Top Silver Plus Silver +
Still want extensive cover but don’t think you’ll need Hospital psychiatric services? Our Top Silver Plus product could be the one for you.
This product gives you a very high level of cover with only one restriction (Hospital psychiatric services) so you’ll be covered for a wide range of services including pregnancy, heart procedures, and hip or knee joint replacements.
Scope of cover
It’s important to understand what it means when a service is listed as ‘restricted’. Here is an overview of what we’ll pay for and what you you’ll have to pay for if going to hospital for treatment for a service that’s restricted:
In a public hospital:
- We pay – accommodation in a shared room (as long as the hospital doesn’t charge above the default rate set out by the Federal Government), and medical costs.
- You pay – any excess (if applicable), and any gap if your hospital charges above the default rate.
In a private hospital:
- We pay – accommodation as if staying in a shared room (at the default rate set out by the Federal Government), and medical costs.
- You pay – any excess (if applicable) and the balance of accommodation costs, plus any theatre costs. This could be costly, so ensure the hospital provides you with the potential costs upfront.
Either way, the hospital should let you know about any out-of-pocket expenses you’ll need to pay. This is called informed financial consent.
Like all health funds, waiting periods may apply when you take out your cover.
You may have to wait if:
- You’re new to private health insurance
- You upgrade your cover to include things that weren’t covered before
- You switch health funds and increase your cover to include things that weren’t covered before.
If you’ve cancelled your membership with another health fund, you’ll need to join us within 60 days to keep up your continuity of cover and not re-serve any applicable waiting periods.
Hospital Waiting Periods
|Pre-existing conditions*||12 months|
|Pregnancy & birth related services||9 months|
|Psychiatric, rehabilitation and 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.