Private health insurance FAQs

Yes they do. Australian Unity applies waiting periods to the following services and on pre-existing conditions (for more details see below). For all other services you will receive immediate cover.

Please note that if you are transferring from an equivalent level of cover with another fund, you will not have to re-serve any completed waiting periods for these services.

Benefits	Waiting periods
Psychiatric	2 months
Rehabilitation	2 months
Palliative Care	2 months
Obstetrics/childbirth for Basic Hospital cover only	9 months
Obstetrics/childbirth for all other covers including Comprehensive Hospital Cover	12 months
Health Management Programs	6 months
Extraction of wisdom teeth	6 months
Optical	6 months
St John Ambulance First Aid Course	6 months
Major Dental (including dentures, crowns, bridgework, implants)	12 months
Orthodontics	12 months
Orthotics	12 months
Hearing aids	12 months
Blood glucose monitors / Blood pressure monitors	12 months
Asthma pumps / Peak flow meters	12 months
TENS Pain Control Machine	12 months
C-PAP Airways Pressure machine	12 months
Non-surgical prostheses	12 months
baby+me® Program	12 months
The coronary artery disease program	12 months
Pre-existing conditions
All Pre-existing conditions except for psychiatric, rehabilitation and palliative care	12 months
Psychiatric, rehabilitation and palliative care	2 months

Important Notice

For all pre-existing conditions, except psychiatric, rehabilitation and palliative care, benefits will not be payable for the first 12 months of membership for any illness, ailment or condition, the signs or symptoms of which were known, or which a medical or para-medical practitioner appointed by the company considers, after examining information furnished by the member's practitioner, and other material relevant to a claim for benefits, were in existence in the member or his/her dependant at any time during the six months preceding the commencement or transfer date. The waiting period for psychiatric, rehabilitation and palliative care services where those conditions are pre-existing is reduced to 2 months. Please see below for information on Benefit Limitation Periods that may applies to some covers in relation to these services.

This is irrespective of whether the member or dependant was aware of the pre-existing illness, ailment or condition, and includes all proposed elective or cosmetic procedures. Australian Unity may request further medical evidence in determining eligibility for benefits.

Dental Maximums

Waiting periods and benefit maximums for major dental can vary if you are moving from one type of cover to another. If you require further information please call 13 29 39 (8.30am – 8.30pm AEST, Monday – Saturday) and ask our friendly customer service staff.

Benefit limitation periods

For psychiatric, rehabilitation on Smart Combination, Smart Start and Hospital Essentials cover, a benefit limitation period applies for the first year of membership for months 3-12.

Unlike some health funds, if you have singles cover with Australian Unity the excess only applies on your first admission to hospital in a calendar year and only up to twice a year on those who have couples or family cover. With Smart Start^® cover, the $100 excess does not apply on day surgery, it only applies once per year to an overnight hospital admission that is not due to an accident.

Yes. The exception is on Smart Start^® Hospital and Extras cover where an excess does not apply on day surgery, it only applies on overnight hospital admissions that are not due to an accident.

Means any illness or ailment, the signs or symptoms of which were known or which a medical or para-medical practitioner appointed by the Company considers after examining information furnished by the member's practitioner, and other material relevant to a claim for benefits, were in existence in the member or his dependant at any time during the six months preceding the commencement or transfer date, irrespective of whether the member or dependant was aware of the pre-existing illness or ailment and includes all proposed elective or cosmetic procedures.

A co-payment is a set dollar amount you agree to pay towards a hospital admission for every night you stay in hospital in exchange for a lower contribution on your cover.  This is sometimes called a patient moiety.

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.

For more information download and print our Gap Cover Brochure.

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An excess is the amount you agree to contribute as part of your health membership towards accommodation costs if you are admitted to hospital. The more excess you agree to pay, the lower your health membership contributions will be.

Australian Unity's Gap Cover* 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.

For more information you can download and print the Gap Cover Brochure.

* Gap Cover is not available under Basic Hospital cover and Overseas Visitors Cover. It does not apply to illnesses or conditions that are specifically excluded from some health covers.

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It's simple. To search for medical doctors participating in Gap Cover, login to Online Services select 'Find a provider' the go to 'Gap Cover doctors'.

You can look up a No Gap Dental provider on the Australian Unity Health website when you search for a health care provider or see the whole list here or download the No Gap Dental Brochure.

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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.

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 login to Online Services, select 'Find a provider', then go to 'HICAPS Provider' where you can search for your nearest provider.

If you're not registered to use Online Services simply click here to register.

Emergency ambulance is included as part of your hospital cover (with the exception of Basic Hospital Cover) and must be coded as emergency transportation by the ambulance service to qualify for benefits.

If you live in NSW or the ACT and decide against having Hospital cover, then you may decide to take out a separate Ambulance cover to pay the cost of non-emergency ambulance transport if you need to be taken to hospital.

In most other states, you can purchase ambulance cover from your state government ambulance scheme instead.

Under changes recently introduced by the Australian Government, Broader Health Cover allows private health insurers to pay benefits towards for health services that can be delivered just as effectively at home as in hospital.

Previously, claims for treatments such as chemotherapy and rehabilitation have been restricted to hospital provided care. The changes mean that these treatments and others can be provided either in conjunction with hospital care or as a substitute, giving you the flexibility to use a range of health care providers. It may even mean you avoid hospital stays altogether.

It also allows private health insurers to pay benefits on preventative programs designed to help people improve and manage their health.

Australian Unity has a longstanding commitment to providing services and programs focusing on preventative and health management outside the hospital setting. Broader Health Cover means we can now expand and improve on the program and benefit options we offer, giving you the freedom to receive the services best suited to your needs in the best location.

To find out what Broader Health Cover programs are currently available click here.

Australian Unity has in place the following Broader Health Cover initiatives:

• The coronary artery disease program: a telephone based support and coaching program for members who suffer from coronary heart disease. Australian Unity developed and initiated this program. We are proud to be the first health insurer to offer this service to its members.
• Member Support Program:  assists members who are well enough to get an early discharge from hospital, but may need some on-going support for a full recovery. So, whether you've had a baby or an operation, the Member Support Program will ensure you get the services you need to get you back on your feet, such as private nursing care, personal care, nappy services or child care- all in the comfort of your own home.

Depending on your level of cover, as with all Australian Unity health policies, our Broader Health Cover initiatives also include quit smoking programs, weight loss benefits, doctor health checks not claimable under Medicare, the baby+me^® support program for expectant parents, and preventative No Gap dental. For more information about these programs click here.

To find out more about Broader Health Cover click here.

In addition, Australian Unity recently launched Wellplan^® Online an innovative program that provides you with personalised and private health information, along with the practical tools you need to stay well and live longer.

To find out more about Wellplan^® Online click here or call 13 29 39 (8.30am – 8.30pm AEST, Monday – Saturday).

The changes to broader health cover will now allow Australian Unity to offer a much wider range of out of hospital benefits to its members. We are currently investigating disease management programs for conditions such as asthma and diabetes as well as chemotherapy and rehabilitation and a range of other services traditionally confined to hospital delivery.

Wellplan^® Rewards is exclusively available to Australian Unity health members 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, and select 'Wellplan^® Rewards' from the 'Wellplan^®' drop down menu.

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 comprehensive books relating to pregnancy and parenting.

To be eligible for this program, you must:

• have Comprehensive Hospital cover (H4, K4 or J4 only), LifeChoice™ or LifeChoice Plus™
• enrol in the program prior to the birth of your child, and
• have held the required level of cover for a continuous period of at least 12 months prior to enrolment.

To enroll in the baby+me® program call 1300 886 488

If you are dissatisfied with any aspect of Australian Unity's health insurance services or products or feel that our service has failed to meet your expectations, 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. To ensure you have the best possible customer experiences please make sure that you:

• gather all supporting documents and information relating to the complaint,
• think about any questions you need answered that will help us resolve the issue more efficiently, and
• contact us as soon as possible.

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

Customer Service Centre:

Phone: 13 29 39

Between 8.30am to 8.00pm, Monday to Friday or 9.00am to 1.00pm, Saturday

Email: healthcover@australianunity.com.au

Mail: Australian Unity

        Reply Paid 64466

        Melbourne Vic 8060

Fax: 1800 852 030