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Top Hospital 250/500 and Standard Extras

 Download product summary

Defence Health’s Top Hospital insurance provides cover for all Medicare-approved treatments in all hospitals throughout Australia. What’s more, we have agreements with over 500 hospitals which enable us to provide 100% cover for hospital costs.. A list of the agreement hospitals can be found on the Find a hospital page.

Your excess

Your premium has been reduced by choosing Top Hospital with a $250 excess for singles and a $500 excess for couples, families and single parent families. The excess applies to same day procedures as well as overnight admissions. It is payable once only per policy, per financial year on an adult admission to hospital. No excess is payable on hospital admissions for dependent children. 

What is covered

Treatment in an agreement hospital

  • 100% cover for all agreement hospital admissions, whether overnight or same-day. That includes:
    • Shared or private room accommodation
    • Theatre fees, including labour ward
    • Intensive care, critical care and high dependency unit
    • Most drugs supplied in hospital
  • Up to 100% for prostheses included on the Federal Government’s Prostheses Listing
  • Up to 100% of doctors’ fees if your doctor uses Access Gap. At a minimum, we cover the difference between the amount Medicare pays and the Medicare Benefits Schedule fee.


Note: If you choose to be treated in a non-agreement private hospital you will incur out-of-pocket expenses.

Features of Defence Health Top Hospital cover

  • Choice of doctor
  • Choice of hospital
  • Hospital in the home – post hospital care such as wound management, intravenous therapy and post-natal care – through selected hospitals.
  • Ambulance service – including mobile intensive care, air and sea ambulance
  • Programs and services outside of hospital (detailed below).
  • Excess options to reduce your premium
  • No excess payable for children
  • Access Gap to reduce out-of-pocket medical expenses
  • Dependent children covered to age 21, or to 25 if they are single and studying fulltime.
  • Children aged 21–25 who are single and not studying fulltime can stay on their family hospital cover if they take out their own Top Extras.
  • Waiting periods already served at other funds honoured

    Programs and services outside of hospital

    Defence Health offers a range of programs and services to help look after your health and wellbeing outside of hospital. These services are made available to members if they are assessed as clinically appropriate for them.

     Health and wellness benefits

    Chronic care

    Our chronic disease management programs are designed for members who have had a hospital admission relating to coronary artery disease.The programs provide telephone-based support that is focussed on keeping your recovery on track. The program coordinators work with your treating practitioner to ensure the support supplements your existing health treatment.

    Home nursing

    Defence Health will pay up to $1,800 per person per financial year (payable at $70 per day) for home nursing provided as an alternative to hospitalisation. The service must be provided by a registered nurse in private practice and certified by a medical practitioner.

    Hospital substitute

    Defence Health has agreements with a number of health care providers to deliver certain services in your home. Such services include wound management, intravenous therapy, administration of blood products and ambulatory sleep studies. We cannot guarantee that a participating provider will be available in your area.

    Midwifery

    We will pay up to $1,000 for midwife attendance at delivery and up to $500 per person per financial year for pre and post-natal visits ($40 per pre-natal visit and $80 per post-natal visit). Your midwife must be registered and in private practice.

    Midwifery benefits are not payable for hospital births. If a doctor is required to intervene in the delivery, benefits will be payable for the doctor’s in-hospital treatment instead.

    What's not covered

    • Treatment received while serving a waiting period.
    • Treatment provided at an emergency department of a hospital.
    • Treatment for which a Medicare benefit is not payable. However, we do cover rehabilitation, psychiatric and palliative care hospital treatments.
    • Treatment not clinically necessary (such as cosmetic surgery).
    • Doctors’ fees in excess of the MBS fee, unless covered by Access Gap.
    • Pharmaceuticals provided on discharge, or unrelated to the reason for hospitalisation.
    • Exceptional (high-cost) drugs.
    • Personal items such as newspapers, toiletries, pay-TV or crutches. (Crutches are claimable under extras cover.)
    • Accommodation in an aged care facility.
    • A hospital stay beyond 35 days that is not supported by an acute care certificate. This will incur out-of-pocket expenses.
    • Surgery provided by a non-accredited podiatric surgeon. For podiatric surgery provided by a Commonwealth accredited podiatric surgeon, hospital benefits will be paid at the insured rates and a limited benefit is payable for the podiatric surgeon’s fees.

    Non-resident limitations

    Defence Health hospital products are not suitable for non-residents without full Medicare entitlements. This includes overseas visitors from countries with Australian Government reciprocal health care arrangements.

    Standard Extras benefits

    Standard Extras provides benefits on a select range of general health care services. Click any of the links below to view the benefit detail.

    Dental

    Dental

    Financial year limit Waiting period

    Defence Health has set benefits for individual dental services. Some services are not payable in combination with others. Some are limited by the number of times they attract a benefit per year. Others may not attract a benefit at all.

    General dental includes items related to general oral health - check-ups, scale & clean, simple fillings etc.
    Major dental includes crowns & bridgework, oral surgery, periodontics, endodontics, orthodontics and other specialised dental procedures.

    $400 per person

    2 months for general dental

    12 months for major dental

    If you are planning extensive treatment, ask your dentist for the item numbers and costs, then call us for a quote.

    Ambulance treatment

    Ambulance treatment

    Financial year limit Waiting period
    100% cover for all treatment provided by a state-appointed ambulance service in Australia including emergency services, non-emergency services, mobile intensive care, air and sea ambulance services.

    Unlimited

    2 months

    Optical

    Optical

    Financial year limit Waiting period
    Our Optical Network providers are Specsavers and VSP Neighbourhood Eyecare. Optical benefits at the Optical Network and other providers are as follows:     

     

    $150 per person

    2 months

       

    Specsavers

               

      VSP-Neighbourhood
    Eyecare

     

    Other providers

    • Single vision lenses
     2 pairs glasses no-gap 1 pair glasses no-gap  up to $80
    • Ground single vision lenses
    2 pairs glasses no-gap  1 pair glasses no-gap  up to $95
    • Bi-focal lenses
    1 pair glasses no-gap  1 pair glasses no-gap  up to $105
    • Multi-focal lenses
    1 pair glasses no-gap  1 pair glasses no-gap  up to $120
    • Frames
    discounted  discounted  up to $95
    • Contact lenses
    10% off in store  15% off in store  up to $120
    In addition, by using our Optical Network, Specsavers provides free sun tint with UV on the first pair of glasses and free digital retinal photography. VSP Neighbourhood Eyecare provides free UV coating on the first pair of glasses. At both providers members are eligible for discounts on optical purchases and other lens options. Benefits are paid only where sight-correcting prescriptions accompany the claim. Visit specsavers.com.au or vsp-australia.com.au to find your nearest store. 

    Physiotherapy, Chiropractic and Osteopathic

    Physiotherapy/Chiropractic/Osteopathic

    Physio benefits are also paid for hydrotherapy treatment

    Financial year limit Waiting period
    • Initial consultation
    up to $28

    $450 per person
    up to
    $1,000 per family

    2 months

    • Subsequent consultation
    up to $22
    • Group therapy session
    up to $10
    • Ante / post natal class max 10
      (or full day ante-natal class up to $100)
    up to $10

    Alternative therapy

    Alternative therapies

    Financial year limit Waiting period
    • Consultation
    up to $18

    $150 per person

    2 months

    Benefits are paid only on consultations for acupuncture, homeopathy, aromatherapy, myotherapy, naturopathy, remedial massage, remedial therapy, Chinese herbal medicine and western herbal medicine where the provider is recognised by the Australian Regional Health Group. Benefits are not payable on any prescribed medications, herbal or dietary preparations.

    Pharmacy and vaccination

    Pharmacy and vaccinations

    Financial year limit Waiting period
    • Per prescription 

    up to $50

    $250 per person

    2 months

    Defence Health provides a benefit for non-PBS pharmaceuticals - including travel vaccinations. The benefit payable is the difference between the prescription amount and the current PBS fee.

     

     

    Know your limits
    Most of the goods or services claimable under extras cover have annual per person limits. Some categories may include family maximums. Limits are re-set on 1 July each year. Once the annual limit has been reached, no further benefits are payable for those services until the next financial year. All services must be provided by an approved practitioner in private practice. Benefits are only payable on goods or services purchased in Australia and only where Medicare benefits are not payable.

     

     

     

     

    This information is current as at 1 April 2014 and effective through to 31 March 2015. It replaces all earlier versions. Please read it carefully.