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Package cover explained

Package cover combines hospital and extras in the one package for you. 

  Hospital cover helps cover your costs when you are treated as a private patient in hospital. It also gives you options – like being treated by your own doctor, shorter waiting times for elective surgery and the timing of your treatment.    With extras cover, you can claim for a range of service that generally aren't covered by Medicare and that aren't covered by your hospital cover. 

Package - Hospital Explained

What’s covered?

Hospital cover helps pay for Medicare-recognised procedures when you are admitted to hospital. With all hospital cover options, you are eligible to receive benefits at your choice of participating hospitals (private or public), Australia-wide. If the procedure or service you require is included in your cover, Health Partners will:

Pay for:

  • Your accommodation in hospital (including registered day facilities)
  • Your theatre, labour ward and intensive care fees
  • All PBS prescriptions relating to your admission, while you’re in hospital
  • An extensive range of government-recognised surgically implanted prostheses
  • Access to a range of health management and support programs.

Pay towards:

  • In-patient medical expenses. 
  • A range of additional services depending on your level of cover.

To compare hospital cover, view the summary of services table.

What’s not covered

There are some situations where your Health Partners hospital cover will not cover you:

  • Outpatient services
  • Services at unregistered day facilities
  • Emergency department facility fees (unless otherwise specified)
  • Excluded services (see individual cover options for details).

 

Limited benefits

Limited benefits apply for admissions where a Medicare rebate does not apply to the treatment procedures. Benefits paid are in accordance with the Federal Government default payment schedule. This may result in large out-of-pocket expenses.

For more information, please refer to what's covered or contact us.

Excess and co-payment

With Health Partners you can select from various excess and co-payment options when deciding on your hospital cover.

An excess is the amount you agree to pay towards your hospital accommodation, should you need to go to hospital. This is payable on admission, once only per person, to a maximum of twice per membership per rolling year (that is, 12 months from the date of the first admission).

The co-payment is the daily amount you agree to pay (in addition to any applicable excess) towards your hospital accommodation. Maximum co-payment amounts apply per person and per membership per rolling year (that is, 12 months from the date of the first admission).

Excess and co-payments are only payable if you are admitted to hospital and are in addition to any out-of-pocket expenses (also known as ‘gaps’) incurred for in-hospital medical treatment.

For more information download the Product Disclosure Statement

Package - Extras Explained

  • Extras cover gives you affordable access to services that generally aren’t covered by Medicare and that aren’t covered by your hospital cover. 
  • Some of the most popular services include dental, optical, physiotherapy, chiropractic and pharmacy. 
  • You can choose from ‘standalone extras’ cover or a ‘package cover’ which combines extras and hospital in the one package for you. 
  • You also have the option of using your extras cover at your own recognised provider, or at a Health Partners professional.

What’s covered?

Extras cover helps pay towards a range of health services. If the service you require is included in your cover, Health Partners will help you cover the costs by paying the benefit specific to your cover.

To compare extras cover, view the summary of services table.

 

Save with Health Partners professionals

For the highest possible benefits for dental, optical, physiotherapy and pharmacy, you can choose a Health Partners professional. 

Health Partners Dental

When you visit a Health Partners Dental centre, you can get back as much as 100% and no less than 60% on general dental treatment. Major dental treatment is also available on most covers, with benefits ranging from 60% to 100%. 

Health Partners Optical

You can expect unbeatable benefits and discounts when you visit a Health Partners Optical centre. You get back as much as 100% and no less than 60% for optical prescription items (including contact lenses and sunglasses). Plus, our unique ‘unlimited benefit’ means that if you reach your annual limits, you can keep on saving on prescription items at a minimum of 40%.

 

Health Partners Participating Pharmacies

We have a state-wide network of participating pharmacies where you receive on-the-spot benefits and discounts. Pharmacy benefits are included on all levels of extras covers and are available at participating pharmacies.

For National Extras members can receive a benefit when items are purchased at other pharmacies outside the metro area.

 

Health Partners Participating Physiotherapists

When you visit any one of our participating physiotherapists you will pay a low, set gap or no-gap at all for most treatments, allowing you to save more. Physiotherapy benefits are included on all levels of extras covers.

Recognised providers

You have the option of claiming benefits for extras services at your own recognised provider. You can contact us to determine if your provider is a Health Partners recognised provider.

Understanding benefits

A benefit is the amount you receive back when you make a claim. If the service you require is included in your cover, Health Partners will help you cover the costs by paying the benefit specific to your cover. For more information, please refer to what's covered or contact us.

  • The examples listed for dental benefits are subject to change annually. You may contact us at any time for a benefit quote.
  • Except where otherwise stated, benefits and limits are per person, per calendar year.
  • There are instances when extras benefits are not payable, such as when a provider is not recognised by us or when your health cover payments are not up to date. If you’re unsure, it’s always best to contact us.
  • If transferring, benefits paid by your previous fund within the current calendar year or specific period will count towards your limits with Health Partners for the same period.
  • Not all benefits are listed on this website for all extras services. To check if a specific item is covered, please contact us.

Understanding limits

For most extras services, there are limits to the amounts that you can claim back or the number of times you can claim a benefit, during the calendar year or the specified period. Health Partners offers some unlimited benefits and discounts – allowing you to save more. All of our limits are per person unless otherwise stated. For more information please refer to  what's covered.

Lifetime limits

Some extras services have lifetime limits which indicate the total amount you can claim in your lifetime. Once you reach the limit, no further benefits will apply. For more information please visit what's covered.

For more information download the Product Disclosure Statement.

Waiting Periods

Waiting periods

Waiting periods are the initial periods after joining or upgrading your extras cover during which you cannot claim extras benefits.

If you haven’t already served waiting periods, after two months you can claim benefits for all extras services available on your level of cover, except for the following, where the respective waiting periods apply:

Major Dental 12 months
Orthodontic 12 months
Apparatus 12 months
Laser Eye Surgery 3 years

If you haven't already served waiting periods, after two months you can claim benefits for hospital services available on your level of cover, except for the following where 12-month waiting periods apply:

  • Pregnancy and birth-related services, including IVF
  • Pre-existing conditions (excluding psychiatric conditions, palliative care and rehabilitation)
  • Home nursing
  • Home sleep studies.

Waiting periods do not apply for:

  • Newborn babies added to a family hospital cover within 60 days after their birth
  • Treatment required immediately following an accidental injury sustained after you’ve joined.
You may be able to obtain immediate benefits if you are transferring from another health fund with an equivalent level of cover. 

Waiting periods when you transfer from another fund

If you transfer from another fund with an equivalent level of cover, and have served the relevant waiting periods, you can obtain immediate access to all services on your selected level of cover. A 12-month waiting period applies to any higher limits on your new Health Partners cover for Orthodontic, Laser Eye Surgery (Platinum package) and CPAP Apparatus. During this time you will receive the same benefits as your previous level of cover.

If you transfer to a higher level of cover, waiting periods apply to the additional benefits available on the higher level of cover. During this time you will receive the same benefits and pay the same excess and co-payment (for hospital or package cover) as the Health Partners equivalent of your previous level of cover.

Where your previous cover had excluded benefits, waiting periods will apply for these specific services.

If you have only partially served waiting periods with your previous fund, the remainder of the waiting period will be served with Health Partners.

Any loyalty bonuses or accrued entitlements with your former fund are not transferable to Health Partners.

When you transfer, we will explain to you which benefits you can claim immediately and the waiting periods that apply (if any).

Waiting periods when you change your cover

For current members changing their level of cover, waiting periods only need to be served for the additional benefits on the new level of cover. During this period you will receive the same benefits as your previous level of cover.

When you change your cover, we will explain to you which benefits you can claim immediately and the waiting periods that apply (if any).

Pre-existing conditions

A pre-existing condition is one where signs or symptoms of an ailment, illness or condition, in the opinion of a medical practitioner appointed by the Fund, existed at any time during the six months preceding the date on which you purchased or upgraded your hospital cover.

A 12-month waiting period applies for pre-existing conditions. This does not apply to psychiatric conditions, palliative care and rehabilitation.

For more information download the Product Disclosure Statement.