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ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Mid Ancillary TAS

Restricted Insurer

$393.93 / month

(Before Rebate, Discount & Loading)

Available in TAS

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: One adult & dependants (2 or more people, only one of whom is an adult).

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/J21/TALZ1D

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 $500 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.

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

$300 per person

combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage

  • Initial visit: $30
  • Subsequent visit: $30
Ante-natal/Post-natal classes 2

$300 per policy

  • Initial visit: 80% of charge
  • Subsequent visit: 80% of charge
Blood glucose monitors 12

$55 per person

  • Per monitor: $55
Chinese medicine 2

$300 per person

combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage

  • Initial visit: 80% of charge
  • Subsequent visit: 80% of charge
Chiropractic 2

$500 per person

combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy

  • Initial visit: $45
  • Subsequent visit: $32
Dietetics/dietary advice 2

$300 per person

combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage

  • Initial visit: 80% of charge
  • Subsequent visit: 80% of charge
Endodontic 9

$1,100 per person

combined limit for endodontic, general dental & major dental

  • Filling of one root canal: $1100
Exercise physiology 2

$500 per person

combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy

  • Initial visit: $22.5
  • Subsequent visit: $22.5
General dental 9

$1,100 per person

combined limit for endodontic, general dental & major dental

  • Fluoride treatment: $100
  • Scale & clean: $100
  • Periodic oral examination: $100
Hearing aids 12

$600 per person

  • Hearing aid: $600
Major dental 9

$1,100 per person

combined limit for endodontic, general dental & major dental

  • Surgical tooth extraction: $270
  • Full crown veneered: $1000
Non PBS pharmaceuticals 2

$400 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: $100
Occupational therapy 2

$500 per person

combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy

  • Initial visit: $80
  • Subsequent visit: $65
Optical 4

$300 per person

  • Multi-focal lenses & frames: $300
  • Single vision lenses & frames: $300
Orthotics (podiatric orthoses) 12

$250 per person

combined limit for orthotics (podiatric orthoses) & podiatry

  • Orthotics supply & fit: 80% of charge
Osteopathy 2

$500 per person

combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy

  • Initial visit: $45
  • Subsequent visit: $32
Physiotherapy 2

$500 per person

combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy

  • Initial visit: $75
  • Subsequent visit: $55
Podiatry 2

$250 per person

combined limit for orthotics (podiatric orthoses) & podiatry

  • Initial visit: 80% of charge
  • Subsequent visit: 80% of charge
Psychology 2

$300 per person

  • Initial visit: $110
  • Subsequent visit: $80
Remedial massage 2

$300 per person

combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage

  • Initial visit: $30
  • Subsequent visit: $30
Speech therapy 2

$500 per person

combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy

  • Initial visit: $50
  • Subsequent visit: $40
Vaccinations 2

$400 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per service: $100
Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage}

Examples of maximum benefits

{Initial visit: $30}

{Subsequent visit: $30}

Ante-natal/Post-natal classes

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per policy}

Examples of maximum benefits

{Initial visit: 80% of charge}

{Subsequent visit: 80% of charge}

Blood glucose monitors

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$55 per person}

Examples of maximum benefits

{Per monitor: $55}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage}

Examples of maximum benefits

{Initial visit: 80% of charge}

{Subsequent visit: 80% of charge}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $32}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage}

Examples of maximum benefits

{Initial visit: 80% of charge}

{Subsequent visit: 80% of charge}

Endodontic

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$1,100 per person}

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

Examples of maximum benefits

{Filling of one root canal: $1100}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy}

Examples of maximum benefits

{Initial visit: $22.5}

{Subsequent visit: $22.5}

General dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$1,100 per person}

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

Examples of maximum benefits

{Fluoride treatment: $100}

{Scale & clean: $100}

{Periodic oral examination: $100}

Hearing aids

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$600 per person}

Examples of maximum benefits

{Hearing aid: $600}

Major dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$1,100 per person}

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

Examples of maximum benefits

{Surgical tooth extraction: $270}

{Full crown veneered: $1000}

Non PBS pharmaceuticals

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per eligible prescription: $100}

Occupational therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy}

Examples of maximum benefits

{Initial visit: $80}

{Subsequent visit: $65}

Optical

Waiting period:  4 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Multi-focal lenses & frames: $300}

{Single vision lenses & frames: $300}

Orthotics (podiatric orthoses)

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Orthotics supply & fit: 80% of charge}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $32}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy}

Examples of maximum benefits

{Initial visit: $75}

{Subsequent visit: $55}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$250 per person}

{combined limit for orthotics (podiatric orthoses) & podiatry}

Examples of maximum benefits

{Initial visit: 80% of charge}

{Subsequent visit: 80% of charge}

Psychology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

Examples of maximum benefits

{Initial visit: $110}

{Subsequent visit: $80}

Remedial massage

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice & remedial massage}

Examples of maximum benefits

{Initial visit: $30}

{Subsequent visit: $30}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for chiropractic, exercise physiology, occupational therapy, osteopathy, physiotherapy & speech therapy}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $40}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: $100}

Excludes Orthodontic, Audiology, Orthoptics, Home nursing. Podiatry and Orthotics does not include benefits for the purchase of shoes to accommodate orthoses or shoe modification.

This policy does not include General treatment (Extras) cover for
Audiology
Eye therapy (orthoptics)
Health management / Healthy lifestyle
Home nursing
Orthodontic

Ambulance cover

Ambulance cover is provided by the State government for residents of Tasmania. This may include cover whilst interstate, except for South Australia and Queensland where no cover applies. In other states please check with Ambulance Tasmania - https://www.health.tas.gov.au/ambulance/fees_and_accounts.

Insurer Details

ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Mid Ancillary TAS

Restricted Insurer

$393.93 / month

(Before Rebate, Discount & Loading)

Available in TAS

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/J21/TALZ1D

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