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Health Insurance

 

Step 1 Tell us about you

& want to cover

I have had continuous cover since I turned 31
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My partner has had continuous cover since they turned 31
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This value affects your government rebate

Step 2 Choose your hospital cover

Tell us the level of cover you require. Below details what each option covers.

Accommodation for overnight and same day stays, operating theatre, intensive care and ward changes.

Benefits are for Private or Public hospital treatments
Pick a cover
  • You pay nil excess.
  • You pay $250 excess. The excess applies once per person per calendar year, and does not apply to day surgery or dependants
  • You pay 10% capped at maximum of $500 per person per calendar year. Not payable for dependant children up to 23 years old or 25 if full-time student.
  • You pay 25% capped at maximum of $1,000 per person per calendar year. Not payable for dependant children up to 23 years old or 25 if full-time student.
  • You pay 35% capped at maximum of $1,000 per person per admission. Not payable for dependant children up to 23 years old or 25 if full-time student
  • Accommodation for overnight and same day stays is limited to public hospital rates. This cover is not designed for use in a Private Hospital as large out-of-pocket expenses may apply.
Accident cover RB
Removal of appendix RB
Removal of tonsils and adenoids RB
Cancer treatment RB
Sterilization RB
Rehabilitation RB
Palliative care RB
Cardiac and related services RB RB
Cataract and eye lens procedures RB
Pregnancy & birth related services RB
Assisted reproductive services RB
Dialysis for chronic renal failure RB
Hip and knee replacements BLP BLP BLP RB
All other joint replacements RB
Gastric banding and related services BLP BLP BLP RB
Psychiatric services BLP BLP BLP RB RB
Choice of your own doctor and/or specialist Coverage of doctor / specialist services while in hospital is for the difference between the Medicare benefit and the Medicare schedule fee or the Access Gap Cover agreed fee.
Approved prostheses benefits such as artificial hips and knees
All other in-hospital services receiving a Medicare benefit RB

^ By choosing 100% Private Hospital Cover with $250 excess, you have the same comprehensive cover with lower regular payment and a maximum of $250 per person per calendar year for hospital visits. $250 excess payable upon admission to hospital.
BLP - For first 24 months from joining, benefit is limited to public hospital rates.
RB - For entire policy duration, benefit restricted to public hospital rates.

Waiting periods and pre-existing conditions Show content

When you take out health insurance for the first time, switch insurers or increase your level of cover, CUA Health asks that you wait a period of time before you can claim for new or higher benefits. Take a look at the table below to find out what waiting periods apply.

No waiting

Accident cover
For CUA Health an accident is an unforeseen and sudden event occurring by chance and caused by an external force or object, resulting in an involuntary bodily injury requiring immediate treatment from a medical practitioner. It does not include any condition that can be attributed to medical causes.

2 months

Psychiatric care, rehabilitation or palliative care (including where the condition is pre-existing)

All other hospital treatments

12 months

Pre-existing conditions
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 – existed at any time during the six months ending on the day on which you purchased your hospital cover or upgraded to a higher level of hospital cover

Obstetrics-related conditions

With our private hospital cover you can be treated as a private patient in a private or public hospital. CUA Health has agreements with the majority of private hospitals and day surgeries where you will receive benefits for your hospital accommodation, including:

  • accommodation for overnight or same-day stays
  • standard single or share hospital accommodation
  • operating theatre, intensive care and ward fees
  • surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List
  • your choice of doctor or specialist

Please contact us prior to any hospital admission to make sure your hospital is in agreement with CUA Health.

  • Hospital treatment for which Medicare pays no benefit, like cosmetic surgery
  • In some cases your doctor’s and/or specialists’ (radiologist, anaesthetist etc) fees may still be more than the Medicare benefit plus the CUA Health gap scheme so you may be required to make an additional payment. Please check this with your doctor before consultation or treatment.
  • Gap payments may apply to certain prostheses (e.g. hip and knee joint replacements, artificial heart valves, pacemaker devices and intra-ocular lenses for cataract surgery)
  • Any items of a personal nature, including TV rental or phone calls while in hospital that are not part of the agreed medical costs
  • You’ll need to pay any additional costs that are applied to any 'nursing home-type' patient admission into a public or private hospital. This amount is determined by the Federal Government.
  • Experimental and some high cost or exceptional drugs
  • Services not invoiced by the hospital
  • If you go to an emergency room and are not admitted but the hospital still charges you for your visit, this charge is not covered and you’ll need to pay this yourself
  • Services able to be claimed by way of compensation or damages. CUA Health reserves the right to a full and immediate reimbursement of any claims covered by way of compensation or damages from another party.
  • Services provided by a family member
  • Any treatment considered an outpatient service, e.g. Radium
  • Benefits for products, services or treatments purchased from or provided by practitioners overseas, whether you buy them in person, by mail order or online
See full Terms & Conditions below

Step 3 Choose your extras cover

With CUA Health Extras Cover, you have the freedom to choose your healthcare professional. You're not restricted by a network of preferred providers so you can choose when and where you're treated, and the healthcare professional you see.

Pick a cover

Important information Show content

Please read the information carefully and retain for your future reference. If you join CUA Health, confirmation of your cover and policy information will be sent to you. If you change your mind CUA Health provides a cooling off period of 30 days from the start date of your policy. For more information including Privacy notice, Code of Conduct and Complaints resolution refer to cuahealth.com.au.

CUA Health insurance is provided by CUA Health Limited ABN 98 098 685 459, a wholly-owned, non-guaranteed subsidiary of CUA.

Hospital Cover
Benefit limitation periods

During the first 24 months from joining and after waiting periods have been served, benefits paid for these treatments will be limited to the same amount you would receive in a public hospital for the same treatment. After 24 months from joining you will be eligible for the full benefits under the policy.

Public Hospital cover

If you choose our Public Hospital cover, benefits will be limited to public hospital rates. You have the option to select you own doctor or specialist, however, public hospital waiting lists still apply. This product is not design no be used in a private hospital as large out-of-pockets expenses may apply.

Medical costs

The medical charge is the cost for any services performed by doctors or specialists. This includes, but is not limited to – surgeons, anaesthetists, pathologists and assistant surgeons. Medicare sets an amount payable toward the medical costs, called the Medicare schedule fee. Medicare pays 75% of the schedule fee and CUA Health pays the remaining 25%. If the doctor or specialist chooses to charge above the schedule fee, then the difference is paid by you, unless your doctor or specialist chooses to participate in CUA Health’s Access gap cover scheme – see below for more info.

Access gap cover scheme

The Access Gap Cover Scheme will reduce or in some instances eliminate your out-of-pocket expenses for specialist care you receive while in hospital.

Doctors and specialists electing to participate in the Access Gap Cover Scheme can bill CUA Health directly. So, not only does your hospital treatment cost you less, but the billing system is made easier for you too.

Access to a complete list of doctors and specialists participating in the Access Gap Cover Scheme is available at cuahealth.com.au. If your doctor or specialist chooses to use the Scheme, you will either:

  • have no out-of-pocket expenses, or
  • be provided with an estimate of out-of-pocket expenses before your treatment

Your doctor or specialist may choose to use the Scheme on a patient-by-patient basis. Of course, whether or not your doctor or specialist participates in the Access Gap Cover Scheme will not change the relationship you have with him or her, or affect the treatment you receive.

Excess and Co-payment

Excess: An upfront amount that you agree to pay towards the cost of hospital treatment, in exchange for lower premiums. For example, if you have 100% Private Hospital Cover with $250 excess, if you require hospital treatment you’ll pay $250 per person, per calendar year. This does not apply to day surgery or dependants listed on the policy.

Co-payment: A percentage amount that you agree to pay towards the cost of hospital treatment, in exchange for lower premiums. For example, if you choose the 90% Private Hospital Cover, you would need to pay 10% of the hospital charge, capped at a fixed amount of $500 per person, per calendar year. CUA Health would then pay the remaining hospital charge.

Agreement hospitals

CUA Health has agreements with the majority of private hospitals and day surgeries. If your hospital or day surgery doesn’t have an agreement with CUA Health, you may be subject to large out-of-pocket expenses, in addition to any excess or co-payment. Please check with your hospital prior to admission. Access to a complete list of agreement hospitals is available at cuahealth.com.au.

Extras Cover

It’s important to know that we only pay a benefit for services performed by private practitioners in a private practice, provided their associations and services are recognised by us. If you’re unsure if the provider you have selected, or service you require is covered under your policy, please contact CUA Health for confirmation. The items, limits and benefits are provided as a general guide only. Please call us if any further information is required. Calendar year limits cover the period 1 January to 31 December each year.

Orthodontic lifetime Limit

If you’re transferring from another health insurer where you have reached your ’Maximum Benefit Limit’ or ’Lifetime Limit’ entitlement for specialist dental services you will be required to serve a 12-month waiting period before you can claim with us.

* First month free is offered only to new policy holders who join via CUA directly and cannot be used in conjunction with any other offer. CUA Health is a wholly owned, non-guaranteed subsidiary of CUA.

Summary

Step 1: About You

Step 2: Choose Hospital

Step 3: Choose Extras

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