Which Hospital and Extras services are covered on this policy?

The Hospital cover component of this policy gives you access to a range of services that are eligible for a Medicare benefit, including:

  • Full cover for a shared room in a contracted private hospital (if you’d like a private room, you simply pay the difference between the cost of a shared and a private room).
  • Joint reconstruction and investigation
  • Joint replacement
  • Cardiac (heart) conditions, procedures and monitoring
  • Cancer related treatment and services
  • Colonoscopy
  • Endoscopy
  • Gastroscopy
  • Back surgery
  • Brain surgery
  • Renal dialysis
  • Non-cosmetic eye surgery
  • Surgical removal of appendix
  • Removal of tonsils and adenoids
  • Hernia repair
  • Intensive care
  • Theatre care
  • Palliative care
  • AccessGap Cover
  • Benefits for surgically implanted prostheses and other items on the Federal Government’s Prostheses Schedule
  • Inpatient pharmacy drugs (charges vary between private hospitals depending on the contracts in place – please check with us or the hospital).

Are any hospital services restricted?
The only restricted service on this policy is psychiatric care and treatment. Benefits for restricted services include basic public hospital rate (only) for accommodation. However, full AccessGap coverage applies for inpatient medical procedures and benefits will be paid towards prostheses in accordance with the Commonwealth Prostheses List. Items on the list (excluding human tissue) may be subject to a patient co-payment.

What's not covered?

  • Pregnancy and birth related services
  • Assisted reproductive technology (eg IVF)
  • Gastric banding and obesity surgery
  • Prostheses items used in relation to excluded services

Your hospital excess.
Excesses apply to all overnight hospital treatments and is not applicable for day procedures such as colonoscopies. A per person excess is only paid once per calendar year, up to the maximum of $500 for a single membership and $1,000 for couples.

Please note: Waiting periods and the pre-existing condition rule apply. For full details, please download a policy factsheet.

The Extras component of this policy includes ambulance, dental, optical, chiro, physio, podiatry consultations, complementary therapies and healthy lifestyle services. Here's an at-a-glance guide to the benefits you can claim on this policy.

Ambulance

Emergency callouts: 100% covered
Non-emergency callouts: A $50 co-payment applies
Limit per person: No limit 
Waiting period: 2 months 
Not covered: Inter-hospital transportation except for inter-hospital transfers relating to an emergency or new illness where approved on a case by case basis by HIF; Transportation from a hospital to your home, nursing home or other hospital; Transportation for ongoing medical treatment; Off road or air ambulance.

Chiro, Physio and Podiatry (combined limit)

Benefit: 60% of the charge
Limit per person: $500/year
Waiting period: 2 months
Please note: The following services have a combined annual limit of $1000 per person, and you can claim 60% back until your annual limit has been reached: Dental; Chiro, physio and podiatry; Complementary therapies; Healthy Lifestyle services.

Complementary Therapies

Services: This policy includes acupuncture, homeopathy, myotherapy, naturopathy, remedial massage, and traditional Chinese medicine.
Benefit: 60% of the charge
Limit per person: $150/year
Waiting period: 2 months
Please note: The following services have a combined annual limit of $1000 per person, and you can claim 60% back until your annual limit has been reached: Dental; Chiro, physio and podiatry; Complementary therapies; Healthy Lifestyle services.

Dental

Services: This policy includes general dental, periodontic, endodontic, inlay/onlay, and dentures, crowns and bridges.
Benefit: 60% of the charge
Limit per person: $600/year
Waiting periods: 2 months: Most general dental, Periodontic & Endodontic. / 12 months: Inlay/onlay,dentures, crowns and bridges, and General Dental item numbers 322-331 and 595-596.
Please note: The following services have a combined annual limit of $1000 per person, and you can claim 60% back until your annual limit has been reached: Dental; Chiro, physio and podiatry; Complementary therapies; Healthy Lifestyle services.

Healthy Lifestyle 

Services: Services include health assessments (including gym memberships), exercise physiology, pilates , yoga, weight management programs, quit smoking plans and skin cancer screenings.
Benefit: 60% of the charge
Limit per person: $150/year
Waiting period: 2 months
Please note: The following services have a combined annual limit of $1000 per person, and you can claim 60% back until your annual limit has been reached: Dental; Chiro, physio and podiatry; Complementary therapies; Healthy Lifestyle services. Benefits are payable for HIF approved programs delivered by registered providers only. Please contact us prior to commencing the program to check your eligibility.

Optical 

Items: Glasses, contact lenses and prescription sunglasses.
Benefit: 100% up to annual limit 
Limit per person: $150/year
Waiting period: 2 months
Please note: Benefits are paid on items carried out by a registered optometrist or optical provider, approved by HIF. Benefits are not paid on non-prescription safety
glasses, tinting, sunglasses, cosmetic glasses or cosmetic contact lenses, or frames not purchased via a registered Australian optical provider.

Pharmacy

Benefit: Member pays Pharmaceutical Benefit Scheme (PBS) contribution. Benefit is 100% of the balance up to $60 per script item. 
Limit per person: $200/year
Waiting period: 2 months
Please note: Benefits are not payable on contraceptives or NHS (PBS) prescriptions or over the counter items purchased with or without a prescription.

Want more info? Download a policy factsheet

Find out more about HIF Hospital Cover.

Use the panels below to learn more about commonly used inpatient services.

Find out more about HIF Extras Cover.

Use the panels below to learn more about our most popular Extras health services.