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Summary

What’s Covered

  • Hospital accommodation (shared or single room) in a public or private hospital
  • Accidents
  • Emergency Ambulance cover
  • Cardiac surgery and coronary care
  • Cataract surgery
  • Delivery suite
  • Eye surgery
  • Gastric banding and all obesity surgeries
  • 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 part of Budget Direct Health Insurance’s medical gap cover scheme).
  • Nursing home type patients
  • Obstetrics
  • Palliative care
  • Psychiatric care
  • Rehabilitation
  • Renal dialysis
  • Same-day treatment
  • Surgically-implanted prostheses
  • Theatre
  • Other agreed charges

What's Not Covered

  • Cosmetic surgery - Anything that Medicare doesn't pay for (such as cosmetic surgery that isn't medically necessary, hair replacement or laser eye surgery)

To find out more, check out the Product Detail.

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, and
  • Have served all waiting periods with that fund.

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

  • 24 months - Benefit Limitation Periods apply to gastric banding and all obesity surgeries, psychiatric or renal dialysis. (You’re covered, but for public hospital benefits in a shared room after you’ve served your other waiting periods.)
  • 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  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 Top 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 Top Hospital covers:

  • Hospital accommodation (shared or single room) in a public or private hospital
  • Accidents that require hospitalisation
  • Cardiac surgery and coronary care (problems with your heart)
  • Cataract surgery
  • Delivery suite
  • Eye surgery
  • Gastric banding and all obesity surgeries (for weight loss)
  • Intensive care (one-on-one care 24/7)
  • IVF and related services
  • Joint reconstruction (e.g. knee)
  • Joint replacement (e.g. hip)
  • Medical Gap up to the Medical Benefits Schedule fee (and 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)
  • Renal dialysis (for kidney disorders)
  • Same day treatment (when you’re in and out of surgery on the same day)
  • Surgically implanted prostheses (Government-prescribed benefits)
  • Theatre (surgery costs)
  • Ambulance cover - 100% Australia wide emergency ambulance transport
  • Other agreed charges - additional costs that come from your hospital stay (but not phone or  TV for example)

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What’s Not Covered

Top Hospital doesn’t cover:

  • Cosmetic surgery (unless it’s medically necessary and your doctor provides a Medicare item number)

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
    • related to your business partner.

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Waiting Periods

The standard waiting periods for Budget Direct Health Insurance are:

  • 24 months - Benefit Limitation Periods apply to gastric banding and all obesity surgeries, psychiatric or renal dialysis. (You’re covered, but only for public hospital benefits in a shared room after your other waiting periods have been served.)
  • 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 completed 9 months of a 12 month waiting period with your old cover, you’ll still need to wait 3 months with your new cover.

Note: If your 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 still 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.
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Hospitals

Private Hospitals

Top Hospital covers you for treatment in participating private hospitals, although you won’t be covered for anything listed under What’s Not Covered.

Non-Participating Private Hospitals 

If you’re treated in a hospital that’s not on Budget Direct Health Insurance’s participating hospitals list, you’ll have to pay the difference between what the hospital charges and what Budget Direct Health Insurance covers.

Public Hospitals

Top Hospital covers you for treatment in public hospitals (you’ll be treated as a private patient). But again, you won’t be covered for anything listed under What's Not Covered.

Shared Or Single Room

Top Hospital covers you for both single and shared rooms in public and participating private hospitals. You’re entitled to a single room if one is available, otherwise you’ll have to share.

This information is important and should be read and retained.

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