healthslips.com.au Policy Information

Navy Health Ltd

Premium Gold Hospital 200 & Healthy Living Extras

Restricted Insurer

$519.27 / month

(Before Rebate, Discount & Loading)

Available in QLD

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 - 21) and students (22 - 31), 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 non classified dependant is defined by Navy Health as a child, legally adopted child or step-child who is unmarried and who is younger than 21 years of age.

Restricted insurer: Membership of this insurer is restricted to Cover for the ADF community - serving, ex-serving ADF, employees of contractors to ADF and families.

Policy ID: NHB/J12/QCTR1D

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
Assisted reproductive services
Back, neck and spine
Blood
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Cataracts
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Dialysis for chronic kidney failure
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
Joint replacements
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)
Pregnancy and birth
Rehabilitation
Skin
Sleep studies
Tonsils, adenoids and grommets
Weight loss surgery

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 $200 per admission. This is limited to a maximum of $200 per person and $200 per policy per year.

Excess payments do not apply to hospital admissions for dependants.

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
  • 12 months for pregnancy and birth (obstetrics)
  • 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

Receive up to 100% cover at over 490 private hospitals and day facilities, in addition to all recognised public hospitals across Australia. You also have access to Member Health Support Program for home recovery, as well as unlimited ambulance cover Australia-wide, which means you are not required to take out ambulance cover elsewhere.

Extras Cover

This health insurer does not operate a preferred provider scheme.

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

$320 per person up to $640 per policy

combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage

  • Initial visit: $32
  • Subsequent visit: $32
Audiology 2

$300 per person

  • Initial visit: $60
  • Subsequent visit: $40
Blood glucose monitors 6

$400 per person

  • Per monitor: 85% of charge
Chinese medicine 2

$320 per person up to $640 per policy

combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage

  • Initial visit: $32
  • Subsequent visit: $32
Chiropractic 2

$550 per person up to $1,100 per policy

combined limit for chiropractic, osteopathy & other services

  • Initial visit: $48
  • Subsequent visit: $35
Dietetics/dietary advice 2

$300 per person

  • Initial visit: $60
  • Subsequent visit: $40
Endodontic 12

$1,500 per person

combined limit for endodontic, major dental & other services

sub-limits apply

  • Filling of one root canal: $129
Exercise physiology 2

$320 per person up to $640 per policy

combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage

  • Initial visit: $32
  • Subsequent visit: $32
Eye therapy (orthoptics) 2

$300 per person

  • Initial visit: $60
  • Subsequent visit: $35
General dental 2

No annual limit

  • Fluoride treatment: $21
  • Scale & clean: $68
  • Periodic oral examination: $42
Hearing aids 12

$900 per person

  • Hearing aid: 100% of charge
Home nursing 2

$1,000 per person

  • Initial visit: $60
  • Subsequent visit: $60
Major dental 12

$1,500 per person

combined limit for endodontic, major dental & other services

sub-limits apply

  • Surgical tooth extraction: $135
  • Full crown veneered: $619
Non PBS pharmaceuticals 2

$500 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: $120
Occupational therapy 2

$400 per person

  • Initial visit: $45
  • Subsequent visit: $33
Optical 6

$260 per person

  • Multi-focal lenses & frames: 100% of charge
  • Single vision lenses & frames: 100% of charge
Orthodontic 12

$2,000 per person

  • Braces for upper & lower teeth, including removal plus fitting of retainer: 70% of charge
Orthotics (podiatric orthoses) 2

$200 per person

  • Orthotics supply & fit: 85% of charge
Osteopathy 2

$550 per person up to $1,100 per policy

combined limit for chiropractic, osteopathy & other services

  • Initial visit: $48
  • Subsequent visit: $35
Physiotherapy 2

$600 per person

  • Initial visit: $55
  • Subsequent visit: $42
Podiatry 2

$300 per person

  • Initial visit: $45
  • Subsequent visit: $35
Psychology 2

$400 per person

  • Initial visit: $90
  • Subsequent visit: $70
Remedial massage 2

$320 per person up to $640 per policy

combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage

  • Initial visit: $32
  • Subsequent visit: $32
Speech therapy 2

$300 per person

  • Initial visit: $90
  • Subsequent visit: $40
Vaccinations 2

$500 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: $120

Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$320 per person up to $640 per policy}

{combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $32}

Audiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $40}

Blood glucose monitors

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Per monitor: 85% of charge}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$320 per person up to $640 per policy}

{combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $32}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$550 per person up to $1,100 per policy}

{combined limit for chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $48}

{Subsequent visit: $35}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $40}

Endodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Filling of one root canal: $129}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$320 per person up to $640 per policy}

{combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $32}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $35}

General dental

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

Examples of maximum benefits

{Fluoride treatment: $21}

{Scale & clean: $68}

{Periodic oral examination: $42}

Hearing aids

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$900 per person}

Examples of maximum benefits

{Hearing aid: 100% of charge}

Home nursing

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,000 per person}

Examples of maximum benefits

{Initial visit: $60}

{Subsequent visit: $60}

Major dental

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Surgical tooth extraction: $135}

{Full crown veneered: $619}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per eligible prescription: $120}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $33}

Optical

Waiting period:  6 months

Benefit limits per 12 months unless otherwise stated

{$260 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: 100% of charge}

{Single vision lenses & frames: 100% of charge}

Orthodontic

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$2,000 per person}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: 70% of charge}

Orthotics (podiatric orthoses)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Orthotics supply & fit: 85% of charge}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$550 per person up to $1,100 per policy}

{combined limit for chiropractic, osteopathy & other services}

Examples of maximum benefits

{Initial visit: $48}

{Subsequent visit: $35}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Initial visit: $55}

{Subsequent visit: $42}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $35}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Initial visit: $90}

{Subsequent visit: $70}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$320 per person up to $640 per policy}

{combined limit for acupuncture, chinese medicine, exercise physiology & remedial massage}

Examples of maximum benefits

{Initial visit: $32}

{Subsequent visit: $32}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $90}

{Subsequent visit: $40}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: $120}

Other treatments covered include: Laser Eye Surgery ($1,200 per person per benefit year), Medically Prescribed Appliances (includes Blood Glucose Monitors) ($400 per person per benefit year) and CPAP Devices ($600 per benefit year). Members can access special offers from any of Navy Health’s preferred optical providers: OPSM, Laubman & Pank, Specsavers, Teachers Eye Care, Eyebenefit and Q Optical Network (QON). General treatment benefit year runs from 1 July to 30 June.

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

Ante-natal/Post-natal classes
Health management / Healthy lifestyle

Other features of this general treatment cover: Telehealth services available for Physiotherapy, Psychology, Dietetics and Speech Therapy.

Ambulance cover

Ambulance cover is provided by the State government for Queensland residents (https://www.ambulance.qld.gov.au). This includes cover whilst interstate.

Other features of this ambulance cover: We cover 100% of the cost of ambulance services within Australia, provided it is provided by a state based run Ambulance service, by either air/sea or land. We do not provide benefits for privately run patient transport services.

Insurer Details

Navy Health Ltd

Premium Gold Hospital 200 & Healthy Living Extras

Restricted Insurer

$519.27 / month

(Before Rebate, Discount & Loading)

Available in QLD

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/NHB/J12/QCTR1D

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