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Core Silver+ Hospital & Premium Extras

Core Silver+ Hospital offers you a great balance of coverage and price. Core Silver+ Hospital is perfect for individuals or families with varying health needs, when combined with Premium Extras cover you will benefit from a high level of cover for non-hospital related services such as dental and optical.

Policy coverage at a glance

Hospital

High Low

Extras

High Low

Core Silver+ Hospital inclusions

What’s included
Services
Rehabilitation
2 month waiting period

Hospital treatment for physical rehabilitation for a patient related to surgery or illness.
For example: inpatient and admitted day patient rehabilitation, stroke recovery, cardiac rehabilitation.
Palliative care
2 month waiting period

Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain.
Brain and nervous system
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the brain, brain related conditions, spinal cord and peripheral nervous system.
For example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.
Eye (not cataracts)
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.
For example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.
Ear, nose and throat
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.
For example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.
Tonsils, adenoids and grommets
2 month waiting period
(12 months for pre-existing)

Hospital treatment of the tonsils, adenoids and insertion or removal of grommets.
Bone, joint and muscle
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.
For example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.
Joint reconstructions
2 month waiting period
(12 months for pre-existing)

Hospital treatment for surgery for joint reconstructions.
For example: torn tendons, rotator cuff tears and damaged ligaments.
Kidney and bladder
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.
For example: kidney stones, adrenal gland tumour and incontinence.
Male reproductive system
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.
For example: male sterilisation, circumcision and prostate cancer.
Digestive system
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.
For example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids
Hernia and appendix
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of a hernia or appendicitis.
Digestive conditions are listed separately under Digestive system.
Gastrointestinal endoscopy
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.
For example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).
Gynaecology
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the female reproductive system.
For example: endometriosis, polycystic ovaries, female sterilisation and cervical cancer.

Miscarriage and termination of pregnancy
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy.
Chemotherapy, radiotherapy and immunotherapy for cancer
2 month waiting period
(12 months for pre-existing)

Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours.

Pain management
2 month waiting period
(12 months for pre-existing)

Hospital treatment for pain management that does not require the insertion or surgical management of a device.
For example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.
Skin
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of skin, skin related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin related condition is also included.
For example: melanoma, minor wound repair and abscesses.
Breast surgery
2 month waiting period
(12 months for pre-existing)

Medically necessary only.

Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy.
For example: breast lesions, breast tumours, asymmetry due to breast cancer surgery, and gynecomastia.
Diabetes management
2 month waiting period
(12 months for pre-existing)

Excluding insulin pumps.

Hospital treatment for the investigation and management of diabetes.
For example: stabilisation of hypo or hyper glycaemia, contour problems due to insulin injections.
Heart and vascular system
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the heart, heart related conditions and vascular system.
For example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.

Lung and chest
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the lungs, lung related conditions, mediastinum and chest.
For example: lung cancer, respiratory disorders such as asthma, pneumonia, and treatment of trauma to the chest.
Blood
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of blood and blood related conditions.
For example: blood clotting disorders and bone marrow transplants.
Back, neck and spine
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion.
For example: sciatica, prolapsed or herniated disc, and spine curvature disorders such as scoliosis, kyphosis and lordosis.

Plastic and reconstructive surgery
2 month waiting period
(12 months for pre-existing)

Medically necessary only.

Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.
For example: burns requiring a graft, cleft palate, club foot and angioma.
Dental surgery
2 month waiting period
(12 months for pre-existing)

Hospital treatment for surgery to the teeth and gums.
For example: surgery to remove wisdom teeth, and dental implant surgery.
Podiatric surgery
2 month waiting period
(12 months for pre-existing)

Must be provided by a registered podiatric surgeon.

Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon.
Implantation of hearing devices
2 month waiting period
(12 months for pre-existing)

Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device.
Stapedectomy is listed separately under Ear, nose and throat.
Insulin pumps
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes.
Pain management with device
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.
For example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).
Sleep studies
2 month waiting period
(12 months for pre-existing)

Hospital treatment for the investigation of sleep patterns and anomalies.
For example: sleep apnoea and snoring.
Ambulance cover
2 month waiting period

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.
What’s Restricted
Services
Hospital psychiatric services
2 month waiting period

Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.
For example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.
What’s Excluded
Services
Cataracts

Hospital treatment for surgery to remove a cataract and replace with an artificial lens.
Joint replacements

Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.
For example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint, spinal disc replacement.
Dialysis for chronic kidney failure

Hospital treatment for dialysis treatment for chronic kidney failure.
For example: peritoneal dialysis and haemodialysis.
Pregnancy and birth

Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth.
Treatment for the baby is covered under the clinical category relevant to their condition. For example, respiratory conditions are covered under Lung and chest.
Assisted reproductive services

Hospital treatment for fertility treatments or procedures.
For example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra fallopian Transfer (GIFT).
Weight loss surgery

Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.
For example: gastric banding, gastric bypass, sleeve gastrectomy.
Services where Medicare does not pay a benefit

Not covered.

Premium Extras inclusions

What’s included
Category Annual Limit
General Dental
2 month waiting period 		unlimited

Covers dental items listed by the Australian Dental Association (ADA) up to a set rebate.
Includes restorations/fillings & Occlusal Therapy.
Major Dental
12 month waiting period 		$2,000
Periodontics up to $1,000
Extractions/Oral Surgery up to $1,000
Endodontics up to $1,000
Crowns/Bridgework up to $1,000
Dentures^/Implants up to $1,000

^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.
Orthodontic
12 month waiting period 		$2,500

Maximum of $2,500 per course of treatment; 80% of provider fee per rolling 3 year period (a treatment plan is required).
Optical
6 month waiting period 		$350

100% of the fee up to the annual limit
Single Vision lens + frame
Bifocal/Multifocal lens + frame
Contact Lenses
Optical benefit is only payable where the lens includes a form of sight correction. A prescription must accompany all claims for benefits.  Benefits are not available for lens coatings and features such as anti-reflection or scratch resistant coatings.
Eye Therapy
2 month waiting period 		$500
Initial Consultation $70
Subsequent Consultation $55
Laser Eye Surgery
12 month waiting period 		$1,500

100% of the fee up to the annual limit
One service every two (rolling) years.
Occupational Therapy
2 month waiting period 		$500
Initial Consultation $60
Subsequent Consultation $40
Physiotherapy
2 month waiting period 		$850

Includes Telehealth Services.

Initial Consultation $67
Subsequent Consultation $52
Group Session $25
Ante/Post Natal Classes up to $100
Chiropractic and Osteopathy
2 month waiting period 		$750

$1,500 per family limit

Initial Consultation $60
Subsequent Consultation $41
Chiropractic X-rays (1 person per year) $70
Podiatry and Chiropody
2 month waiting period 		$500
Initial Consultation $57
Subsequent Consultation $44
Impression cast $50
Podiatry Surgery $200
Dietitian
2 month waiting period 		$500

Includes Telehealth Services.

Initial Consultation $80
Subsequent Consultation $55

This is a consultation benefit only and does not cover any prescribed medications, herbal or dietary preparations or organised weight reduction programs.
Non-PBS Pharmacy
2 month waiting period 		$600

Per Prescription up to $120
Navy Health pays the difference between the cost of the prescription and set cost of the Pharmaceutical Benefit Scheme (PBS), up to the maximum per prescription.
For more information and conditions please refer to the Pharmacy page.
Natural Therapies
2 month waiting period 		$550

$1,100 per family limit
Per Service $38
Natural therapies include Acupuncture, Chinese Herbal Medicine, Exercise Physiology, Myotherapy, Remedial Massage/Therapy. Benefits are not payable on any prescribed medications, herbal or dietary preparations, or weight reduction programs.

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. 
Psychology
2 month waiting period 		$600

Includes Telehealth Services.

Initial Consultation $110
Subsequent Consultation $80
Group Session $55

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.
Speech Therapy
2 month waiting period 		$500

Includes Telehealth Services.

Initial Consultation $110
Subsequent Consultation $55
Medically Prescribed Appliances (MPAs)
6 month waiting period 		$700

85% of the fee up to the annual limit
For more information and conditions please refer to the Medically Prescribed Appliance (MPA) page.
CPAP Devices
12 month waiting period 		$1,000

100% of the fee up to the annual limit
Includes repairs to the CPAP device.
Three year replacement period applies for new CPAP devices.
Orthotics and Orthopaedic Appliances
2 month waiting period 		$300

85% of the fee up to the annual limit
Orthopaedic footwear must be for a medically prescribed purpose and constructed for the individual member by a specialist orthopaedic footwear manufacturer. Commercially available brands of footwear and sporting footwear are not eligible for benefits. Includes repairs to Orthotics.
Hearing Aids
12 month waiting period 		$1,300

100% of the fee up to the annual limit
Repairs on Hearing Aids up to $150
Supply of hearing aids is limited to one supply (either single or two aids) every three years. The maximum three year limit applies to any three (rolling calendar) year period from the first date of service.
Audiology
2 month waiting period 		$500
Initial Consultation $70
Subsequent Consultation $55
Home Nursing
2 month waiting period 		$1,000

Per Service $60
Home nursing is classified as professional treatment by a registered nurse on the recommendation of a medical practitioner.

School Accidents
2 month waiting period 		$800

Benefits include costs that result from a school accident to a member’s dependent child. Claims must be accompanied by notification of the accident on school letterhead.

Ambulance Services
2 month waiting period 		unlimited

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

Privacy Policy  Terms and Conditions  Code of Conduct

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© Navy Health Ltd All Rights Reserved 2023

Privacy Policy  Terms and Conditions  Code of Conduct