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About out-of-pocket expenses

How can I reduce my hospital out-of-pockets?

Hospital charges

If possible, go to a Members' Choice hospital where our agreement with the hospital limits what you can be charged.

This means your out-of-pockets for hospital charges should be limited to things like:

Any excess you may have with your cover

Any pharmaceuticals not covered by our agreement with the hospital. This includes the cost of any drugs issued on discharge from hospital

Any gap for surgically implanted prostheses and other items on the Federal Government's Prostheses Schedule

Costs for services not covered, or not fully covered, by our agreement with the hospital or under your cover

Costs for treatment in an emergency department in a private hospital. Note, with Ultra Health Cover you can claim benefits on the facility fee charged (subject to annual limits).

If you go to a non Members' Choice private hospital, you're likely to have significant out-of-pocket expenses.

Doctors' charges

Before you go to hospital, try to arrange to see a doctor who'll participate in our GapCover scheme. This is because GapCover can help reduce or eliminate your out-of-pocket expenses for doctors' services received in a private hospital. It's important to be aware that doctors can choose to participate in GapCover on a claim-by-claim basis and more than one doctor may be involved in your treatment

GapCover doesn't apply to pathology and radiology services, any applicable excess payment, services not included under your cover or out-of-hospital consultations.

Ultra Health Cover

Ultra Health Cover includes additional features to help reduce or eliminate your out-of-pocket costs when you are admitted to hospital. For example, if your doctor agrees to participate in GapCover there will be no out-of-pockets for your doctor's charge. There is also an Ultra bonus which is automatically applied to reduce any eligible out-of-pockets costs for in-hospital medical treatment and hospital related costs. Call us to find out more on 1300 183 959.