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Each person is permitted to be admitted as a private patient in a private hospital for up to 5 separate day procedures within a financial year (July to June). No theatre fees are covered in the case of an overnight admission; admission in a non-contracted hospital; or after the fifth day procedure. In these circumstances, government default benefits will apply. Please ask the hospital in regards to the current rates and please note no theatre fees are covered by default benefits’. When combined with Healthy Living Extras you will benefit from a high level of cover for non-hospital related services such as dental or optical.
Hospital
| Services | |
|---|---|
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Cancer 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Treatment for accidents 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Cardiac + cardiac related services 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Tonsils + adenoids 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Appendicitis 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Wisdom teeth (Hospital benefits only) 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Arthroscopy + colonoscopy 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Pregnancy + pregnancy related services 12 month waiting period |
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Covered as a private patient in a public hospital only. |
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Assisted Reproductive services (IVF, etc.) 12 month waiting period |
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Covered as a private patient in a public hospital only. |
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Spinal surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Shoulder surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Knee reconstruction 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Psychiatric services 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Rehabilitation 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Palliative care 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Major eye surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Dental surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Kidney dialysis 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Bariatric surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Hip + knee replacement 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Other joint replacement 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Prosthetic appliances 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Early release home nursing 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Podiatry surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. Limited benefits are available when Podiatric Surgery is performed in a contracted hospital by an Australian Government Accredited Podiatrist. |
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Non-cosmetic surgery/plastic surgery 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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Ambulance cover 2 month waiting period |
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100% of the cost of ambulance services within Australia provided that the service is from a State/Territory registered ambulance service and deemed medically necessary. |
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All other services recognised by Medicare 2 month waiting period |
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Covered as a private patient in a public hospital only. |
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| Services | |
|---|---|
| Cosmetic surgery |
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Not Covered. |
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| Services where Medicare does not pay a benefit |
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Not Covered. |
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| Category | Annual Limit | |
|---|---|---|
|
General Dental 2 month waiting period |
unlimited |
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Covers dental items listed by the Australian Dental Association (ADA) up to a set rebate. |
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Major Dental 12 month waiting period |
$1,500 |
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^For dentures a rolling three year minimum replacement period applies from the first date of service. Set benefits are payable for individual dental services and may not attract the fully major dental annual sub-limit. |
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Orthodontic 12 month waiting period |
$2,000 |
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Maximum of $2,000 per course of treatment; 70% of provider fee per rolling 3 year period (a treatment plan is required). |
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Optical 6 month waiting period |
$260 |
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100% of the fee up to the annual limit |
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Eye Therapy 2 month waiting period |
$300 |
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Laser Eye Surgery 12 month waiting period |
$1,200 |
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100% of the fee up to the annual limit |
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Occupational Therapy 2 month waiting period |
$400 |
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Physiotherapy 2 month waiting period |
$600 |
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Includes Telehealth Services. |
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Chiropractic and Osteopathy 2 month waiting period |
$550 |
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$1,100 per family limit |
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Podiatry and Chiropody 2 month waiting period |
$300 |
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Dietitian 2 month waiting period |
$300 |
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Includes Telehealth Services. This is a consultation benefit only and does not cover any prescribed medications, herbal or dietary preparations or organised weight reduction programs. |
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Non-PBS Pharmacy 2 month waiting period |
$500 |
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Per Prescription up to $120 |
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Natural Therapies 2 month waiting period |
$320 |
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$640 per family limit From 1 April 2019, all health insurers will no longer be able to pay a benefit on the following Natural Therapies; Alexander technique, aromatherapy, Bowen therapy, Buteyko, Feldenkrais, herbalism, Western herbalism, homeopathy, iridology, kinesiology, naturopathy, reflexology, Rolfing, shiatsu, tai chi, and yoga. |
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Psychology 2 month waiting period |
$400 |
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Includes Telehealth Services. Hypnotherapy is payable if the provider is a fully registered member of the Psychology Board in their State/Territory or if they are a clinical member of an approved association. |
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Speech Therapy 2 month waiting period |
$300 |
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Includes Telehealth Services. |
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Medically Prescribed Appliances (MPAs) 6 month waiting period |
$400 |
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85% of the fee up to the annual limit |
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CPAP Devices 12 month waiting period |
$600 |
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100% of the fee up to the annual limit |
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Orthotics and Orthopaedic Appliances 2 month waiting period |
$200 |
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85% of the fee up to the annual limit |
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Hearing Aids 12 month waiting period |
$900 |
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100% of the fee up to the annual limit |
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Audiology 2 month waiting period |
$300 |
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Home Nursing 2 month waiting period |
$1,000 |
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Per Service $60 |
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Ambulance Services 2 month waiting period |
unlimited |
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100% of the cost of ambulance services within Australia provided that the service is from a State/Territory registered ambulance service and deemed medically necessary. |
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© Navy Health Ltd All Rights Reserved 2023
© Navy Health Ltd All Rights Reserved 2023
