Basic Hospital

Basic Hospital is our base level hospital product designed specifically for those who are young and healthy and don’t want to pay high premiums for services they feel they are unlikely to need in the near future.

Basic Hospital provides cover for your choice of doctor in a public hospital and cover for five key services in a private hospital - refer to the table below for more information. This product does not entitle you to avoid public hospital waiting lists.

Private Hospital (Agreement private hospital and same day surgeries)

Choice of Agreement private hospital

Click here to search for an agreement hospital.

Accommodation – shared and private room (when available)

Theatre fees, intensive care fees

Labour ward fees

Private Hospital Services

Removal of tonsils and adenoids

Knee and shoulder investigations and reconstructions

Appendicitis treatment

Hernias

Removal of wisdom teeth

Pregnancy & birth related services

Restricted

Infertility treatments

Restricted

Hip, knee, shoulder & ankle replacements

Restricted

Coronary care & cardiothoracic surgery

Restricted

Dialysis procedures & treatments

Restricted

Major eye & eye lens surgery

Restricted

Bariatric surgery

Restricted

Sterilisation & reversal of sterilisation

Restricted

Psychiatric, rehabilitation & palliative care

Restricted

All other services where Medicare pays a benefit

Restricted

Services that do not attract a Medicare benefit

Medical services

Choice of doctor

Access Gap Cover

Click here for more information about Access Gap Cover.

Government approved surgically implanted prostheses

Public Hospital

Shared room

Private room (where available)

Theatre fees, intensive care fees

Labour ward fees

Other

Excess

Non-emergency Ambulance

Emergency Ambulance Transport

Exemption from Medicare levy surcharge

Restricted services

We pay Minimum Benefits for restricted services. This means that we will pay the minimum default benefit rate for a shared room as set out by the Commonwealth Minister for Health from time to time, and minimum benefits for Government approved Prosthesis List items.
If you choose to be treated:
  • In a private hospital – the benefits we pay will not cover all hospital costs resulting in significant out-of-pocket expenses
  • In a public hospital as a private patient – you may have an out-of-pocket expense to pay, in the event that the minimum benefit is less than what your chosen public hospital charges

Regardless of where you’re treated, the hospital should advise you before you are admitted or have treatment, and seek your consent about any out-of-pocket expenses you’ll need to pay. This is known as informed financial consent.

Waiting periods

A waiting period is the time you need to wait after taking out your cover before you can receive benefits for those services or items and apply to:

  • new members to private health insurance
  • existing Nurses & Midwives Health members who upgrade to a higher level of cover or reduce their level of excess
  • members who transfer from another health fund who have not already completed the required waiting periods, or who are transferring to a higher level of cover
If you have cancelled your health insurance membership with another health fund, you need to join Nurses & Midwives Health within 60 days to make sure you receive continuity of cover.


Hospital waiting periods

Pre-existing conditions* 12 months
Pregnancy & birth related services 9 months
Psychiatric, rehabilitations & palliative care 2 months
All other hospital services 2 months
Emergency ambulance transport 1 day
Non-emergency ambulance transport 1 day

* A pre-existing condition is an illness, ailment or condition where the signs or symptoms of which, in the opinion of the Fund Medical Advisor or other relevant medical practitioner appointed by Nurses & Midwives Health, existed at any time during the six months before taking out private health insurance or transferring to a higher level of cover. This rule applies to new members to private health insurance and existing members who are upgrading their level of cover. If you are a new member to private health insurance you will have to wait 12 months before you can receive benefits for items or services related to a pre-existing condition. If you change to a higher level of cover, you may have to wait 12 months to receive benefits, including benefits for services not previously covered. A 12 month waiting period applies to all pre-existing conditions except pregnancy & birth related services, which is a 9 month waiting period and psychiatric, palliative care and rehabilitation, which is a two month waiting period. 

Frequently Asked Questions