Private health insurance FAQs



Information about your Health cover

Do any waiting periods apply?

Yes they do. Australian Unity applies waiting periods to some services. Check your fact sheet to see if waiting periods apply and to check you are covered.

Remember, if you transfer to Australian Unity from another health fund and your previous cover was of a similar or higher level of cover, you won’t re-serve any waiting periods.

It's important to remember that like all health insurers, Australian Unity has a 12 month waiting period for pre-existing conditions for hospital treatment. For more information on pre-existing conditions, see below.

Benefit limitation periods

Depending on your level of cover, psychiatric and rehabilitation, and gastric reduction, obesity procedures and revisions may have a benefit limitation period. This is like a waiting period, if you are treated within the first 12 or 24 months of starting your cover, then treatment may be limited to a shared room in a public hospital.

What is an excess?

Excess is the additional amount you agree to pay towards accommodation costs if you need hospital treatment. The higher your excess, the less you’ll pay for your cover.

How is excess applied by Australian Unity?

Unlike some health funds, singles will only pay an excess for the first hospital admission each year. Families or couples will only pay an excess for the first two hospital admissions each year. Depending on your level of cover, you won’t pay an excess if your kids visit a hospital.

Plus with Smart Start® and Smart Essentials cover, the excess does not apply on day surgery.

With Care ‘n Repair, Smart Start®, Smart Essentials, Budget Hospital and Basic Hospital (UB2) does not apply to an overnight hospital admission that is not due to an accident.

I have hospital cover with an excess. Is the excess applicable on day surgery?

Yes. The exceptions are Smart Start® and Smart Essentials cover where an excess does not apply on day surgery.

What are pre-existing conditions?

A pre-existing condition is an illness, ailment or condition where the signs or symptoms existed up to six months before and on the day you joined Australian Unity or upgraded your cover, irrespective of whether you were aware of it. If you make a hospital claim in the first 12 months of your membership, we may ask you to get your first consulting doctor (eg your dentist, GP or specialist) to complete a medical report.

The report will help our appointed medical advisor assess if your treatment relates to a pre-existing condition. You should ask us to carry out this assessment before going into hospital.

What is a hospital co-payment?

A co-payment is a set dollar amount you agree to pay towards a hospital accommodation for each night you stay in hospital, this lowers price of your cover.  Sometimes, hospitals may call a patient moiety.

What is a medical gap?

The Australian Government sets a schedule of fees (Medicare Benefits Schedule) for treatments by doctors in a hospital or day surgery, and Medicare covers you for 75% of this schedule fee. Australian Unity then picks up the difference, the remaining 25%. However, some doctors and specialists charge more than the MBS fee and that extra amount is 'the medical gap,' which is your out-of-pocket.

What is Gap Cover?

Australian Unity's Gap Cover Scheme can reduce or remove your out-of-pocket expenses. We set our own schedule of fees, which is generally higher than the Government schedule. This means that when your doctor or specialist agrees to use Australian Unity's Gap Cover Scheme, we can help to pay some of the gap or the entire gap that can occur if your doctor's charge is higher than the Medicare Benefits Schedule Fee.

Gap Cover is available to all doctors who treat private patients in hospitals or day surgeries, but they don't always participate. If a doctor participates but chooses to charge out-of-pocket-expenses, they must inform you of the extra amount in writing before treating you.

You should always ask your doctor if they participate in the Australian Unity Gap Cover Scheme.

Gap Cover is not available on any of our Overseas Visitors Health Covers. Gap Cover only applies to the treatment of illnesses or conditions available under your health cover.

How can I find out which doctors participate in Gap Cover?

It's simple. To search for medical doctors participating in Gap Cover, go to Find Gap Cover doctors page.

What are Agreement Hospitals?

Most private hospitals and day facilities have an agreement with Australian Unity which guarantees that you'll be covered for 100% of accommodation and most other services like theatre fees (not including your excess).

To find out which hospitals are Agreement Hospitals click here.

How can I find out which providers in my area participate in HICAPS?

HICAPS let you enjoy the convenience of easy, on the spot claiming when you visit a participating dentist, chiropractor, optometrist, physiotherapist, osteopath, podiatrist, occupational therapist or psychologist.

HICAPS is an electronic system that lets you use your Membership Card to "pay" for a health service instead of using your own money and then submitting a claim.

Numerous providers have these facilities, simply go to the Find HICAPS Providers page where you can search for your nearest provider.

Do I need ambulance cover?

Emergency ambulance is included as part of your hospital cover and must be coded and invoiced as emergency transportation by the ambulance service for it to be paid. Depending on your level of cover, you may be covered for two ambulance attendances per year where you are not transported to hospital.

Health Support Progams - what is it?

Australian Unity offers a range programs designed to help people improve and manage their health. To find out what Health Support Programs programs are currently available click here.

What is Wellplan Rewards and am I entitled to use it?

Wellplan® Rewards is exclusively available to Australian Unity health and lifestyle solutions customers to help you stay healthy and happy by saving you money on a wide range of health, fitness and lifestyle products and services.

To access Wellplan® Rewards login to Online Services.

What is the baby+me program?

Depending on your level of cover, Australian Unity's baby+me® program provides care and practical support when parents need it most. Continuing until the baby's first birthday, this exclusive three-phase program provides access to a range of complimentary services for expectant parents.

These include telephone contact with an individually assigned midwife, an informative website and a range of information about pregnancy and parenting.

What should I do if I have a complaint?

If you are dissatisfied with any aspect of Australian Unity's services, we would appreciate hearing from you. We are committed to resolving complaints in a fair and efficient manner and view your feedback as a vital opportunity for us to improve.

You can lodge your complaint in any of the following ways:

Customer Service Centre:

Phone: 13 29 39

Between 8.30am to 5.00pm, Monday to Friday

Contact us online

Mail: Australian Unity

        Reply Paid 64466

        Melbourne Vic 8060

Fax: 1800 852 030