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I have a question about:

My Budget Direct Health Insurance Membership

What Am I Covered For?

That depends on your level of cover and the treatment you're receiving. To find out what you are covered for, visit your online member area.

How Do I View My Membership Details?

Budget Direct Health Insurance keeps your cover, claims history and other details online. And you can look them up any time by going to your online member area.

How Will I Know Budget Direct Health Insurance Has Sent Me A Message?

Depending on your preference, Budget Direct Health Insurance will let you know with either an email or a text message. You can then log in to read the message.

I Didn't Receive Any Emails When I Signed Up. What Do I Do?

First, check your Spam folder. Outlook, Gmail and other email systems often class messages from businesses new to you as spam.

If there's nothing there, contact Budget Direct Health Insurance.

Am I Covered If I Go Overseas?

No. If you want to be covered overseas you'll need to take out travel insurance.

What Do I Use My Membership Card For?

You need to have your membership card on hand when you:

  • arrange admission to hospital
  • visit a provider
  • call Budget Direct Health Insurance.

I've Lost My Membership Card. Can You Send Me A New One?

Yes. Just request one in the online member area, and Budget Direct Health Insurance will send one out as soon as possible.

How Do I Pay For My Budget Direct Health Insurance?

You can pay by the usual methods (bank account, credit card, etc.) or set up a Direct Debit.

Is The Budget Direct Health Insurance Website Secure?

The secure parts of the Budget Direct Health Insurance website (i.e. signup form and online member area) encrypt pages before they are sent using 128-bit encryption. The website's identity has also been independently verified by VeriSign.

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Family Membership

How Does Family Membership Cover My Kids?

Budget Direct Health Insurance Family membership covers you, your partner, and any child under 21 including stepchildren, adopted children and permanent foster children.

What Happens To The Family Membership When My Kids Grow Up?

When a dependant turns 21, they're no longer covered by your Family membership. Within two months of their birthday we'll get in touch with them and offer them cover under their own membership. If they accept, they'll need to pay for any interim cover they received after turning 21.

Is Family Cover The Same As Couples Cover?

Family cover is for couples who have children (including stepchildren, adopted children and permanent foster children), with each child listed on the policy. Couples cover is just for you and your partner.

You can easily change from Couples cover to Family cover and vice-versa, but you may need to serve waiting periods. If you're not sure if everyone is covered, get in touch with us.

When Do I Need Family Cover?

If your current cover doesn't include obstetrics, you'll need to change to Top Family cover at least a year before your baby is born to complete all the obstetrics waiting periods.

What about Student dependants?

Student dependants – are covered up until they turn 25 years of age. They have two months to organise health insurance from this date however, their new membership will commence from the date they turned 25. They will not be required to serve waiting periods when transferring to an equivalent or lower level of health insurance.

Student dependants – mid-year school/apprenticeship and traineeship leavers who transfer from their parent’s Budget Direct membership within two months of leaving school or finishing an eligible apprenticeship or traineeship through a registered training group*** are not required to serve waiting periods when transferring to an equivalent or lower level of cover. A letter from their school or registered training group confirming the date of completion is required.

Student dependants – end of year school/apprenticeship and traineeship leavers are covered under their parent’s family or single parent membership until the 31st of March the following year. They will not be required to serve waiting periods when transferring to an equivalent or lower level of health insurance.

*Group Training is an employment and training arrangement whereby an organisation employs apprentices and trainees under an Apprenticeship/Traineeship Training Contract and places them with host employers. A registered Group Training Organisation undertakes the employer responsibilities for the quality and continuity of the apprentices’ and trainees’ employment and training. To qualify as a traineeship and be eligible to attract Commonwealth Government incentives, there must be a registered training contract between the trainee and the employer. Please contact us on 1800 234 004 for more information.

Hospital Cover

What Is Hospital Cover?

Hospital cover helps with hospital costs such as treatment, accommodation and nursing care. Exactly what costs are covered (and for how much) depends on your level of cover, the procedure or care given, and the hospital you stay in.

Where Are Budget Direct Health Insurance's Participating Hospitals?

Check out Budget Direct Health Insurance's list of participating hospitals.

What Happens If I Receive A Bill For My Stay In Hospital?

Most providers send accounts directly to Budget Direct Health Insurance. But if they send one to you, get in touch with us and we'll tell you the best way to submit your claim.

What Is Hospital Excess?

A hospital excess is a fee you pay in return for lower membership costs. The most you'll have to pay for excess each year is $450 for Singles and $900 for Couples and Families. There is no excess for child dependants.

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Will I Have To Pay An Excess Every Time I Go To Hospital?

No. If you've already paid the maximum excess for the calendar year you don't have to pay it again, no matter how many times you're sent to hospital. There is no excess for child dependants.

What If I Receive Treatment From A Hospital That's Not On Your Participating List?

Budget Direct Health Insurance's participating hospitals charge agreed rates because of our contracts with them. Being admitted to a non-participating hospital could result in significant out-of-pocket expenses. (If you want to know more, get in touch with us.)

My Hospital Cover Doesn't Include Joint Replacements And I'm Booked For A Knee Arthroscope. Will That Be Covered?

Yes, provided you have Budget Direct Health Insurance hospital cover and are admitted as a private patient.

Am I Covered For Cosmetic Surgery?

Budget Direct Health Insurance doesn't cover cosmetic surgery that isn't medically necessary and where Medicare doesn't pay benefits. You may, however, be entitled to a basic benefit.

What Is A Pre-Existing Condition?

A pre-existing condition is any ailment, illness or condition with signs or symptoms that existed six months before you:

  • joined Budget Direct Health Insurance
  • upgraded your cover.

A doctor appointed by Budget Direct Health Insurance will decide whether or not you have one.

What If I Have A Pre-Existing Condition?

Whether you're a new member or are upgrading your cover, if you have a pre-existing condition you have to wait 12 months (2 months for psychiatric, rehabilitation and palliative care) before you're covered for any hospital benefit.

To determine whether you have a pre-existing condition Budget Direct Health Insurance will send some forms for your doctors to complete. Budget Direct Health Insurance's medical advisor will then determine whether or not it's pre-existing.

Am I Covered For An Emergency Admission To Hospital?

Yes, although you'll probably be sent to a public hospital as a public patient which is paid by Medicare. (Private hospitals generally don't have emergency wards).

If you have Budget Direct Health Insurance Mid or Top Hospital cover you can ask to be transferred to a private hospital once you're well enough.

How Much Of My Doctors' Bills Does Budget Direct Health Insurance Cover?

Medicare will generally pay 75% of your doctor's costs in a hospital or day surgery, and we'll pay the other 25% to make up the full Medical Benefits Schedule (MBS) fee. Get in touch with us before your treatment so we can give you the most up-to-date information.

If your doctor is one of Budget Direct Health Insurance's participating doctors, you'll be covered up to 20% above the MBS fee.

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What Is The Medical Gap?

The Gap is the difference between what your doctor charges for your in-hospital treatment and what Medicare and Budget Direct Health Insurance will pay towards this cost. Between them, Medicare and Budget Direct Health Insurance will cover the Medical Benefits Schedule (MBS) fee. If your doctor charges the MBS fee there will be ‘No Gap’ that you are required to pay. Anything your doctor charges above the MBS fee is known as a ‘Known’ medical gap which may leave you financially out of pocket. You should discuss with your doctor any potential out of pocket expenses prior to treatment.

What Is Gap Cover?

Gap Cover (which is included in all Budget Direct Health Insurance Hospital covers) helps reduce your medical Gap. If your doctor charges above the MBS fee, Budget Direct Health Insurance will pay you a higher benefit so your Gap is reduced and you're less out-of-pocket.
Budget Direct Health Insurance's Gap Cover scheme covers you for up to 20% above the MBS fee, as long as your doctor is one of the 14,000 doctors participating in the scheme.

How Can I Reduce My Gap?

You can reduce your Gap by ensuring the hospital you stay in is on Budget Direct Health Insurance's participating hospitals list, and your doctors are part of Budget Direct Health Insurance's Gap Cover scheme. For more information, see our participating hospitals list or get in touch with us.

What's Not Covered Under Gap Cover?

Budget Direct Health Insurance's Gap Cover scheme doesn't cover services provided by pathologists and radiologists, such as blood tests and imaging. Medicare pays 75% of the MBS fee for these treatments and we pay the other 25%, so you only have to pay extra if your doctor charges above the MBS fee.

What If My Doctor Charges Above The Medical Benefits Schedule (MBS) Fee?

As long as your doctor is one of the 14,000 billing through the Budget Direct Health Insurance Gap Cover scheme, we will cover an additional 20% above the MBS fee.
Any amounts above that, you'll have to pay.

How Can I Tell If My Doctor Is Registered For Medical Gap Cover?

It's always best to ask. But if you don't want to, or they won't give you an answer, contact Budget Direct Health Insurance.

When Will My Medical Account Be Paid?

Once the information about the treatment and charges from the hospital is received and processed, Budget Direct Health Insurance will pay your account.

Can I Claim On Both In-Patient And Out-Patient Costs?

No. Budget Direct Health Insurance pays your in-patient costs, and Medicare pays your out-patient costs.

Does Budget Direct Health Insurance Hospital Cover Automatically Cover Me For Ambulance?

Budget Direct Health Insurance offers emergency ambulance transportation under your hospital benefits. As long as you continue to hold hospital cover with Budget Direct Health Insurance, we will cover you for all clinically necessary, emergency ambulance services in Australia.

We recommend checking with your ambulance authority to ensure you are correctly covered for all non-emergency ambulance transportation within Australia.

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What Are Benefit Limitation Periods?

Benefit Limitation Periods restrict what Budget Direct Health Insurance will pay for a hospital treatment for a period of time. It starts when you either join Budget Direct Health Insurance or switch covers.

Budget Direct Health Insurance pays public hospital benefits in a shared room, provided you've served all other waiting periods. A benefit limitation period of 24 months applies to:

  • gastric banding and all obesity surgeries, psychiatric and renal dialysis (Top Hospital cover)
  • psychiatric (Mid Hospital cover).

What Is A Co-Payment?

Co-payments are what you'll pay for a single room when you go into hospital or day surgery. (You don't pay it if you stay in a shared room). If you're on Budget Direct Health Insurance's Mid Hospital cover you'll pay $100 per night, capped at 7 nights per admission. Budget Direct Health Insurance uses co-payments to share health care and keep premiums low. So if you don't go into hospital or if you share a room you won't have to pay a co-payment.

Extras Cover

What Is Extras Health Insurance Cover?

Extras cover is for health-related services that aren't covered under Hospital cover such as dental, optical, physiotherapy, massage, chiropractic, podiatry and psychology services. You can take Extras cover by itself, or combine it with Hospital cover for more complete protection.

In most cases you can claim your Extras benefits on the spot by swiping your Budget Direct Health Insurance card.

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How Do I Make An Extras Claim?

With most healthcare providers you'll just need to swipe your Budget Direct Health Insurance card. If your healthcare provider doesn't have an electronic terminal, you'll need to pay your account and then claim online.

Simply log into your Budget Direct Health Insurance online member area, enter your account/receipt details, and keep your receipt safe for two years in case our Audit Team want to check. (Don't send them to us unless we ask.) Budget Direct Health Insurance will then make a payment into your bank account the next business day.

For claims that can't be processed online (e.g. orthodontic), send your receipts to:

Budget Direct Health Insurance 
PO Box 761

You can also lodge claims at any Medicare office and they'll pass them on to Budget Direct Health Insurance.

Which Extras Providers Can I Claim On?

Budget Direct Health Insurance has thousands of Extras providers. Make sure your practitioner works in a private practice that's registered with bodies recognised by Budget Direct Health Insurance. If you're not sure, get in touch with us.

Does Extras Cover Me For An Ambulance Trip?

See Does Budget Direct Health Insurance hospital cover automatically cover me for ambulance?above.

What Type Of Massage Is Covered By Extras?

Budget Direct Health Insurance only covers treatment by remedial massage therapists that speeds up injury recovery, provides pain relief or promotes general wellbeing.

Can I Claim Massage From The Chiropractor?

Yes, providing the massage was part of the chiropractic consultation.

Am I Covered For Chinese Medicine?

No. Budget Direct Health Insurance covers only acupuncture, not Chinese Medicine (which includes herbal medicine treatments).

Can I Claim On Herbal Medicines From My Acupuncturist?

No. Budget Direct Health Insurance only pays benefits towards acupuncture consultations, not any medicinal treatments that come from them.

What Dental Limits Do I Get?

Your dental limits depend on the Extras cover you hold and the type of treatment you get. You can see what you're entitled to by logging into your online member area.

What Is The Difference Between General And Major Dental?

General dental refers to treatments that maintain teeth and try to prevent major dental work (e.g. checkups, removal of plaque, fillings). 
Major dental involves large-scale dental work such as surgical extractions, crowns, bridgework, and root canals. These treatments are often expensive, which could result in large out-of-pocket expense.

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Why Can't I Claim On Some Australian Dental Association Items?

Budget Direct Health Insurance only pays for treatments that are clinically necessary. It does not cover cosmetic services such as some tooth whitening.

What Are The Annual Sub-Limits On Preventive Dental?

The annual sub-limits are:

  • Top Extras—$500 per person (up to $1000 per policy)
  • Basic Extras—$250 per person (up to $500 per policy)

These limits are based on dentists seeing a patient twice a year for preventative dental consultations (e.g. a check-up, scale and clean).

Does Budget Direct Health Insurance Have Participating Dentists?

No, you can choose any dentist you want. If you're worried about what your out-of-pocket dental expenses might be, you can contact Budget Direct Health Insurance to get information about your refunds. Make sure you have the dental item numbers for the treatment handy—we'll need them to identify the relevant refunds.

Can I Claim On Sunglasses?

Yes, but only if they're fitted with prescription lenses. Non-prescription sunglasses are excluded.

Can I Claim On Having New Lenses Placed Into Old Frames?

Yes, you can claim on new prescription lenses.

For Psychology Services, When Does Medicare Pay And When Does Budget Direct Health Insurance Pay?

Medicare will refund up to 12 individual sessions and offer rebates on 12 group sessions per year. If you have Extras cover that includes psychology, you can start claiming through Budget Direct Health Insurance once you've reached Medicare's maximum threshold.

Are Foot Orthotics Covered By Extras?

Budget Direct Health Insurance only covers custom-made orthotics (where a cast or mould is taken) supplied by registered podiatrists.

What's The Difference Between Custom-Made Orthotics And Customised Orthotics?

With custom-made orthotics, they take a cast or mould of your foot. They then make a model of your foot, and create the orthotic to fit that model. With customised orthotics, they simply trim, heat or adjust off-the-shelf, pre-made orthotics. As it doesn't involve taking a cast, customised orthotics aren't covered by Budget Direct Health Insurance.

Can I Claim For Podiatry Services Performed By A Chiropractor Or Anyone Who's Not A Podiatrist?

Budget Direct Health Insurance will only pay for podiatry services provided by a registered podiatrist in private practice.

Why Do Podiatry Surgical Procedures Require A Medical Surgeon?

Medicare and Budget Direct Health Insurance will only pay for services that have a Medical Benefits Schedule (MBS) number. To be eligible for an MBS number, podiatry services must be performed by a medical surgeon.

Can I Claim On Jenny Craig, Weight Watchers Or Gym Memberships?


Can I Claim On Bowen Therapy?


What Is The Difference Between A Physiotherapy Group Consultation And An Individual Consultation?

Individual consultations are where you spend at least 15 minutes one-on-one with a physiotherapist. Group consultations are where there's more than one patient, and the physiotherapist doesn't spend time with each person directly. Budget Direct Health Insurance pays benefits towards both individual and group physiotherapy consultations provided by a physiotherapist.

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General Health Insurance

What Is The Medicare Levy Surcharge?

The Medicare Levy Surcharge (MLS) is a charge placed on individuals and families on higher incomes who don't have private hospital cover. It encourages Australians who can afford it to take up private health insurance and reduce the burden on the public health system.

How Much Is The Medicare Levy Surcharge, And Who Has To Pay It?

The MLS is an additional tax charged to high income earners without private hospital insurance. The MLS is a charge of up to 1.5% of your taxable income, and is additional to the normal 2% Medicare levy.

You'll need to pay the surcharge if you're:

  • single with a taxable income greater than $90,000
  • a family, couple or single parent with a combined taxable income of more than $180,000. (The income bracket increases by $1,500 per child after the first child.)
  Tier 0 Tier 1 Tier 2 Tier 3
Singles $90,000 or less $90,001-105,000 $105,001-140,000 $140,001 or more
Couples/Families $180,000 or less $180,001-210,000 $210,001-280,000 $280,001 or more
  Medicare Levy Surcharge
All ages 0.0% 1.0% (unchanged) 1.25% 1.5%

What Is Lifetime Health Cover Loading?

Lifetime Health Care (LHC) loading is a Government initiative to encourage people to take out hospital cover earlier in life. If you don't join a health care fund by the 1st of July after your 31st birthday, you'll pay money on top of your membership premium.

The LHC loading adds 2% to your normal health care premium for every year you're over 30 when you join. For example, if you're 40 when you join, you'll pay 20% more in membership premiums every year than people who joined before they turned 31. (The maximum is 70% for people aged 65 and over.) 

Has there been a change to the rebate on Lifetime Health Cover Loading?

Yes. As of 1 July 2013, the private health insurance rebate will not be applied to the Lifetime Health Cover loading component on any membership.

This change has been introduced by the Federal Government and the legislation applies to all health funds.

Budget Direct Health Insurance will communicate directly with members who will be impacted by this change.

What has changed?
In the past, the Federal Government has offered a private health insurance rebate to Australians who have held eligible hospital cover. The rebate amount depended on your age and income level.

If you took out hospital cover with a private health insurer after the 1st of July following your 31st birthday, you would be paying a 2% Lifetime Health Cover (LHC) loading on top of your premium for every year you are aged over 30.

  • Up until 1 July 2013, the rebate was applied to your entire premium including your loading component.
  • From the 1 July 2013 onward, the rebate will not apply to your loading component.

What this means for Budget Direct Health Insurance members with a loading on their policy
Members with a LHC loading on their policy will not receive any rebate they were previously entitled to on their LHC loading amount, meaning they will need to pay more for their health insurance.

For example, in 2012/13 a single person under the age of 65 paying a $1,000 annual premium with a LHC loading of 20% would pay a total of $1,200 p.a. If that person received a full 30% rebate their premium would be reduced to a total of $840.

In 2013/14 the same person will now be paying $900 instead of $840. This has increased because the same 30% rebate has only been applied to the $1,000 cost of your premium, rather than the full $1,200 which includes the loading component ($200). This results in $60 premium increase to the member.

Due to the late notice of this legislation, Budget Direct Health Insurance members will continue to be charged at the current rate which includes the rebate on the LHC loading until the 1st August 2013.

Members who are affected and make a payment towards their premium during July will need to make up the difference with the Australian Taxation Office when submitting the 2013/14 annual tax assessment.

More information
For more information about LHC and the rebate please visit www.privatehealth.gov.au.

Members affected by this change will be notified in full detail by Budget Direct Health Insurance. Please contact Budget Direct Health Insurance directly, if you have any questions regarding your membership.

What Are Waiting Periods?

To stop people joining when they're sick and immediately claiming medical expenses, health funds impose waiting periods on certain treatments. These waiting periods affect both new members and current members increasing their health cover.

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When Do Waiting Periods Apply?

Waiting periods apply if:

  • you've never had health insurance before
  • you've had health insurance before, but haven't had any cover in the past 30 days
  • you're switching to Budget Direct Health Insurance from another insurer and upgrading your cover
  • you're already a Budget Direct Health Insurance member and are upgrading your cover.

How long you have to wait can depend on:

  • the type of treatment
  • whether it involves a pre-existing condition
  • whether you've been insured before
  • the type of cover you had
  • how long you had the cover for.

What Is The Australian Government Rebate On Private Health Insurance?

The rebate is a payment from the Federal Government for taking out private health insurance and helping to free up the public health system. The income Tier amounts are:

  Base Tier Tier 1 Tier 2 Tier 3
Singles $90,000 or less $90,001-105,000 $105,001-140,000 $140,001 or more
Couples/Families $180,000 or less $180,001-210,000 $210,001-280,000 $280,001 or more
  Private Health Insurance Rebate
Under 65 years 27.820% 18.547% 9.273% 0%
65-69 Years 32.457% 23.184% 13.910% 0%
70 years and over 37.094% 27.820% 18.547% 0%

* Applicable from 1 April 2015.

Note: The income tiers increase each year, and we'll let you know what they are (once the Government decides).

The easiest way to claim the rebate is to complete the application form for the Australian Government Rebate on Private Health Insurance when you're applying for Budget Direct Health Insurance. If applicable, we'll deduct the rebate from your premiums so you pay less. You can also claim the rebate when you lodge your annual tax return, or as a direct payment from the Government through any Medicare office.

If you don't have private health insurance, and earn more than $90,000 ($180,000 for couples and families) you'll have to pay the Medicare Levy Surcharge. So Budget Direct Health Insurance could also save you tax.

Are GP Visits Covered By Private Health Insurance?

No, Budget Direct Health Insurance only covers doctors you see in hospital.

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Independent Advice

Free Independent advice is available from the Private Health Insurance Ombudsman. You can call the Ombudsman for free on 1300 362 072 or GPO Box 442, Canberra, ACT 2601.

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