Changes to your cover

Effective 1 July 2020

New 2 month Waiting Period from 1 July 2020
(Fund Rule F.3.2)

From 1 July 2020 we’ll be introducing an additional standard two month waiting period to hospital treatments for new members on all our hospital covers, something that already applies for a number of health funds.

This means that if you commence your policy, add a new member to your policy or upgrade your level of cover from 1 July 2020, this waiting period will apply. The waiting period will be waived in the case of an Accident occurring after joining the cover, or where the waiting period for that treatment has already been served.

Remember, you can’t claim benefits for treatments while serving a waiting period.

Changes to Access Gap Cover

Currently, medical specialists who agree with you to participate in our Access Gap Cover scheme may charge an out-of-pocket cost of $400 per medical item, without an overall cap per admission. This means that your out-of-pocket costs may exceed $400 if there are multiple medical items, per specialist, per admissionunder the current scheme. From 1 July 2020, the maximum out-of-pocket cost will be capped at $500 per specialist, per admission, even if there are multiple medical items ($800 for Management of Labour and Delivery of a baby, where covered).

Also, from 1 July 2020, doctors who use Access Gap Cover won’t be able to charge you additional fees, sometimes referred to as ‘Booking Fees’ or ‘Administrative Fees’ or any other fees not associated with a Medicare item number.

If you’re currently having hospital treatment, or have treatment booked on or after 1 July 2020, please check with your doctor for any additional out-of-pocket costs.


Effective 1 July 2020

Summary of Fund Rules changes

Fund Rule Current From 1 July 2020
F.3.2 Hospital Treatment Waiting Periods The following Waiting Periods apply to a Benefit for Hospital Treatment or Hospital-Substitute Treatment subject to the Members chosen New Product;

12 months Private Hospital Benefits for Obstetrics (Pregnancy and Birth) and related services.
Pre-Existing Conditions with exception to psychiatric, rehabilitation and Palliative Care services.
9 months Minimum (default) Benefits for Obstetrics (Pregnancy and Birth) and related services.
2 months All psychiatric*, rehabilitation and Palliative Care services regardless of it being due to a Pre-Existing Condition.

*Unless an eligible Member is making use of the Mental Health Waiver.
0 months Hospital Treatment that is required as a result of an Accident that took place after a Member’s Commencement Date
The following Waiting Periods apply to a Benefit for Hospital Treatment or Hospital-Substitute Treatment subject to the Members chosen New Product;

12 months Private Hospital Benefits for Pregnancy and Birth.

Pre-Existing Conditions except Psychiatric, Rehabilitation and Palliative Care
9 months Minimum (default) Benefits for Pregnancy and Birth.
2 months Psychiatric*, Rehabilitation and Palliative Care (regardless of it being due to a Pre-Existing Condition).

All other treatments not listed in this table.

*Unless an eligible Member is making use of the Mental Health Waiver.
0 months Hospital Treatment or Hospital-Substitute Treatment that is required as a result of an Accident that took place after a Member’s Commencement Date
Fund Rules

This document contains comprehensive information about the rights and obligations of the health fund and our members. You can view a copy of the current Fund Rules here.

As of 1 July 2020, the Fund Rules link above will be updated with the new version.

We must comply with the Australian Consumer Law, the Private Health Insurance Act 2007 (Cth) and the Private Health Insurance Code of Conduct whenever we make changes to our Fund Rules. If you are unsatisfied with the changes, please note that you can cancel your cover at any time and you will be entitled to a refund for any unused portion of premiums paid in advance.