Waiting Periods
A waiting period is the time you need to wait after purchasing your policy before you can claim. You cannot claim for medical treatment that is provided during the waiting period. This means that you will need to pay for all expenses for the treatment.
Out-of-pocket fees
You may incur an out-of-pocket fee (known as a gap fee) if the amount the medical provider charges is more than the benefit you are entitled to under your cover. You will need to pay the gap fee yourself and won’t be able to claim that amount. We recommend you call your doctor or hospital before visiting to get an idea of what it will cost you.
Direct Billing Network
Using our network of direct billing providers makes it easier for you to claim when you visit a doctor. All you need to do is provide your valid membership e-card and the provider will bill us directly for the covered amount of your bill.
With direct billing, the doctor bills us directly. You do not have to make a claim.
Make sure you select a doctor or medical provider that specifies they can direct bill.
Hospital excess
The excess is the amount you must pay upfront before a benefit is paid by us for overnight or same day hospital admissions under your policy. The excess is payable once per adult per financial year (1 July – 30 June). No excess applies to any children on your policy under the age of 18.
If your plan has a hospital excess payable, you will need to pay the excess amount towards your hospital treatment costs before we will pay any benefit.
