Private health insurance FAQs



Information about your Health cover

What is Medicare?

Medicare is the name of Australia’s publicly funded health care system that provides no out-of-pocket or low-cost health care to Australian residents. Visitors from countries that have Reciprocal Health Care Agreements with Australia are eligible to receive some subsidised health services for essential medical treatment while visiting Australia. Visitors from countries without a reciprocal agreement must pay for their treatment with their own money. The Australian Government has signed Reciprocal Health Care agreements with a number of countries however these agreements can vary. To find out more, click here.

For more information about Medicare please ring 13 20 11 or visit their website.

What is the Medicare Benefits Schedule?

The Medicare Benefits Schedule (MBS) is a list of all the medical services subsidised by the Australian Government. We use this schedule to calculate benefits for Overseas Visitors Cover. It's important to note that your health professional may charge above the MBS fee for their services, and depending on your level of cover, you’ll need to pay the difference.

For more information about the MBS, visit the Medicare website.

What is the Pharmaceutical Benefits Scheme (PBS)?

The Pharmaceutical Benefits Scheme (PBS) is a Government run scheme which provides access to a wide range of medicine within Australia. Under the PBS, all Australian residents and overseas visitors from countries that have a Reciprocal Health Care Agreement with Australia have access to a range of prescription medicines at a more affordable cost.

More information about the PBS can be found on the Medicare website.

Why do I need Overseas Visitors Cover if my Visa has no specific health requirements?

Health services in Australia can be expensive and the last thing you want if you become ill or have an accident is unexpected out-of-pocket expenses. Even visitors who receive reciprocal benefits from Medicare will find that Overseas Visitor Cover will give them a wider choice of hospital treatments and may minimise the wait for non-emergency hospital care.

I would like to have someone else look after my health insurance on my behalf, can I do this?

Yes, you can. But, so we can protect your privacy you must authorise that person to look after your health insurance matters. To do this, just fill in the Delegated Authority form, including the name of the person who will be handling your health insurance matters and make sure you sign it. Australian Unity will then be able to discuss your health insurance with that person.

What are Agreement Private Hospitals?

Australian Unity has agreements with over 500 private hospitals and day surgeries across Australia, which means if you are admitted to one of these facilities, your accommodation and theatre fees will be covered (up to yearly limits), depending on your level of cover and the treatment you require*.

To find out which hospitals have an agreement with us click here.

*Excludes some overseas visitors covers. Restrictions and exclusions may also apply. Please check your Overseas Visitors Cover fact sheet for further information.

What is a waiting period?

A waiting period is simply the time you must wait before you can claim a benefit. It’s the time between when you joined us and when you’re covered for a service or treatment. There are different waiting periods for different services – a complete list of waiting periods is detailed in your Overseas Visitors cover fact sheet.

Why do I need a medical report when I make a claim?

 It is very important that when making a claim you also include a medical report completed by the doctor you first consulted in relation to the condition. Without a medical report Australian Unity may be unable to assess whether the ailment, illness or condition relates to a pre-existing condition, and therefore we may be unable to pay benefits for your claim.

What is a pre-existing condition?

A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical practitioner appointed by Australian Unity, the signs or symptoms of that illness, ailment or condition existed at any time in the period of six months, ending on the day on which you became insured under the policy. Australian Unity may ask you for more information to determine if you are eligible for benefits. Under select Overseas Visitors Covers, you can claim on treatment for pre-existing conditions after a 12 month waiting period is served. For more information about pre-existing conditions refer to the Overseas Visitors Cover Terms and Conditions.

Can I choose my own hospital and doctor?

With Overseas Visitors Cover you can choose from a large number of our Agreement Private Hospitals in Australia to stay in and, if you are covered in a public hospital, you can choose to have your own doctor, if they are available.

What is the difference between an inpatient and outpatient?

It’s important to understand the difference between inpatient and outpatient hospital services as your level of cover may differ for each service type.

  • You are considered an inpatient when you are formally admitted to a hospital with a doctor’s order. 
  • Prior to being admitted as an inpatient, you are considered an outpatient while you receive emergency department services, such as being under general observation or receiving outpatient surgery, lab tests, X-rays, or any other hospital services and the doctor hasn’t written an order to admit you to a hospital. In these cases, you’re an outpatient even if you spend the night at the hospital.

If I need to go to hospital how do I make sure I am getting the best out of my Overseas Visitors Cover?

When preparing to go to hospital you should ask your doctor and the hospital if there will be any out-of-pocket fees or charges that might be higher than those covered by your Overseas Visitors Cover. It is also important to check with Australian Unity before you go to hospital, that way we can advise you if there are any exclusions, restrictions or limits on the treatment you require under your selected level of cover.

What if I'm on a 457 working visa?

We recommend that you purchase our 457 Visitors Health Cover, which meets the Australian Government 457 visa requirements.

How do I access the Wellplan Rewards programs?

When you join Australian Unity you are able to access a wide variety of generous discounts on a range of health and lifestyle products and services immediately. Find out more.