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ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Flex Ancillary NT

Restricted Insurer

$186.72 / month

(Before Rebate, Discount & Loading)

Available in NT

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: Only one person.

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

Policy ID: ACA/J26/DANP10

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

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Chinese medicine 2

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Dietetics/dietary advice 2

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Exercise physiology 2

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
General dental 9

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Fluoride treatment: 60% of charge
  • Scale & clean: 60% of charge
  • Periodic oral examination: 60% of charge
Optical 4

$175 per policy

  • Multi-focal lenses & frames: 60% of charge
  • Single vision lenses & frames: 60% of charge
Physiotherapy 2

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Initial visit: 60% of charge
  • Subsequent visit: 60% of charge
Vaccinations 2

$650 per policy

combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations

  • Per service: 60% of charge
Acupuncture

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

General dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Fluoride treatment: 60% of charge}

{Scale & clean: 60% of charge}

{Periodic oral examination: 60% of charge}

Optical

Waiting period:  4 months

Benefit limits per 12 months unless otherwise stated

{$175 per policy}

Examples of maximum benefits

{Multi-focal lenses & frames: 60% of charge}

{Single vision lenses & frames: 60% of charge}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Initial visit: 60% of charge}

{Subsequent visit: 60% of charge}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$650 per policy}

{combined limit for acupuncture, chinese medicine, dietetics/dietary advice, exercise physiology, general dental, physiotherapy & vaccinations}

Examples of maximum benefits

{Per service: 60% of charge}

Also excludes Blood glucose monitors, Audiology, Ante-natal/Post-natal classes, Orthoptics, Home nursing, Occupational therapy, Orthotics, Osteopathy, Speech therapy, Vaccinations

This policy does not include General treatment (Extras) cover for
Ante-natal/Post-natal classes
Audiology
Blood glucose monitors
Chiropractic
Endodontic
Eye therapy (orthoptics)
Health management / Healthy lifestyle
Hearing aids
Home nursing
Major dental
Non PBS pharmaceuticals
Occupational therapy
Orthodontic
Orthotics (podiatric orthoses)
Osteopathy
Podiatry
Psychology
Remedial massage
Speech therapy

Ambulance cover

Pensioner Concession Card and Commonwealth Seniors Health Card holders are entitled to free ambulance transport services. St John's ambulance offers a subscription service for ambulance cover in the Northern Territory (https://www.stjohnnt.org.au/ambulance/ambulance-cover.php). Cover is included whilst interstate for less than 21 days.

Insurer Details

ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Flex Ancillary NT

Restricted Insurer

$186.72 / month

(Before Rebate, Discount & Loading)

Available in NT

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/J26/DANP10

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