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Summary

What’s Covered

  • Hospital accommodation (shared room) as a private patient in a public hospital
  • Accidents
  • Cardiac surgery and coronary care
  • Cataract surgery
  • Delivery suite
  • Eye surgery
  • Intensive care
  • IVF and related services
  • Joint reconstruction
  • Joint replacement
  • Medical gap up to the Medical Benefits Schedule fee (20% more if your doctor is a part of Budget Direct Health Insurance’s medical gap cover scheme)
  • Nursing home type patients
  • Obstetrics
  • Palliative care
  • Psychiatric care
  • Rehabilitation
  • Same-day treatment
  • Surgically-implanted prostheses
  • Theatre (in a public hospital only)
  • Emergency Ambulance cover
  • Other agreed charges

What’s Not Covered

  • Cosmetic surgery
  • Gastric banding and all obesity surgeries
  • Renal dialysis

To find out more, check out the Product Detail.

Hospital Accommodation on Budget Direct Health Insurance’s Public Hospital Cover

Budget Direct Health Insurance’s Public Hospital covers the cost of a shared room in a public hospital. It does not cover you for:

  • a single room in a public hospital
  • a private hospital.

If you want to be covered for either scenario you should consider Budget Direct Health Insurance’s Mid or Top Hospital cover.

Excess

The most you’ll have to pay for excess (the fee you pay to lower your premiums) each calendar year is:

  • $450 for Singles
  • $900 for Couples and Families
  • No hospital excess applies to child dependents when admitted as a private patient

If one person from a Couple or Family membership goes to hospital, they’ll have a maximum excess of $450. The maximum excess of $900 applies only when more than one person being covered is hospitalised.

Waiting Periods

If you’re transferring from another fund you’ll be fully covered when you sign up as long as you:

  • Transfer to an equal or lower level of Budget Direct Health Insurance cover within 30 days of your membership ceasing with your previous fund
  • Provide a transfer certificate and claims history from your previous health fund within 14 days
  • Have served all waiting periods with that fund.

If you don’t meet all of those conditions you’ll have to wait:

  • 12 months - pre-existing conditions (except psychiatric, rehab or palliative care)
  • 12 months - obstetrics and maternity care
  • 2 months - psychiatric, rehab or palliative care
  • 2 months - all other hospital treatment
  • 0 months - accidents (bodily injuries that happen the day after you join or upgrade to a higher level of cover)

You can find out more in the Product Detail.

Product Detail

Here’s everything you need to know about Public Hospital cover.

You can click on a topic for more information, or look at the Product Summary.

What’s Covered:

Budget Direct Health Insurance’s Public Hospital covers you as a private patient in a public hospital for:

  • Hospital accommodation (shared room) as a private patient in a public hospital
  • Accidents that require hospitalisation
  • Cardiac surgery and coronary care (problems with your heart)
  • Cataract surgery
  • Delivery suite
  • Eye surgery
  • Intensive care (one-on-one care 24/7)
  • Joint reconstruction (e.g. knee)
  • Joint replacement (e.g. hip)
  • Medical Gap up to the Medical Benefits Schedule fee (20% more if your doctor is a part of Budget Direct Health Insurance’s medical gap cover scheme)
  • Nursing home type patients (patients who don’t need medical care, but still need to be looked after in hospital)
  • Obstetrics (childbirth services)
  • Palliative care (e.g. caring for a cancer patient)
  • Psychiatric care (mental health care)
  • Rehabilitation (e.g. for drug problems or accident recovery)
  • Same-day treatment (when you’re in and out of surgery on the same day)
  • Surgically-implanted prostheses (Government prescribed benefits)
  • Theatre in a public hospital (surgery costs)
  • Ambulance Cover - 100% Australia wide emergency ambulance transport
  • Other agreed charges - additional costs that come from your hospital stay (but not phone and TV for example)

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What’s Not Covered:

Public Hospital doesn’t cover:

  • Hospital accommodation, theatre fees and other charges such as pharmacy in a private hospital
  • Hospital accommodation (single room) as a private patient in a public hospital
  • Cosmetic surgery (unless it’s medically necessary and your doctor provides a Medicare item number)
  • Gastric banding and all obesity surgeries (for weight loss)
  • Renal dialysis (for kidney disorders)

Other things that aren’t covered:

  • Damages or compensation you can claim from someone else
  • Treatments you can get free from the government (e.g. a traditional bulk billing GP visit or public hospital emergency department episode—Medicare covers those)
  • Anything not covered by your membership
  • Any equipment hire (e.g. crutches or an oxygen tent) unless Budget Direct Health Insurance tells you otherwise
  • Any treatment you have overseas
  • Drugs you bought from a chemist or anywhere else outside of a hospital. (There’s also a limit on how much you can claim for drugs administered during your hospital stay. For more information, contact Budget Direct Health Insurance.)
  • Treatments performed by someone who doesn’t work in a private practice, for a registered hospital, or for an organisation recognised by Budget Direct Health Insurance.
  • Any more than the schedule fee if your doctor works at a public hospital. (If the total fee is more than the schedule fee, you’ll have to pay the gap amount.)
  • Any more than you were charged for a treatment. (Claiming the same treatment from someone else as well will affect how much you receive from Budget Direct Health Insurance.)

It will also not cover you if:

  • Your membership is suspended, or you haven’t paid your fees
  • The person who treated you is:
    • a relative
    • your business partner
    • or related to your business partner.

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Hospital Accommodation on Budget Direct Health Insurance’s Public Hospital Cover

Budget Direct Health Insurance’s Public Hospital covers the cost of a shared room in a public hospital. It does not cover you for:

  • a single room in a public hospital.
  • a private hospital stay.

If you want to be covered for either scenario you should consider Budget Direct Health Insurance’s Mid or Top Hospital cover.

As a private patient in a public hospital you may have a choice of doctor if that doctor is available and has rights of private practice at that hospital. Depending on the situation this may or may not be the same doctor who would have been allocated to you by the hospital as a public patient.

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Waiting Periods

The standard waiting periods for Budget Direct Health Insurance are:

  • 12 months - pre-existing conditions (except psychiatric, rehab or palliative care)
  • 12 months - obstetrics and maternity care
  • 2 months - psychiatric, rehab or palliative care
  • 2 months - any other hospital treatment
  • 0 months - accidents (bodily injuries that happen the day after you join or upgrade to a higher level of cover)

Switching From Another Health Insurer or Budget Direct Health Insurance Policy

If your treatment wasn’t covered by your previous cover, you’ll need to wait the standard waiting periods described earlier.

If your treatment was covered by your previous cover, and you’ve completed the waiting periods for that treatment, you’ll be covered from day one of your new cover. Otherwise you’ll have to wait the remainder of any waiting period for that benefit (including pre-existing conditions).

For example, if you’ve completed 9 months of a 12 month waiting period with your previous cover, you’ll still need to wait 3 months with your new cover.

Note: If you’re new Budget Direct Health Insurance cover has higher benefits than your previous cover, you’ll need to complete the standard waiting periods to receive those higher benefits. But you’ll be covered for your previous (lower) benefits during that time.

Adding Another Person to Your Budget Direct Health Insurance Membership

Anyone you add to your Budget Direct Health Insurance membership will be fully covered from day one, provided they:

  • are your newborn baby
  • are your adopted or permanent foster child
  • have already served the waiting periods with Budget Direct Health Insurance or another fund (at an equal or higher benefit level).

If the person doesn’t meet any of these conditions, they’ll have to wait the standard waiting periods described earlier.

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Excess

If you’re sent to hospital, you’ll need to pay an excess (the fee you pay to get lower membership costs).

The most you’ll have to pay for excess each calendar year is:

  • $450 for Singles
  • $900 for Couples and Families.
  • No excess for child dependants

If one person from a Couple or Family membership goes to hospital, they’ll have a maximum excess of $450. The maximum excess of $900 applies only when more than one person being covered is hospitalised.

This information is important and should be read and retained.

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