Does the purchase of 100% hospital cover guarantee that I will not have any out-of-pocket expenses for a private hospital visit?
No. Health funds vary their level of benefits for hospital related costs and medical bills according to whether the hospital is or is not a designated Participating Hospital. Prior to admission, members should contact their health fund to verify the status of the hospital they wish to use. If the hospital is a designated Participating Hospital, health funds will typically reimburse 100% of costs related to: • Room or accommodation charges • Theatre fees • Labour ward • Intensive care • Coronary care • Day surgery • Hospital substitute treatment for chronic disease management programmes may also be included as a benefit (this would be dependent on the excess and benefits inlcuded in your health policy) • Supply of medication as agreed with the hospital. Medical expenses incurred in hospital are reimbursed to at least 100% of the Medicare Scheduled Fee – 75% refund from Medicare and 25% refund from your health fund. If a medical provider is a participant in a ‘No Gap/Known Gap’ scheme of
