1. What's included in this product?
- Surgical removal of wisdom teeth
- Removal of tonsils and adenoids
- Minor gynaecological procedures^
- Joint reconstruction
- Hospital cover as the result of an accident*
- Private or shared room in a public hospital or contracted private hospital
- Intensive care
- Theatre fees
- Same-day accommodation
- Same-day theatre
- AccessGap Cover
What is AccessGap Cover?
Doctors can charge more than the Medicare Benefits Schedule (MBS). And if they do, their patients without gap cover insurance will incur an out-of-pocket expense for the difference between the fee charged and the MBS. The good news is that AccessGap Cover, our medical gap arrangement, minimises or even eliminates these out-of-pocket expenses for medical services you receive as an in-patient in a registered overnight hospital or day facility. That said, you need to bear in mind that Australian doctors can nominate to opt in or out of AccessGap, so it makes sense to check in advance. View our online list of registered participating AccessGap specialists, or simply ask your doctor or specialist if they will treat you under the AccessGap Cover arrangement.
2. What’s excluded from this product?
Cardiac (heart) conditions, procedures or monitoring*
Assisted reproductive technology (e.g. IVF)
Gastric banding and obesity surgery
Surgery by podiatrists
Services not covered by Medicare
Ambulance (except for emergency services applicable under NSW & ACT legislation)
All other services not specifically listed as included
* This includes thing like heart bypass surgery, angiograms, and coronary care.
^ Cosmetic Services’ refers to any treatment that’s deemed to be cosmetic by Medicare and does not attract a Medicare rebate.
3. What excess applies for GoldVital?
An excess is the amount you pay towards your eligible hospital treatment, after which we take care of the rest. For GoldVital, there’s a standard $500 excess per person per admission (up to a maximum of $1000 per year). The excess applies to overnight and same day admissions.
4. Are there any restrictions?
With GoldVital, we pay a basic benefit (known as the public hospital rate) towards accommodation charges* for the following services:
*All other charges raised by the hospital during the stay will be paid by the member.
5. What about waiting periods and the pre-existing condition rule?
All health funds have to enforce waiting periods. It’s the only way we can protect our members from people who simply join our fund to claim large amounts and then leave. However, we try to keep waiting periods to a minimum. That’s why, if you switch to HIF from another health fund, we’ll honour your full length of membership with your previous fund, (meaning you won’t have to re-serve any unnecessary waiting periods).
If you aren’t switching from another fund, the waiting periods with GoldVital are:
1 day for treatment received as the result of an accident *
2 months for general hospitalisation claims
12 months for all treatments related to a pre-existing ailment or condition
* An accident means an unforeseen event, occurring by chance and caused by an external force or object which results in an injury to the body requiring immediate medical treatment in hospital within 24 hours of the accident. If further hospital treatment (as an admitted patient) is required, the patient must be re-admitted to a hospital within 90 days of the initial hospital treatment.