Your private hospital cover is intended to help you pay for medically necessary treatments as an inpatient only. You are not covered for any non-medically necessary procedures. For example, you are not covered for cosmetic surgery. However, you are covered for plastic surgery, reconstructive surgery, or any elective surgery that your doctor and Medicare deem to be medically necessary. Check your product guide for any applicable restrictions or exclusions.
Some covers have excluded services for which we pay no benefit. If your cover has excluded services, these are listed in your product guide.
Some covers have restricted services. If your cover has restricted services, these are listed in your product guide. For restricted services, we will pay the default benefit for hospital accommodation as determined by the Government.
You are not covered for visits to public or private hospital emergency departments. Even if you have a Medicare card, you will be required to pay triage fees when you visit a private hospital emergency department.
You’re not covered for consultations with doctors or specialists before your admission or after you are discharged, even if your appointments are at the hospital. Medicare will pay a percentage of the Medicare Benefits Schedule (MBS) fee for these appointments, but due to legislation we are not able to pay any benefits.
Booking or administration fees
You are not covered for booking or administration fees, that surgeons charge patients on top of their quoted medical costs. Health funds can’t cover these fees as they are not for a medical procedure. If you see a fee like that on a statement, ask your doctor to explain the clinical or medical relevance of the charge. If you don’t get a satisfactory answer, you should not pay that fee.
Pre-existing ailments or conditions
You may not be covered for pre-existing ailments if you're new to Union Health or recently upgraded to a higher cover.
Possible hospital out-of-pocket costs include
hospital treatment that is not medically necessary or treatment which is not eligible for Medicare benefits
charges above the Medicare Benefits Schedule (MBS) fee
some pharmacy items
personal incidentals (e.g. toiletries, newspapers, tv, etc.)
high cost medications*
robotic surgery consumables*
medical devices not included in hospital theatre fee charges as determined by law.
*Special consideration for benefits toward high cost medications, exceptional medical procedures or other extraordinary costs related to the health care of a Union Health member may be given at the discretion of Union Health in accordance with the hospital contract. Requests are considered on a case-by-case basis.
We have a great range of hospital covers, so you can pick the one that suits your lifestyle and budget.With extras you can claim for services such as dental, optical, physio and massage. We have a great range of covers, so you can pick the one that suits your lifestyle and budget.
(*) Prices include direct debit discount. (R) Restrictions apply. Sub limits may apply on extras products, click on for more details. Set extras benefits apply per service and vary depending on cover. Waiting periods may apply. Your rates may differ based on your Lifetime Health Cover loading (LHC). Actual rates may differ from those stated by up to 5c due to rounding increments.
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Unfortunately, we don’t have a level of cover that matches the criteria you have selected. If you would like to discuss this further, please contact us on 1300 661 283 or via email at email@example.com.