Public Hospital 100%

Waiting periods

If you have not previously held private health insurance, or you upgrade your cover, the following waiting periods will apply:

Accident cover	no waiting
Ambulance	no waiting
Pre-existing condition	12 months
Obstetrics-related condition	12 months
Crowns and bridges, dentures, orthodontic, periodontic, wisdom teeth, endodontics, hearing aids#, orthotic appliances, podiatry-related aids, prostheses benefits and approved appliances#.	12 months
Optical benefits, Health Management Programs	6 months
Psychiatric care, rehabilitation or palliative care (even if the condition is pre-existing)	2 months
All other benefits	2 months

^# Replacements for hearing aids and approved appliances are payable every three years.

What is an accident?

An accident means an unforeseen and sudden event occurring by chance and caused by an external force or object, resulting in involuntary bodily injury requiring immediate treatment from a medical practitioner. It does not include any condition which can be attributed to medical causes.

What's not covered

• Any difference between your doctor's fees and the Medicare Schedule/Access Gap Cover agreed fee.
• Gap payments may be applicable to certain prostheses (i.e. hip and knee joint replacements, artificial heart valves, pacemaker devices and intra-ocular lenses for cataract surgery).
• Any patient contributions for Pharmaceutical Benefit Scheme (PBS) prescriptions - unless receiving Private Hospital 100% benefits whilst in hospital.
• Any items of a personal nature, including TV rental or phone calls where not part of the agreed charges.
• The patient's portion that is applied to any 'nursing home-type' patient admission into a public or private hospital. This amount is determined by the Federal Government.
• Cosmetic, (plastic and reconstructive procedures) - benefits are only payable where it is required for a medical purpose and Medicare benefits are payable.
• Experimental and some high cost or exceptional drugs.
• Services not invoiced by the hospital.
• Emergency room treatment.
• Services able to be claimed by way of compensation or damages.

Pre existing conditions

*What is a pre-existing condition?

A pre-existing condition is one where signs or symptoms of your ailment, illness or condition – in the opinion of a medical practitioner appointed by us (not your own doctor) – existed at any time during the six months ending on the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover.

The only person authorised to decide if an ailment, illness or condition is pre-existing is the medical practitioner appointed by us. The medical practitioner we appoint must; however, consider any information regarding signs and symptoms provided by your treating medical practitioner(s).

Private health insurers can apply a special waiting period to new customers of hospital tables who have pre-existing conditions.

This waiting period also applies to existing policy holders who have recently upgraded their level of hospital cover.

If the ailment, illness or condition is considered pre-existing:

• New customers must wait 12 months for any hospital benefits. For psychiatric care, rehabilitation or palliative care, the maximum waiting period is 2 months (even if the condition is pre-existing).
  
• Policy holders transferring/upgrading to a higher hospital table must wait 12 months to get the higher hospital benefits.

General conditions

1. Premiums are payable up to 12 months in advance. Policies are automatically cancelled if premiums are two or more months in arrears.
2. Benefits are NOT payable for any services received while overseas. Members may apply to suspend their policy for periods of two weeks to 36 months while overseas. Documents such as but not limited to your boarding pass or overseas itinerary may be required to be sighted by us before cover is reinstated.
3. Family policies provide cover for the policy holder, their spouse and any dependant children/young adults until their 23rd birthday. Full-time student dependants are covered up until they turn 25. Student dependants must be registered each year from when they turn 23 years of age.
4. Benefits are paid in accordance with CUA Health’s rules and they shall not exceed the cost of any service. Benefits are not payable if your policy is in arrears.
5. You may not contribute to similar tables with more than one private health insurer.
6. Benefits are paid for claims lodged within 24 months of treatment.
7. If you are transferring from another private health insurer, CUA Health will grant you continuity of cover at an equivalent level, as long as you join within two months of the date that you were paid up to with your previous private health insurer. Loyalty bonuses are not transferable from one insurer to another. We will record your official date of joining CUA Health as at the day immediately after the date that you were “paid to” with your previous insurer, so that there is no period of time for which you are not covered. Your premiums will also be due from that date.
8. If you upgrade your cover, you will need to serve the waiting periods for your increased level of cover. Your existing level of cover will apply until these waiting periods are completed.
9. Single hospital policies for mothers covers the cost of the birth of the baby but does not cover any costs incurred by the baby. For your baby to be eligible for benefits immediately upon birth, the mother must have contributed to a family or single parent policy for at least two calendar months prior to the infant’s birth.
10. Benefits are not payable in respect of expenses incurred where you or your dependants are/were entitled to claim by way of compensation or damages.