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National Health Benefits Australia Pty Ltd (onemedifund)

Gold Hospital $250/$500 Excess & Extras

$371.35 / month

(Before Rebate, Discount & Loading)

Available in All States

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: Only one person.

This policy exempts you from the Medicare Levy Surcharge.
This policy does not provide accident cover.
This policy does not provide benefits for travel or accommodation outside of hospital.

Policy ID: OMF/H8/AAAU10 Source: Private Health Information Statement (PHIS)

Hospital Cover

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 on admission. This is limited to a maximum of $250 per person and $250 per policy per year.

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

Ambulance Cover Nationwide. No waiting period applies for hospital treatment resulting from an accident.

For further information about this policy see: https://www.onemedifund.com.au/siteassets/documents/cover-descriptions/oms/gold-hospital-$250-$500-excess--extras.pdf

By using onemedifund's 'preferred providers' you may have lower out of pocket costs on Dental and Optical treatments and have access to more 'no gap' treatments. A list of 'preferred providers' is available from the fund.

Policy ID: OMF/H8/AAAU10 Source: Private Health Information Statement (PHIS)

Extras Cover

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

$750 per policy

combined limit for acupuncture, chiropractic, dietetics/dietary advice, osteopathy, podiatry, remedial massage & other services

Initial visit: $40
Subsequent visit: $30

Ante-natal/Post-natal classes

$150 per policy

Initial visit: 80% of charge
Subsequent visit: 80% of charge

Blood glucose monitors

$130 per policy

Per monitor: $130

Chiropractic

$750 per policy

combined limit for acupuncture, chiropractic, dietetics/dietary advice, osteopathy, podiatry, remedial massage & other services

sub-limits apply

Initial visit: $40
Subsequent visit: $30

Dietetics/dietary advice

$750 per policy

combined limit for acupuncture, chiropractic, dietetics/dietary advice, osteopathy, podiatry, remedial massage & other services

Initial visit: $40
Subsequent visit: $30

Endodontic

No annual limit

sub-limits apply

Filling of one root canal: $200

Exercise physiology

$550 per policy

combined limit for exercise physiology, eye therapy (orthoptics), occupational therapy, physiotherapy & other services

Initial visit: $60
Subsequent visit: $40

Eye therapy (orthoptics)

$550 per policy

combined limit for exercise physiology, eye therapy (orthoptics), occupational therapy, physiotherapy & other services

Initial visit: $90
Subsequent visit: $75

General dental

No annual limit

sub-limits apply

Fluoride treatment: $30
Scale & clean: $80
Surgical tooth extraction: $200
Periodic oral examination: $50

Health management / Healthy lifestyle

$150 per policy

Health management: $150

Hearing aids

$1,500 per policy

Hearing aid: $1500

Home nursing

$1,000 per policy

Initial visit: $45
Subsequent visit: $45

Major dental

$2,650 per policy

sub-limits apply

Full crown veneered: $850

Non PBS pharmaceuticals

$500 per policy

combined limit for non pbs pharmaceuticals & vaccinations

sub-limits apply

Per eligible prescription: $65

Occupational therapy

$550 per policy

combined limit for exercise physiology, eye therapy (orthoptics), occupational therapy, physiotherapy & other services

Initial visit: $60
Subsequent visit: $40

Optical

$275 per policy

Multi-focal lenses & frames: $275
Single vision lenses & frames: $275

Orthodontic

$2,100 per policy

$2,100 lifetime limit

Braces for upper & lower teeth, including removal plus fitting of retainer: $2100

Orthotics (podiatric orthoses)

$250 per policy

Orthotics supply & fit: 80% of charge

Osteopathy

$750 per policy

combined limit for acupuncture, chiropractic, dietetics/dietary advice, osteopathy, podiatry, remedial massage & other services

Initial visit: $40
Subsequent visit: $30

Physiotherapy

$550 per policy

combined limit for exercise physiology, eye therapy (orthoptics), occupational therapy, physiotherapy & other services

sub-limits apply

Initial visit: $60
Subsequent visit: $40

Podiatry

$750 per policy

combined limit for acupuncture, chiropractic, dietetics/dietary advice, osteopathy, podiatry, remedial massage & other services

Initial visit: $40
Subsequent visit: $30

Psychology

$500 per policy

sub-limits apply

Initial visit: $120
Subsequent visit: $80

Remedial massage

$750 per policy

combined limit for acupuncture, chiropractic, dietetics/dietary advice, osteopathy, podiatry, remedial massage & other services

Initial visit: $40
Subsequent visit: $30

Speech therapy

$800 per policy

Initial visit: 80% of charge
Subsequent visit: 80% of charge

Vaccinations

$500 per policy

combined limit for non pbs pharmaceuticals & vaccinations

Per service: $65

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

Audiology

Chinese medicine

Other features of this general treatment cover: Loyalty bonuses apply to Surgical Equipment/Health Aids, Crowns & Bridges, Dentures & Orthodontics after 5yrs continuous cover on this product. Ambulance Cover Nationwide.

For further information about this policy see: https://www.onemedifund.com.au/siteassets/documents/cover-descriptions/oms/gold-hospital-$250-$500-excess--extras.pdf

Ambulance cover

In all states this policy provides:

Emergency: Unlimited with no waiting period.

Non-emergency: Unlimited transport with no waiting period.

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

State schemes provide ambulance services for residents of Tasmania (https://www.health.tas.gov.au/ambulance/fees_and_accounts) and Queensland (https://www.ambulance.qld.gov.au).

For further information about this policy see: https://www.onemedifund.com.au/siteassets/documents/cover-descriptions/oms/gold-hospital-$250-$500-excess--extras.pdf

Insurer Details

National Health Benefits Australia Pty Ltd (onemedifund)

Gold Hospital $250/$500 Excess & Extras

$371.35 / month

(Before Rebate, Discount & Loading)

Available in All States

Call now 1800 148 626 Sponsor link

National Health Benefits Australia Pty Ltd (onemedifund)

http://www.onemedifund.com.au

info@onemedifund.com.au

1800 148 626

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/OMF/H8/AAAU10