healthslips.com.au Policy Information

Australian Unity Health Limited

Smart Essentials (Silver Plus)

$535.6 / month

(Before Rebate, Discount & Loading)

Available in SA

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading or an insurer discount. Check with your insurer for details.

This policy covers: One adult & dependants (2 or more people, only one of whom is an adult).

Children (0 - 17), non-classified* dependant (18 - 22) and students (23 - 30), as well as persons with a disability who qualify as a child, non-classified* dependant and student in these age ranges. *Non-classified dependant: A period during which we cover single dependants regardless of student status.

Policy ID: AUF/J33/SEMS1D

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy provides accident cover - check with insurer for details.
  • This policy does not provide benefits for travel or accommodation outside of hospital.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Back, neck and spine
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Heart and vascular system
Hernia and appendix
Hospital psychiatric services
Implantation of hearing devices
Insulin pumps
Joint reconstructions
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Pain management with device
Palliative care
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets
Weight loss surgery

This policy does not include cover for

Assisted reproductive services
Cataracts
Dialysis for chronic kidney failure
Joint replacements
Pregnancy and birth

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess of $500 per admission. This is limited to a maximum of $500 per person and $1000 per policy per year.

Excess payments do not apply to hospital admissions for dependants and day surgery.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members

Waiting periods:

  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 2 months for all other treatments

Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

Additional Benefits of the cover include: Hospital Care at Home & Rehabilitation at Home. There are Preventative Health Services and Health Support Programs available on this cover, waiting periods may apply. Please refer to the product Fact Sheet or contact Australian Unity for further details.

Extras Cover

Using a preferred provider means you may have lower out of pocket costs and can access more No Gap treatments on dental, plus discounts on some optical purchases. A preferred providers list is available from Australian Unity.

This policy includes General treatment (Extras) cover for

Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture 2

$350 per person up to $700 per policy

combined limit for acupuncture & remedial massage

  • Initial visit: $40
  • Subsequent visit: $40
Chiropractic* 2

$350 per person up to $700 per policy

combined limit for chiropractic & osteopathy

  • Initial visit: $40
  • Subsequent visit: $40
Dietetics/dietary advice 2

$200 per person up to $400 per policy

combined limit for dietetics/dietary advice & psychology

  • Initial visit: $40
  • Subsequent visit: $40
Endodontic* 12

$1,500 per policy

combined limit for endodontic, general dental, major dental & other services

  • Filling of one root canal: $95
Exercise physiology 2

$350 per person up to $700 per policy

combined limit for exercise physiology, physiotherapy & other services

  • Initial visit: $40
  • Subsequent visit: $40
General dental* 2

$1,500 per policy

combined limit for endodontic, general dental, major dental & other services

  • Fluoride treatment: $21
  • Scale & clean: $44
  • Surgical tooth extraction: $105
  • Periodic oral examination: $30
Major dental* 12

$1,500 per policy

combined limit for endodontic, general dental, major dental & other services

sub-limits apply

  • Full crown veneered: 70% of charge
Non PBS pharmaceuticals 2

$150 per person up to $300 per policy

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: $50
Optical 6

$200 per person

  • Multi-focal lenses & frames: $200
  • Single vision lenses & frames: $200
Orthotics (podiatric orthoses) 12

$250 per person up to $500 per policy

combined limit for orthotics (podiatric orthoses) & podiatry

  • Orthotics supply & fit: 70% of charge
Osteopathy 2

$350 per person up to $700 per policy

combined limit for chiropractic & osteopathy

  • Initial visit: $40
  • Subsequent visit: $40
Physiotherapy 2

$350 per person up to $700 per policy

combined limit for exercise physiology, physiotherapy & other services

  • Initial visit: $40
  • Subsequent visit: $40
Podiatry 2

$250 per person up to $500 per policy

combined limit for orthotics (podiatric orthoses) & podiatry

  • Initial visit: $40
  • Subsequent visit: $40
Psychology 2

$200 per person up to $400 per policy

combined limit for dietetics/dietary advice & psychology

  • Initial visit: $40
  • Subsequent visit: $40
Remedial massage* 2

$350 per person up to $700 per policy

combined limit for acupuncture & remedial massage

sub-limits apply

  • Initial visit: $40
  • Subsequent visit: $40
Vaccinations* 0

$150 per person up to $300 per policy

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: 100% of charge

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$350 per person up to $700 per policy}

{combined limit for acupuncture & remedial massage}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Chiropractic*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$350 per person up to $700 per policy}

{combined limit for chiropractic & osteopathy}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person up to $400 per policy}

{combined limit for dietetics/dietary advice & psychology}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Endodontic*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per policy}

{combined limit for endodontic, general dental, major dental & other services}

Examples of maximum benefits

{Filling of one root canal: $95}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$350 per person up to $700 per policy}

{combined limit for exercise physiology, physiotherapy & other services}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

General dental*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per policy}

{combined limit for endodontic, general dental, major dental & other services}

Examples of maximum benefits

{Fluoride treatment: $21}

{Scale & clean: $44}

{Surgical tooth extraction: $105}

{Periodic oral examination: $30}

Major dental*

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per policy}

{combined limit for endodontic, general dental, major dental & other services}

{sub-limits apply}

Examples of maximum benefits

{Full crown veneered: 70% of charge}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$150 per person up to $300 per policy}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per eligible prescription: $50}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $200}

{Single vision lenses & frames: $200}

Orthotics (podiatric orthoses)

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$250 per person up to $500 per policy}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Orthotics supply & fit: 70% of charge}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$350 per person up to $700 per policy}

{combined limit for chiropractic & osteopathy}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$350 per person up to $700 per policy}

{combined limit for exercise physiology, physiotherapy & other services}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person up to $500 per policy}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person up to $400 per policy}

{combined limit for dietetics/dietary advice & psychology}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Remedial massage*

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$350 per person up to $700 per policy}

{combined limit for acupuncture & remedial massage}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $40}

{Subsequent visit: $40}

Vaccinations*

Waiting period:  0 month

Benefit limits per 12 months unless otherwise stated

{$150 per person up to $300 per policy}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: 100% of charge}

Annual benefit limits apply per calendar year. Myotherapy, $40 per consultation, Combined maximum of $350 per person ($700 per family), (combined limit - see Physiotherapy limit) 2 month waiting period. Orthotic benefits are for supply only. Braces, Splints and Garments - up to 70% of the cost, maximum $250 per person up to $500 per policy (combined limit - see Podiatry) 12 month waiting period.

This policy does not include General treatment (Extras) cover for

Ante-natal/Post-natal classes
Audiology
Blood glucose monitors
Chinese medicine
Eye therapy (orthoptics)
Health management / Healthy lifestyle
Hearing aids
Home nursing
Occupational therapy
Orthodontic
Speech therapy

Other features of this general treatment cover: Please refer to the product Fact Sheet or contact Australian Unity for further details.

Ambulance cover

In SA this policy provides:

Emergency: Unlimited with no waiting period.

Call-out fees: Will be paid for each attendance, including emergency treatment without transport to hospital.

Other features of this ambulance cover: Despite the above, call-out fees where you're not taken to hospital are limited to 2 ambulance attendances per-person per-calendar year. Please note: This cover doesn't include non-emergency ambulance transportation. Emergency ambulance transportation to hospital is only covered if transport is coded and invoiced as emergency transport by a state/territory ambulance service/authority. Some authorities provide certain ambulance services at no cost to eligible residents. Refer to your local ambulance provider for more information. Australian Unity won't pay a Benefit if you're eligible to claim from, or are covered by, another source. Australian Unity doesn't pay a benefit towards ambulance subscription services.

Insurer Details

Australian Unity Health Limited

Smart Essentials (Silver Plus)

$535.6 / month

(Before Rebate, Discount & Loading)

Available in SA

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/AUF/J33/SEMS1D

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