02 4990 1385

Hospital Covers

HHI Provide Health Insurance in three main areas

Hospital Covers is the first of the three areas covered.

Excesses are available on all Hospital products aside from Bronze Smart or Basic.

Aged-Based discounts are available on Gold Hospital products.

Call our office for more information.

Clinical Category Basic Bronze Plus Smart Silver Plus Thrifty Silver Plus Young Silver Plus Gold
Rehabilitation

Physical rehabilitation related to surgery or illness. For example: stroke recovery, cardiac rehabilitation

R R R R R Y
Hospital psychiatric services

Treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. For example: Schizophrenia, depression, eating disorders, addiction therapy, and post-natal depression

R R R R R Y
Palliative Care

Providing quality of life care for a patient with a terminal illness, including treatment to alleviate and manage pain

R R R R Y Y
Brain and nervous system

The investigation and treatment of the brain, brain-related conditions, spinal cord, and peripheral nervous system. For example, stroke, brain or spinal cord tumours, head injuries, epilepsy, and Parkinson’s disease.

 

This category does not include the treatment of spinal column conditions and chemotherapy or radiotherapy for cancer.

R Y Y Y Y Y
Eyes (not cataracts)

The investigation and treatment of the eye and contents of the eye socket. For example, retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.

 

This category does not include cataracts, eyelid procedures, and chemotherapy and radiotherapy for cancer.

R Y Y Y Y Y
Ear, nose and throat
The investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes, and related areas of the head and neck.This category does not include tonsils, adenoids, grommets, implantation of hearing devices, orthopaedic neck conditions, sleep studies, and chemotherapy and radiotherapy for cancer.
R Y Y Y Y Y
Tonsils, adenoids and grommets
Treatment of the tonsils, adenoids, and insertion or removal of grommets.
R Y Y Y Y Y
Bone, joint and muscle
Treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. For example: carpal tunnel, fractures, hand surgery, joint fusions, bone spurs, and bone cancer.This category does not include chest surgery, spinal cord conditions, spinal column conditions, joint reconstructions, joint replacements, podiatric surgery, management of back pain, and chemotherapy and radiotherapy for cancer.
R Y Y Y Y Y
Joint reconstructions
Treatment for joint reconstructions. For example: torn tendons, rotator cuff tears, and damaged ligaments.This category does not include joint replacements, bone fractures, spinal column procedures, and podiatric surgery.
R Y Y Y Y Y
Kidney and bladder
The investigation and treatment of the kidney, adrenal gland and bladder. For example: kidney stones, adrenal gland tumour and incontinence.This category does not include dialysis and chemotherapy and radiotherapy for cancer.
R Y Y Y Y Y
Male reproductive system

The investigation and treatment of the male reproductive system including the prostate. For example: male sterilisation, circumcision and prostate cancer.

This category does not include chemotherapy and radiotherapy for cancer.

R Y Y Y Y Y
Digestive system
The investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.This category does not include endoscopy, hernia and appendicectomy procedures, bariatric (weight loss) surgery, and chemotherapy and radiotherapy for cancer
R Y Y Y Y Y
Hernia and appendix
The investigation and treatment of a hernia or appendicitis.This category does not include digestive conditions.
R Y Y Y Y Y
Gastrointestinal endoscopy

The diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope (an instrument using a camera to look inside the body) For example: colonoscopy and gastroscopy.

This category does not include non-endoscopic procedures for the digestive system.

R Y Y Y Y Y
Gynaecology
The investigation and treatment of the female reproductive system. For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.This category does not include fertility treatments, pregnancy and birth-related conditions, miscarriage or termination of pregnancy, and chemotherapy and radiotherapy for cancer.
R Y Y Y Y Y
Miscarriage and termination of pregnancy
The investigation and treatment of a miscarriage or for termination of pregnancy.
R Y Y Y Y Y
Chemotherapy, radiotherapy and immunotherapy for cancer
Treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.This category does not include surgical treatment of cancer, which is listed separately under each body system.
R Y Y Y Y Y
Pain management
Treatment for pain management that does not require the insertion or surgical management of a device. For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.This category does not include pain management using a device such as an infusion pump or neurostimulator.
R Y Y Y Y Y
Skin
The investigation and treatment of skin, skin related conditions and nails. This category includes the removal of foreign bodies, and plastic surgery that is medically necessary and relating to the treatment of a skin related condition. For example: melanoma, minor wound repair and abscesses.This category does not include removal of excess skin due to weight loss, and chemotherapy and radiotherapy for cancer.
R Y Y Y Y Y
Breast surgery (medically necessary)
The investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.This category does not require benefits to be paid for cosmetic breast surgery that is not medically necessary.
R Y Y Y Y Y
Diabetes management (excluding insulin pumps)
The investigation and management of diabetes. For example: stabilisation of hypo- or hyper- glycaemia, contour problems due to insulin injections.Treatment for diabetes related conditions is listed separately under each body system affected.This category does not include treatment for ulcers or provision and replacement of insulin pumps.
R Y Y Y Y Y
Heart and vascular system
The investigation and treatment of the heart, heart related conditions and vascular system. For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls. Also known as cardiac services.This category does not include chemotherapy and radiotherapy for cancer.
R Y Y Y Y
Lung and chest
The investigation and treatment of the lungs, lung related conditions, mediastinum and chest. For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.This category does not include chemotherapy and radiotherapy for cancer.
R Y Y Y Y
Blood
The investigation and treatment of blood and blood related conditions. For example: blood clotting disorders and bone marrow transplants.This category does not include treatment for cancers of the blood.
R Y Y Y Y Y
Back, neck and spine
The investigation and treatment of the back, neck and spinal column, including spinal fusion. For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis.This category does not include joint replacements, joint fusions, spinal cord conditions, management of back pain, and chemotherapy and radiotherapy for cancer.
R Y Y Y Y Y
Plastic and reconstructive surgery (medically necessary)
Treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital. For example: burns requiring a graft, cleft palate, club foot and angioma.This category does not include treatment of skin-related conditions and chemotherapy and radiotherapy for cancer.
R Y Y Y Y
Dental surgery

Hospital treatment for surgery to the teeth and gums. For example: surgery to remove wisdom teeth, and dental implant surgery.

R Y Y Y Y Y
Podiatric surgery (provided by a registered podiatric surgeon)
The investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon. This is limited to cover for hospital accommodation and the cost of a prosthesis.Note that insurers are not required to pay for any other benefits for podiatric surgery, such as the surgeon’s fee or medical fees such as the anaesthetist, though they may choose to do so.
R Y Y Y Y Y
Implantation of hearing devices
Treatment to correct hearing loss, including implantation of a prosthetic hearing device.
R Y Y Y Y Y
Cataracts
Surgery to remove a cataract and replace with an artificial lens.
R Y Y
Joint replacements
Surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.This category does not include joint fusions, spinal fusions, joint reconstructions, and podiatric surgery performed by a registered podiatric surgeon.
R Y
Dialysis for chronic kidney failure
Dialysis treatment for chronic kidney failure (renal failure). For example: peritoneal dialysis and haemodialysis.
R Y
Pregnancy and birth
Investigation and treatment of conditions associated with pregnancy and child birth. Also known as obstetrics.This category does not include treatment for the baby (this is covered under the clinical category relevant to their condition), female reproductive conditions, fertility treatments, miscarriage and termination of pregnancy.
R Y Y
Assisted reproductive services

Hospital treatment for fertility treatments or procedures. For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra fallopian Transfer (GIFT).

This category does not include treatment of the female reproductive system, and pregnancy and birth-related services.

 

R Y
Weight loss surgery
Surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure. For example: gastric banding, gastric bypass, sleeve gastrectomy.
R Y
Insulin pumps
The provision and replacement of insulin pumps for treatment of diabetes.
R Y Y Y Y Y
Pain management with device
The implantation, replacement or other surgical management of a device required for the treatment of pain. For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).This category does not include treatment of pain that does not require a device.
R Y Y Y Y Y
Sleep studies
The investigation of sleep patterns and anomalies. For example: sleep apnoea and snoring.
R Y Y Y Y Y

 

Key:

Y Clinical category is covered on an unrestricted basis, providing cover as a private patient in a public or private hospital
R Restricted benefit that provides partial cover for hospital costs as a private patient in a public hospital. You may incur significant out of pocket expenses in a private room or private hospital. Members should check with Hunter Health Insurance for details.
No coverage for these clinical categories for that product

 

Waiting Periods

Waiting periods may apply for new and transferring members and for current members who are upgrading their cover.

The maximum waiting periods the Fund imposes are:

  • 12 months for pre existing conditions
  • 12 months for obstetrics (pregnancy)
  • 2 months for psychiatric care (if transferring from another Fund, 2 months waiting if not previously fully covered for psychiatric), rehabilitation or palliative care, even for a pre existing condition
  • 2 months in all other circumstances

Waiting periods for general treatment (ancillary or extras) varies dependent on the type of service

* The Federal Government rebate on Private Health Insurance is available to all Private Health Fund members eligible for Medicare and is means tested effective 1/7/2012. We recommend you register to participate in the Contribution Reduction Scheme. Higher rebates may also apply to contributors depending on their age and when initial joining of certain health products. Members who are over the age of 30 and not held continuous hospital cover since the 1 July 2000 are liable to pay an additional 2% loading for each year cover is not held under the Federal Government ‘Lifetime Health Cover’ initiative

Should you have any questions please do not hesitate to contact our staff on 02 4990 1385 or email: enquiries@hunterhi.com.au.

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