Default benefit
For any service that is restricted on your level of cover, only default benefits are payable.* This benefit is determined by the Government and is the minimum amount funds must pay for accommodation costs in hospitals. Default benefits do not provide any benefit for labour ward or theatre fees. The default benefit covers the cost of
shared accommodation as a private patient at a public hospital;
a reduced level of accommodation benefits as a private patient at a private hospital;
Access Gap/Medical Gap Cover with participating doctors; and
surgically-implanted medical devices and human tissue products - we will cover the full cost of any Government approved (no gap) medical devices and human tissue products and the minimum benefit for gap permitted medical devices and human tissue products.
Significant out-of-pocket costs may result if the treatment can only be claimed at default benefit rates so remember to check whether your level of cover suits your needs, or if applicable choose a contracted hospital.
*Default benefits are also only payable for non-contracted hospitals.
