Before you go to hospital

When you're admitted to hospital as an inpatient, you will incur medical costs, in addition to fees charged by the hospital. Medical charges can include the costs of medical specialists, surgeons, anaesthetists, and radiologists to name a few.

You can claim the medical costs with Medicare if they have a Medicare item number under the Medicare Benefit Schedule. Additionally, you can also claim these costs with Defence Health if the clinical category is included in your level of cover.

An outpatient service is when you are referred to a specialist for a consultation about your medical condition. Or when you see the specialist in the weeks after a hospital admission or have a minor procedure in the specialist’s rooms at the hospital. You are not an admitted inpatient in the hospital for these outpatient appointments.  

Private health insurers, including Defence Health, cannot pay benefits towards outpatient services. Eligible outpatient services with a Medicare item number can be claimed through Medicare.  

Your private hospital cover with Defence Health does not include the following:

• Any clinical categories of treatment that are excluded from your cover
• Treatment received while you’re serving a waiting period (including for pre-existing conditions)
• Treatment provided at an emergency department of a hospital
• Treatment for which a Medicare benefit is not payable, e.g. most cosmetic surgery 
• Treatment in doctors’ rooms or specialist tests as an outpatient
• Surgery by a non-accredited podiatric surgeon  
• Private midwifery fees if a doctor is required to intervene in the delivery.

Check your Product Guide  for your included and excluded clinical treatment, as well as other situations where benefits cannot be claimed. If you're unsure about whether you're covered, please contact us.