Hospital cover and

clinical categories

The most important thing about Hospital cover is knowing what you’re covered for.

To make it easier for you to understand what is and what isn’t covered by your policy, in 2019 the government introduced standardised clinical categories, with minimum requirements for what must be covered.

Every hospital procedure or service that we cover under your Hospital cover has a list of Medicare Benefits Schedule (MBS) items associated with it. These MBS items are now grouped into ‘clinical categories’.

Understanding the clinical categories on your Hospital cover

Hospital cover needn’t be confusing. Simply refer to the ‘Individual Cover Details’ for your chosen cover for a list of all the clinical categories covered.

Get your Individual Cover Details when you log in or register for Members Online. Find it in the section ‘Your Cover Details’. Or contact us and we’ll send it to you.

Understanding MBS items

Each treatment that’s covered within a clinical category has a Medicare Benefits Schedule (MBS) item. There are over 5,700 MBS items that provide patient benefits for a wide range of services including consultations, diagnostic tests, and operations.

With the introduction of standardised clinical categories, it’s now possible for all consumers to know exactly which MBS items are covered under their Hospital product.

To search MBS items visit MBS Online.

Learn more about clinical categories and the hospital treatments each category covers on the Department of Health website.

We’ve prepared the following information to help with your questions

Clinical categories are simply groups of hospital treatments. Each clinical category, for example, ‘Lung and Chest’ or ‘Heart and Vascular System’, sets out the hospital treatments that must be covered.

The Hospital cover you chose will determine which clinical categories are covered. If a Hospital product covers a certain category, then it must cover everything listed under that category as outlined by the government – not only some things.

Standardised clinical categories have made it easier and more transparent for consumers to understand Hospital cover.

From 2019, each clinical category will have minimum requirements of what must be covered. If you already have private health insurance, clinical categories will help you to understand what you’re covered for – and what you’re not covered for. If you’re looking to take out Hospital cover for the first time, they will help you to compare different policies.

Without standardised clinical categories, individual health funds are left to determine which hospital treatments will (and will not) be covered in each of their categories.

Health Partners welcomes changes that make it easier for people to understand what they’re covered for.

The government introduced the new clinical categories from 1 April 2019, and gave private health funds until 1 April 2020 to adopt them for all products.

We applied the new clinical categories to our Hospital products in 2019.

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