommended only to a fraction of the Australian population.
Surgery to join or "fuse" two or more vertebrae in your spinal column.
|No longer covered, although common spinal treatments, such as a herniated or slipped disk are still covered.||Already covered.|
All other joint replacement
Replacement surgery for shoulders, elbows and ankles.
|Already covered.||All joint replacement surgery, except hip and knees, is now covered.|
Frequently asked questions
To help you better understand what the changes mean for you, we’ve put together some FAQs below
What is a pre-booking?
A pre-booking means prior 4 August 2015:
a. you’ve booked in for a procedure, which is scheduled after 28 September 2015
b. the date has been accepted by the hospital, and
c. the date has been confirmed to you in writing (either by the hospital or the surgeon).
If you elect to change the date of your surgery, you’ll no longer be considered pre-booked for treatment.
I think I might need one of the services in the future. Is there a waiting period if I upgrade my cover?
You can upgrade your cover before 28 September 2015 and you won’t have to re-serve any waiting periods for services covered on Basic or Standard Hospital. If you upgrade after 28 September 2015, you’ll have waiting periods for these services, including a 12 month waiting period if your condition is found to be pre-existing.
What is accident coverage?
Accident cover means you’ll be covered for initial hospital treatment for injuries resulting from an accident, as well as ongoing treatment where the services form part of your initial course of treatment.
Some extra conditions apply to claiming accident coverage benefits:
- you need to seek treatment from a medical practitioner in Australia within 7 days of having the accident, and
- your membership must not be suspended at the time of the accident.
For Basic Hospital members, this means you’ll be covered for services that are normally excluded or restricted if injuries result from an accident from 28 September 2015.
For Standard Hospital members, you already have accident coverage, but the new conditions to claim will apply from 28 September 2015.
What are restricted or excluded services?
A restricted service means we pay only a minimum benefit for hospital accommodation in a private hospital. Excluded services are services we don’t pay any benefits for at all.
What is spinal fusion?
Spinal fusion is major surgery, usually lasting several hours. Bone is taken from the pelvic bone or from a bone bank and is used to make a bridge between adjacent vertebrae. This bone graft helps new bone to grow.
How likely are you to need spinal fusion treatment? Spinal fusion is not a common procedure. Last year, less than 0.1% of our Basic and Standard Hospital members claimed for spinal fusion treatment.
What is weight loss surgery?
The two most common forms of weight loss surgery are laparoscopic gastric banding and gastric bypass surgery.
Laparoscopic gastric banding involves placing a band around the upper part of your stomach to create a small pouch to hold food. This band limits the amount of food you can eat by making you feel full after eating only small amounts of food.
Gastric bypass surgery is where the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch. The small intestine is then rearranged to connect to these new stomach sections.
How common is weight loss surgery? In 2014, less than 0.5% of our Basic and Standard Hospital members claimed for weight loss surgery.
Any questions? Get in touch if you need help
If you have a pre-booking for any treatment being removed from your cover or need help upgrading your cover, call us on 1300 011 631 or email us. We'll be happy to help.