HCi hospital cover excludes the following:

• Cosmetic surgery
• Extra services beyond the hospital treatment plan
• Personal expenses like phone calls, newspapers and TV rental
• Hospital services not eligible for Medicare benefits
• Pharmaceutical items supplied or prescribed on discharge
• Medicare gap (ie out of pocket expenses)
• Surgically implemented prosthesis gap
• Medical treatment provided in a doctor’s rooms out of hospital
• Services, treatments and appliances purchased from non-Australian suppliers or websites

Managing hospital costs

Remember Medicare covers public hospital treatment for Australian residents, and emergency patients usually go to a public hospital with Intensive Care Units.

With HCi hospital cover, you can elect to be a private patient in a public hospital.

You can choose your doctor and have a private room if available. However, you will still be subject to waiting lists for elective procedures.

Medical fees

HCi hospital cover enables you to get full private hospital access to services, a doctor of your choosing at a convenient time with no (or reduced) waiting periods.

Under the Commonwealth Medical Benefits Schedule (MBS) 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 MBS fee, HCi does not cover these expenses. Read our factsheet on The Gap for more information.

HCi’s Access Gap

HCi has relationships with over 500 private hospitals and day hospital facilities around Australia. See our comprehensive list of our contracted hospitals in your local area.

If 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 HCi’s Access Gap?
• Can you send the bill to HCi directly?
• Will I have any out-of-pocket expenses? Please provide a formal quote of these costs.
• If I need any assisting doctors, will they also use Access Gap Cover? If so, how can I obtain a quote for their services?

See our participating health providers for one that suits your needs.

Gap Cover and surgically implanted prostheses:

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 covers the cost of at least one prostheses – this is referred to as a ‘no gap’ prostheses. However, some items listed on the Prostheses Schedule are not or only partially covered. Therefore, please review the list with your doctor prior to surgery.