Up to 100% of hospital accommodation costs and theatre fees in all contracted hospitals and day surgery facilities in Australia.
Up to 100% of the cost of surgically implanted prostheses (as listed by the Federal Government).
Private room accommodation (if available).
Up to 100% of the cost of most hospital prescriptions relating to the admission. (Subject to hospital agreement details).
Dental theatre costs for surgical tooth extraction by an oral surgeon.
100% of the cost of the difference between the Medicare refund and the Commonwealth Medical Benefit Scheme (CMBS) fee for medical services provided during a hospital admission.
Up to 100% of the cost of medical services provided during a hospital admission where the doctor charges above the Commonwealth Medical Benefit Scheme (CMBS) fee and chooses to use Access Gap Cover.
Extra services beyond the hospital treatment plan.
Personal expenses like phone calls, newspapers and TV rental.
Hospital benefits where the professional service performed is not eligible for Medicare benefits.
Pharmaceutical items supplied or prescribed on discharge.
Surgically Implanted Prosthesis Gap.
Medical treatment provided in doctors’ rooms out of hospital.
It’s important to remember that as an Australian resident, Medicare covers public hospital treatment and emergency patients will normally go to a public hospital with Intensive Care Units.
With HCI hospital cover you can elect to go as a private patient into a public hospital.
You can choose your doctor and have a private room if available. You will still be subject to waiting lists for elective procedures.
Under the Federal Commonwealth Medical Benefits Schedule (CMBS) fees are determined and accordingly split between HCI and Medicare. It is important to discuss fees with your doctor prior to treatment as there may be out of pocket expenses. If your doctor charges above the CMBS fee HCI does not cover these expenses.
HCI hospital cover enables you to get full private hospital access to immediate services, a doctor of your choosing at a convenient time with no waiting periods.
HCI has relationships with over 500 private hospitals and day hospital facilities around Australia. For a comprehensive list of our contracted hospitals in your local area click here
Should you need specialist care in hospital your doctor can use HCI’s Access Gap Cover – a much simpler billing system to eliminate out of pocket expenses altogether or let you know exactly what you have to pay prior to treatment.
Remember to ask your doctor:
Will you treat me under Access Gap Cover?
Will I have any out-of-pocket expenses? Please provide a formal quote of these costs.
Will any assisting doctors also use Access Gap Cover and if so, how can I obtain a quote for their services?
Surgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.
For medical procedures covered by Medicare HCI fully cover the cost of at least one prostheses – this is referred to as a ‘no gap’ prostheses. There are however some items listed on the Prostheses Schedule that are not or only partially covered. Please review the list with your doctor prior to surgery.
Hospital cover excess options
Having a hospital excess will reduce your premium, the greater the excess the lower the premium.
There is no excess for day admissions.
There is no excess for dependent children under the age of 18 years.
The excess per adult is the maximum payable in any calendar year.
If a person covered is under the age of 18 but not a dependant on a single or couple policy they will be required to pay the excess.
There are no co-payments for any of our hospital benefits, you will only need to pay your excess (if applicable).
We have a range of excesses you can choose to suit your needs.