All 38 clinical categories, restrictedEvery Australian hospital policy is described using the same 38 government-defined clinical categories, so cover can be compared like for like between funds. This cover pays benefits on all 38, on a restricted basis.
Healthy Start Package
Public hospital cover across all clinical categories, accident treatment in a participating private hospital, plus extras for everyday health.
- Cover for all clinical categories in a public hospital, and accidents only in a participating private hospital
- Emergency ambulance
Healthy Start Package
from $25.90/wk
What you’re covered for
What's restricted
38 of 38 clinical categories
Restricted means limited benefits, typically treatment as a private patient in a public hospital, which can leave a large out-of-pocket cost. Your PDS sets out exactly what’s paid.
Rehab, mental health & palliative
Restricted:RehabilitationDetails
Treatment to improve and restore function
Restricted:Hospital psychiatric servicesDetails
Mental health conditions
Restricted:Palliative careDetails
Treatment for terminal illness and end of life care
Bones, joints & spine
Restricted:Bone, joint and muscleDetails
Carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and surgery for bone cancer
Restricted:Joint reconstructionsDetails
Torn tendons, rotator cuff tears and damaged ligaments
Restricted:Joint replacementsDetails
Full or partial replacement of joints
Restricted:Back, neck and spineDetails
Sciatica, prolapsed discs, curvature of spine
- Restricted:Podiatric surgery (provided by a registered podiatric surgeon)
Heart, lungs & blood
Restricted:Heart and vascular systemDetails
Heart attack, stents, varicose veins
Restricted:Lung and chestDetails
Lung cancer, respiratory conditions, asthma, pneumonia
Restricted:BloodDetails
Blood clotting disorder, bone marrow transplants
Restricted:Sleep studiesDetails
Investigation of sleep apnoea and snoring
Digestive, kidney & urinary
Restricted:Digestive systemDetails
Gallstones, irritable bowel syndrome, haemorrhoids
Restricted:Hernia and appendixDetails
Hernia operations and appendicitis
Restricted:Gastrointestinal endoscopyDetails
Colonoscopy and gastroscopy
Restricted:Kidney and bladderDetails
Kidney stones, adrenal gland tumour and incontinence
Restricted:Dialysis for chronic kidney failureDetails
Filtering blood through a machine
Restricted:Male reproductive systemDetails
Male sterilisation, circumcision and prostate cancer
Eyes, ears, nose, throat & dental
Restricted:Eye (not cataracts)Details
Retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye
Restricted:CataractsDetails
Replacement of eye lens
Restricted:Ear, nose and throatDetails
Damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer
Restricted:Tonsils, adenoids and grommetsDetails
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets
Restricted:Implantation of hearing devicesDetails
Cochlear implants
Restricted:Dental surgeryDetails
Removal of wisdom teeth, dental implants
Brain, nerves & pain
Restricted:Brain and nervous systemDetails
Stroke, brain or spinal cord tumours
Restricted:Pain managementDetails
Treatment of chronic pain NOT with a device
Restricted:Pain management with deviceDetails
Insertion of a device to manage pain
Pregnancy & women's health
Restricted:GynaecologyDetails
Endometriosis, polycystic ovaries, repairs post childbirth
Restricted:Pregnancy and birthDetails
Treatment before, during and after having a baby
- Restricted:Miscarriage and termination of pregnancy
Restricted:Assisted reproductive servicesDetails
Treatment to assist conception
Restricted:Breast surgery (medically necessary)Details
Breast lesion, breast tumours
Cancer, skin & other surgery
- Restricted:Chemotherapy, radiotherapy and immunotherapy for cancer
Restricted:SkinDetails
Surgery to remove melanoma, other skin lesions and wound repair
Restricted:Plastic and reconstructive surgery (medically necessary)Details
Burns, skin grafts
Restricted:Diabetes management (excluding insulin pumps)Details
Stabilisation
Restricted:Insulin pumpsDetails
Treatment of diabetes with a pump that delivers insulin
Restricted:Weight loss surgeryDetails
Surgical treatment of obesity
Waiting periods
- 1 dayEmergency ambulance
- 2 monthsPsychiatric services, rehabilitation and palliative careAll other hospital services, including accident-related treatment (for clinical categories included in the product)
- 12 monthsPre-existing conditions (excluding hospital psychiatric services, rehabilitation and palliative care)Pregnancy and birth
Extras included in Healthy Start Package
Emergency ambulanceUnlimited ambulance transports where necessaryShow 1 serviceHide serviceBenefit No limitLimit No limitWaiting 1 day
What’s included
| Service | Benefit we pay |
|---|---|
| Unlimited ambulance transports where necessary | No limit |
Paid per service, within the limit and waiting period above.
General dentalItems as per dental schedulePeriodic oral examination · Scale and clean · Simple tooth extraction · Adhesive restoration (filling 1 surface) · Mouth guard supplied by dentist or dental technicianShow 5 servicesHide servicesBenefit Varies by serviceLimit $500 per person$2000 per membershipCombined limitWaiting 2 months
What’s included
| Service | Benefit we pay |
|---|---|
| Periodic oral examination | $30.50 |
| Scale and clean | $57.60 |
| Simple tooth extraction | $63.15 |
| Adhesive restoration (filling 1 surface) | $63.30 |
| Mouth guard supplied by dentist or dental technician | $80 per person |
Paid per service, within the limit and waiting period above.
Major DentalItems as per dental scheduleTreatment resulting from an accident onlyShow 1 serviceHide serviceBenefit $250 per accidentLimit $500 per person$2000 per membershipCombined limitWaiting 12 months
What’s included
| Service | Benefit we pay |
|---|---|
| Treatment resulting from an accident only | $250 per accident |
Paid per service, within the limit and waiting period above.
OpticalGlasses, contact lenses and prescription sunglassesShow 1 serviceHide serviceBenefit $150Limit $150 per personWaiting 6 months
What’s included
| Service | Benefit we pay |
|---|---|
| Glasses, contact lenses and prescription sunglasses | $150 |
Paid per service, within the limit and waiting period above.
Physiotherapy, chiropractic & massageGroup physiotherapy / hydrotherapy · Physiotherapy · Chiropractic · Chiropractic X-ray (one per year) · Osteopathy · Massage (with registered provider) · Podiatry Consultations (Other Items as per podiatry schedule) · Pharmaceuticals (compounded medicine excluded) · Travel vaccinesShow 9 servicesHide servicesBenefit Varies by serviceLimit $250 per person$500 per membershipWaiting 2 months
What’s included
| Service | Benefit we pay |
|---|---|
| Group physiotherapy / hydrotherapy | $9 |
| Physiotherapy | $30 |
| Chiropractic | $26 |
| Chiropractic X-ray (one per year) | $28 |
| Osteopathy | $25 |
| Massage (with registered provider) | $25 |
| Podiatry Consultations (Other Items as per podiatry schedule) | $25 |
| Pharmaceuticals (compounded medicine excluded) | $25 per script |
| Travel vaccines | $25 per travel vaccination |
Paid per service, within the limit and waiting period above.
Your premium depends on your details, and prices and available plans can change. Each cover’s policy document prevails over this summary.
Good to know
Waiting periods
Hospital services have waiting periods before you can claim, so it’s worth checking what’s covered and when. You’ll find the details for this cover in the table above and its policy document. Switching from another Australian health fund? If you’ve already served waiting periods for equivalent cover, you generally won’t need to serve them again.
Switching health funds
Switching is easier than you think. If you’ve already served waiting periods for equivalent cover with another Australian health fund, you generally won’t need to serve them again. We’ll tell your old fund and close your policy, so nothing overlaps (the bit people actually worry about). Consider the break-up handled.
Emergency ambulance
You’re covered for unlimited emergency ambulance transport by road, boat or air, after a one-day waiting period. Live in Queensland? Your state ambulance scheme covers you Australia-wide instead. Tasmanian residents are covered by their state scheme in Tasmania; the policy document explains trips interstate. We don’t cover non-emergency transport, like a transfer between hospitals or a trip home.
Australian Government Rebate
The Australian Government Rebate reduces what you pay for private health insurance, based on your age and income, and is indexed annually. The price shown here already has the base-tier rebate applied. Your quote will confirm the tier that actually applies to you.
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