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Accommodation refers to in-hospital or day facility services such as occupying a bed, meals and nursing care. It does not include care by doctors or other health professionals.

Benefits paid by health funds cover the cost of private or shared room accommodation in agreement private hospitals.

Coronary care

Care of patients with heart attacks, unstable angina and other cardiac conditions that require continuous monitoring and treatment. Most funds cover the cost for treatment of heart related surgery such as open heart and bypass surgery, coronary angiogram and angioplasty.

Cosmetic surgery

Cosmetic surgery is performed to improve and correct a structural defect, physical feature, irregularity or normal evidence of aging. Benefits for cosmetic surgery or services are only payable where it is medically necessary.


Dialysis is a procedure used to treat people with kidney failure. A dialysis machine is used to remove waste, salt and extra water from the blood. It also corrects the level of certain chemicals in the blood such as potassium, sodium and bicarbonate.

Eye surgery

Eye surgery is surgery performed on the eye or its adnexa.

Gap cover

Gap cover is an out of pocket amount that you may have to pay. It is not covered by Medicare and in most cases by Overseas Visitors Cover. If your doctor or specialist charges more than the Medicare Benefits Schedule (MBS) fee for your medical or hospital treatment, you will be required to pay the gap. Some policies provide gap cover to insure you for some or all of the additional costs.

Intensive care

Intensive care is for patients who have life-threatening illnesses, injuries or complications and who usually require intensive monitoring.

IVF related services/Assisted reproductive services

Services and treatment relating to methods used to achieve pregnancy other than through natural means. Procedures involved include artificial insemination and invasive techniques such as IVF, GIFT and ICSI.

Joint replacement surgery

Joint replacement surgery is a procedure in which the arthritic or dysfunctional joint surface is replaced with an orthopaedic prosthesis. Hips and knees are replaced most often. Other joints that can be replaced include the shoulders, fingers, ankles and elbows.

Neo natal intensive care

Neo natal intensive care specialise in the care of ill or premature newborn infants.

Operating theatre

An operating theatre is located within a hospital or day surgery. It is where medical procedures are carried out in a sterile environment.

Palliative care

Specialised health care for patients with an advanced or terminal illness. Palliative care focuses on relieving and preventing the suffering of patients by addressing their physical, emotional, spiritual and social concerns. Support is also provided to family and caregivers.

Pharmaceutical Benefits Scheme (PBS) pharmaceuticals – out patient

Pharmaceuticals prescribed on discharge from hospital, which are covered under the Pharmaceutical Benefits Scheme (PBS).

Pharmaceuticals in-hospital

Pharmaceuticals prescribed in-hospital directly associated with the reason for admission. Benefits are payable towards the cost of in-hospital pharmaceuticals. However, benefits paid by health funds can exclude experimental and high cost pharmaceuticals not covered under the Pharmaceutical Benefits Scheme (PBS). It also excludes payments for pharmaceuticals prescribed on discharge from hospital or any pharmaceutical prescriptions outside of hospital.

Psychiatric services

Psychiatric services involve prevention, diagnosis and treatment of mental disorders such as depression, anxiety, schizophrenia and eating disorders. Psychiatric services can also include drug and alcohol abuse, anorexia nervosa, bulimia or postnatal depression, aged psychiatry and therapeutic programs.

Rehabilitation services

Rehabilitation programs are designed to assist patients with recovery from strokes, surgery and accidents. It aims to make clients become as independent as possible and teaches strategies for ongoing disabilities.

Restricted benefits

In order to pay lower health insurance premiums, you can opt to take out a policy that offers restricted benefits on certain services. For these services access to agreement private hospitals is restricted and if used will result in significant out of pocket expenses to the member.

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