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ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Ancillary Lite QLD

Restricted Insurer

$401.96 / month

(Before Rebate, Discount & Loading)

Available in QLD

You may be entitled to an Australian Government Rebate on the above premium. Your premium may also include a Lifetime Health Cover Loading or an insurer discount. Check with your insurer for details.

This policy covers: Two adults & dependants (3 or more people, only 2 of whom are adults).

Children (0 - 17), non-classified* dependant (18 - 20) and students (21 - 24), as well as persons with a disability who qualify as a child, non-classified* dependant and student in these age ranges. *Non-classified dependant: Dependant aged 18 to 20

Restricted insurer: Membership of this insurer is restricted to Seventh-day Adventist Church employees, Local Church Officers and their families.

Policy ID: ACA/J16/QAIS2D

Source: Private Health Information Statement (PHIS)

Hospital Cover

  • This policy exempts you from the Medicare Levy Surcharge.
  • This policy does not provide accident cover.
  • This policy does not provide benefits for travel or accommodation outside of hospital.
Covered
Restricted Cover
Not Covered
This policy includes cover for
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Chemotherapy, radiotherapy and immunotherapy for cancer
Diabetes management (excluding insulin pumps)
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Gynaecology
Hernia and appendix
Hospital psychiatric services
Joint reconstructions
Kidney and bladder
Male reproductive system
Miscarriage and termination of pregnancy
Pain management
Palliative care
Rehabilitation
Skin
Tonsils, adenoids and grommets
This policy does not include cover for
Assisted reproductive services
Back, neck and spine
Blood
Cataracts
Dental surgery
Dialysis for chronic kidney failure
Heart and vascular system
Implantation of hearing devices
Insulin pumps
Joint replacements
Lung and chest
Pain management with device
Plastic and reconstructive surgery (medically necessary)
Podiatric surgery (provided by a registered podiatric surgeon)
Pregnancy and birth
Sleep studies
Weight loss surgery

The benefits paid for hospital treatment will depend on the type of cover you purchase and whether your fund has an agreement in place with the hospital in which you are treated. See ‘Agreement Hospitals’ on privatehealth.gov.au for which hospitals have arrangements with your insurer – https://privatehealth.gov.au/dynamic/agreementhospitals.

Under this policy, you may have to pay out-of-pocket costs above what you get from Medicare or your private health insurer. Before you go to hospital, you should ask your doctors, hospital and health insurer about any out-of-pocket costs that may apply to you.

The following payments may also apply for hospital admissions

Excess: You will have to pay an excess on admission. This is limited to a maximum of $500 per person and $1000 per policy per year.

Co-payments: No co-payments

The following waiting periods for hospital admissions apply to new or upgrading members Waiting periods:
  • 2 months for palliative care, rehabilitation and hospital psychiatric treatments, even if pre-existing
  • 12 months for other pre-existing conditions
  • 12 months for pregnancy and birth (obstetrics)
  • 2 months for all other treatments
Gap Cover

This provider offers 'known gap' or 'no gap' cover for medical bills for this product. The Medical Costs Finder (https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder) lets you find out more about the cost of specialist medical services.

Other features of this hospital cover

$500 excess per person per annum for adult non-dependents. For NSW & ACT residents only, Hospital cover includes ambulance cover for emergency (unlimited with no waiting period) and call-out fees (paid for each attendance, including emergency treatment without transport to hospital) in that state or territory only. No ambulance cover for excluded services.

For further information about this policy see: https://acahealth.com.au/quote-details/?hospital=essentials&extras=lite

Extras Cover

This health insurer does not operate a preferred provider scheme.

This policy includes General treatment (Extras) cover for
Treatment & waiting period (months)
Benefit limits per 12 months unless otherwise stated
Examples of maximum benefits
Acupuncture 2

$100 per person

combined limit for acupuncture & remedial massage

  • Initial visit: $20
  • Subsequent visit: $20
Chiropractic 2

$300 per person

combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services

  • Initial visit: $25
  • Subsequent visit: $25
Endodontic 9

$700 per person

combined limit for endodontic, general dental, major dental & other services

sub-limits apply

  • Filling of one root canal: $400
General dental 9

$700 per person

combined limit for endodontic, general dental, major dental & other services

sub-limits apply

  • Fluoride treatment: $100
  • Scale & clean: $100
  • Periodic oral examination: $100
Major dental 9

$700 per person

combined limit for endodontic, general dental, major dental & other services

sub-limits apply

  • Surgical tooth extraction: $168
  • Full crown veneered: $400
Non PBS pharmaceuticals 2

$250 per person

  • Per eligible prescription: $50
Optical 4

$200 per person

  • Multi-focal lenses & frames: $200
  • Single vision lenses & frames: $200
Osteopathy 2

$300 per person

combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services

  • Initial visit: $25
  • Subsequent visit: $25
Physiotherapy 2

$300 per person

combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services

  • Initial visit: $37.5
  • Subsequent visit: $26.5
Podiatry 2

$300 per person

combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services

  • Initial visit: $25
  • Subsequent visit: $25
Remedial massage 2

$100 per person

combined limit for acupuncture & remedial massage

  • Initial visit: $20
  • Subsequent visit: $20
Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$100 per person}

{combined limit for acupuncture & remedial massage}

Examples of maximum benefits

{Initial visit: $20}

{Subsequent visit: $20}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $25}

Endodontic

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$700 per person}

{combined limit for endodontic, general dental, major dental & other services}

{sub-limits apply}

Examples of maximum benefits

{Filling of one root canal: $400}

General dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$700 per person}

{combined limit for endodontic, general dental, major dental & other services}

{sub-limits apply}

Examples of maximum benefits

{Fluoride treatment: $100}

{Scale & clean: $100}

{Periodic oral examination: $100}

Major dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$700 per person}

{combined limit for endodontic, general dental, major dental & other services}

{sub-limits apply}

Examples of maximum benefits

{Surgical tooth extraction: $168}

{Full crown veneered: $400}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

Examples of maximum benefits

{Per eligible prescription: $50}

Optical

Waiting period:  4 months

Benefit limits per 12 months unless otherwise stated

{$200 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $200}

{Single vision lenses & frames: $200}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $25}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services}

Examples of maximum benefits

{Initial visit: $37.5}

{Subsequent visit: $26.5}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for chiropractic, osteopathy, physiotherapy, podiatry & other services}

Examples of maximum benefits

{Initial visit: $25}

{Subsequent visit: $25}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$100 per person}

{combined limit for acupuncture & remedial massage}

Examples of maximum benefits

{Initial visit: $20}

{Subsequent visit: $20}

This policy does not include General treatment (Extras) cover for
Ante-natal/Post-natal classes
Audiology
Blood glucose monitors
Chinese medicine
Dietetics/dietary advice
Exercise physiology
Eye therapy (orthoptics)
Health management / Healthy lifestyle
Hearing aids
Home nursing
Occupational therapy
Orthodontic
Orthotics (podiatric orthoses)
Psychology
Speech therapy
Vaccinations

For further information about this policy see: https://acahealth.com.au/quote-details/?hospital=essentials&extras=lite

Ambulance cover

Ambulance cover is provided by the State government for Queensland residents (https://www.ambulance.qld.gov.au). This includes cover whilst interstate.

For further information about this policy see: https://acahealth.com.au/quote-details/?hospital=essentials&extras=lite

Insurer Details

ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Ancillary Lite QLD

Restricted Insurer

$401.96 / month

(Before Rebate, Discount & Loading)

Available in QLD

Disclaimer: This document is not a Private Health Information Statement (PHIS), and it is not intended to replace that document. The details contained in the healthslips.com.au Policy Information was provided by the insurer to the Australian Government. It is intended as general information. It may not take into account your circumstances. For further information contact the insurer. Information used is Licensed from the Commonwealth of Australia under a Creative Commons 3.0 licence.Private Health Information Statement is available from the Private Health Insurance Ombudsman website at https://privatehealth.gov.au/dynamic/Premium/PHIS/ACA/J16/QAIS2D

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