Which HIF policies cover joint reconstruction or replacement?

Basic Cover
Top Cover
Premium Cover

Who needs joint replacement surgery?

According to the Australian Institute of Health and Welfare (AIHW), the most common age group for musculoskeletal surgery is 55 to 64. So if you're young and fit, you may think you don't need cover for joint replacement. Truth is though, anyone can be affected by painful joints, especially if you play a lot of sport or live an active lifestyle. In fact, the latest data from the Australian Orthopaedic Association reports that nearly 115,000 joint procedures were performed in 2016, including 60,233 knee procedures, 46,661 hip procedures and 5,772 shoulder procedures. 

What's the difference between total and partial joint replacement surgery?

A total joint replacement involves a damaged joint being surgically removed and replaced with a new prosthetic (artificial) joint which has been designed to move just like regular joints. 

A partial joint replacement refers to a surgery which involves using prosthetics to fix only the damaged parts of a joint.

What's the difference a joint replacement and a joint reconstruction?

A joint reconstruction aims to repair damaged joints in order to offer temporary or permanent pain relief for joint disorders - for example, an Anterior Cruciate Ligament (ACL) injury such as a tear or sprain. The treatment you receive will depend on the type and severity of the joint disorder. Some common reconstructive surgeries include arthroscopy, arthrodesis, osteotomy, resurfacing and small joint surgery.

Do hospital waiting periods apply?

Whether we’re answering your call, or helping you switch from another health fund, we don’t like to keep people waiting. But unfortunately waiting periods (the time you have to wait before you can claim for treatment) are a universal necessity. All health funds have them. We wouldn't be able to offer our affordable premiums and generous rebates without them.

Waiting periods protect us and our members against people who simply join us, claim large amounts and then leave. We always try to keep waiting periods to an absolute minimum though. That’s why, if you join us from another health fund, we’ll take your previous policy into account so you don’t have to re-serve waiting periods on an equivalent level or higher level of cover.

For HIF Hospital Cover, the waiting periods are as follows:

  • 2 months: General hospitalisation; Psychiatric care and treatment; In-hospital rehabilitation; and Palliative care.
  • 12 months: All pregnancy related services.
  • 12 months: Pre-existing conditions or ailments.

A pre-existing condition is defined as: ‘Any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the health insurer, the signs or symptoms of that illness, ailment or condition existed at any time in the period of six months ending on the day on which the person became insured under the policy.’ A pre-existing condition can be identified by the presence of signs or symptoms of the illness, ailment or condition (i.e. it’s not necessary for the member or their doctor to know what their condition is, or for it to be diagnosed). In assessing whether a condition is a pre-existing condition or not, an HIF-appointed medical practitioner will take into account information provided by your treating doctor.


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