Hospital cover

A waiting period is the amount of time you have to wait after joining or upgrading until you can make a claim for a service or treatment.

Excess is the additional amount you agree to pay towards accommodation costs if you need hospital treatment. Please refer to your product Fact Sheet for details about the maximum excess payable in a calendar year and any excess waivers that may apply.

A pre-existing condition is an ailment, illness or condition that in the opinion of a medical practitioner appointed by Australian Unity (not your own doctor), the signs or symptoms of that ailment, illness or condition existed at any time in the period of six months ending on the day on which 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 joining or upgrading your cover, we will ask you to get your consulting doctors or other practitioner (e.g. your dentist, GP or specialist) to complete a medical report. You should ask us to carry out this assessment before going into hospital.

Accident means an unplanned and unforeseen event, occurring by chance, and leading to bodily injuries caused solely and directly by an external force or object requiring treatment from a Medical Practitioner (defined here as a medical doctor who is not the member or a relative of the Member) within 7 days of the event, but excludes injuries arising out of: surgical procedures; unforeseen illness; pregnancy; drug use; and aggravation of an underlying condition or injury.

Restricted services are hospital claims which are limited to a minimum (default) benefit. This is the minimum dollar amount set by the Australian Government for accommodation as a private patient in a shared room of a public hospital. A Restricted service does not pay any money towards the cost of intensive or coronary care, labour ward or theatre fees in a private hospital or private day centre. Therefore you may incur a large out-of-pocket expense. Contact us for more information.

If you select a hospital cover that has treatments listed as ‘Excluded’ or 'Not Covered', this means that we will not pay any benefits for the treatment you have received and this can result in you incurring large out-of-pocket costs. Always refer to your product Fact Sheet for more details about your hospital cover entitlements.

If you are admitted to hospital (including for Covered treatments) you may have out-of-pocket costs, e.g. an excess,  a ‘gap’ in your doctors’ medical bills, emergency department fees, or the additional cost of a private room in a public or non-agreement hospital. If you want more specific information about what you can expect these costs to be, we recommend you obtain a quote from your doctors/hospital before undergoing treatment. Then contact us for details of benefits before proceeding with your treatment. Additionally, benefits are not payable for claims where you have the right to claim compensation, damages or benefits from another source (e.g. TAC or WorkCover), now or at a later date.