Changes to your Mid Hospital Cover

Changes to your Mid Hospital Cover

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* Based on an Australian Government Rebate of %, % LHC loading, $ excess for a in . Please note that our prices will increase from 1 April

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Effective 1 April 2019

As part of the Federal Government’s Private Health Insurance Reforms, all health funds are required to align their hospital products to new Standard Clinical Categories and Gold/Silver/Bronze/Basic product tiers.

Each Standard Clinical Category has a defined list of services that are covered. While most of your current cover has directly matched the new categories, in some cases we’ve had to add or remove services to fit the new structure.

 

  • Where financially viable, we have increased cover for some services.
  • In the case where premiums would be significantly impacted, we have decreased cover.
  • We’re also required to include the new product tier in the name, so from now on we’ll refer to this product as Mid Hospital (Basic Plus).

What does Basic Plus mean?

Mid Hospital has restrictions – meaning that for some clinical categories you’re covered as a private patient in a public hospital.

Under the new rules, only Basic policies are allowed to have restrictions (besides rehabilitation, hospital psychiatric services and palliative care). We wanted to make as few changes to your cover as possible, which means the only tier Mid Hospital can fit into is ‘Basic Plus’. The ‘Plus’ means that we have exceeded the minimum requirements for the ‘Basic’ tier.

Upgrade without waiting periods

To help make the process easier, we’re waiving all hospital waiting periods if you change your cover to Mid Classic (Silver Plus) or Top Hospital (Gold) - with or without an excess - by 1 May 2019.

The upgrade waiver offer applies only to members who have held their current level of hospital cover for at least 12 months. If you’ve held your current level of hospital cover for less than 12 months, waiting periods may apply if you upgrade.

Mid Hospital Basic +

Legend

Covered
Not Covered
Restricted

Scope of cover

Additional Information
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Increased cover: Major eye and eye lens surgery were previously Restricted. From 1 April 2019, these services will be Covered.
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Detrimental change: Hospital admissions for vascular system are changing from Covered to Restricted. This is because of the new clinical categories - Heart and Vascular system are grouped together. If we had chosen to cover this service, it would have had a significant impact on premiums.
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Accommodation – shared and private room (where available)
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Theatre fees, intensive care fees
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Labour ward fees
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Choice of doctor
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Shared room
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Private room (where available)
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Note: Restricted cover - For restricted services provided in a public hospital, we pay for accommodation in a shared room (as long as the hospital doesn’t charge more than the default rate set out by the Federal Government), and medical costs.

For a definition of each clinical category, visit the Department of Health website.