Hospital Cover

When you take out health insurance for the first time, switch insurers or increase your level of cover, CUA Health asks that you wait a period of time before you can claim for new or higher benefits. Take a look at the table below to find out what waiting periods apply.

With our private hospital cover you can be treated as a private patient in a private or public hospital. CUA Health has agreements with the majority of private hospitals and day surgeries where you will receive benefits for your hospital accommodation, including:

• accommodation for overnight or same-day stays
• standard single or share hospital accommodation
• operating theatre, intensive care and ward fees
• surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List
• your choice of doctor or specialist

Please contact us prior to any hospital admission to make sure your hospital is in agreement with CUA Health.

• Hospital treatment for which Medicare pays no benefit, like cosmetic surgery.
• In some cases your doctor’s and/or specialists’ (radiologist, anaesthetist etc) fees may still be more than the Medicare benefit plus the CUA Health gap scheme so you may be required to make an additional payment. Please check this with your doctor before consultation or treatment.
• Gap payments may apply to certain prostheses (e.g. hip and knee joint replacements, artificial heart valves, pacemaker devices and intra-ocular lenses for cataract surgery).
• Any items of a personal nature, including TV rental or phone calls while in hospital that are not part of the agreed medical costs.
• You’ll need to pay any additional costs that are applied to any 'nursing home-type' patient admission into a public or private hospital. This amount is determined by the Federal Government.
• Experimental and some high cost or exceptional drugs.
• Services not invoiced by the hospital.
• If you go to an emergency room and are not admitted but the hospital still charges you for your visit, this charge is not covered and you’ll need to pay this yourself.
• Services able to be claimed by way of compensation or damages. CUA Health reserves the right to a full and immediate reimbursement of any claims covered by way of compensation or damages from another party.
• Services provided by a family member.
• Any treatment considered an outpatient service, e.g. Radium.
• Benefits for products, services or treatments purchased from or provided by practitioners overseas, whether you buy them in person, by mail order or online.
• Benefits in relation to sport, recreation or entertainment unless they are part of an approved chronic disease management or a health management program.
• Benefits for treatment, goods or services if false or misleading information is provided.
• Extras cover services for which a Medicare benefits is payable, except as allowable as hospital substitute treatment.
• Treatment, goods or services provided during a waiting period.