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ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Complete Ancillary WA

Restricted Insurer

$550.02 / month

(Before Rebate, Discount & Loading)

Available in WA

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 (and no-one else).

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

Policy ID: ACA/J9/WAHK20

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.

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

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

$500 per person

combined limit for acupuncture, chinese medicine, remedial massage & other services

  • Initial visit: $45
  • Subsequent visit: $45
Ante-natal/Post-natal classes 2

$500 per policy

  • Initial visit: 80% of charge
Audiology 2

No annual limit

  • Initial visit: 50% of charge
  • Subsequent visit: 50% of charge
Blood glucose monitors 12

$150 per person

  • Per monitor: $150
Chinese medicine 2

$500 per person

combined limit for acupuncture, chinese medicine, remedial massage & other services

  • Initial visit: $45
  • Subsequent visit: $45
Chiropractic 2

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

  • Initial visit: $56
  • Subsequent visit: $40
Dietetics/dietary advice 2

$300 per person

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

$1,700 per person

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

sub-limits apply

  • Filling of one root canal: $1200
Exercise physiology 2

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

  • Initial visit: $22.5
  • Subsequent visit: $22.5
Eye therapy (orthoptics) 2

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

  • Initial visit: 80% of charge
General dental 9

$1,700 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
Hearing aids 12

$1,500 per person

  • Hearing aid: $1500
Home nursing 2

$1,200 per person up to $100 per service

sub-limits apply

  • Initial visit: $1200
Major dental 9

$1,700 per person

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

sub-limits apply

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

$800 per person

combined limit for non pbs pharmaceuticals & vaccinations

  • Per eligible prescription: $100
Occupational therapy 2

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

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

$450 per person

sub-limits apply

  • Multi-focal lenses & frames: $400
  • Single vision lenses & frames: $400
Orthodontic 9

$1,700 per person

$3,600 lifetime limit

sub-limits apply

  • Braces for upper & lower teeth, including removal plus fitting of retainer: $3600
Orthotics (podiatric orthoses) 12

$400 per person

  • Orthotics supply & fit: $400
Osteopathy 2

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

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

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

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

$400 per person

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

$500 per person

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

$500 per person

combined limit for acupuncture, chinese medicine, remedial massage & other services

  • Initial visit: $45
  • Subsequent visit: $45
Speech therapy 2

$950 per person

combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services

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

$800 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

{$500 per person}

{combined limit for acupuncture, chinese medicine, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $45}

Ante-natal/Post-natal classes

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per policy}

Examples of maximum benefits

{Initial visit: 80% of charge}

Audiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{No annual limit}

Examples of maximum benefits

{Initial visit: 50% of charge}

{Subsequent visit: 50% of charge}

Blood glucose monitors

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$150 per person}

Examples of maximum benefits

{Per monitor: $150}

Chinese medicine

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$500 per person}

{combined limit for acupuncture, chinese medicine, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $45}

Chiropractic

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $56}

{Subsequent visit: $40}

Dietetics/dietary advice

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$300 per person}

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

{$1,700 per person}

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

{sub-limits apply}

Examples of maximum benefits

{Filling of one root canal: $1200}

Exercise physiology

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $22.5}

{Subsequent visit: $22.5}

Eye therapy (orthoptics)

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: 80% of charge}

General dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$1,700 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}

Hearing aids

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$1,500 per person}

Examples of maximum benefits

{Hearing aid: $1500}

Home nursing

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$1,200 per person up to $100 per service}

{sub-limits apply}

Examples of maximum benefits

{Initial visit: $1200}

Major dental

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$1,700 per person}

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

{sub-limits apply}

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

{$800 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

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $80}

{Subsequent visit: $65}

Optical

Waiting period:  4 months

Benefit limits per 12 months unless otherwise stated

{$450 per person}

{sub-limits apply}

Examples of maximum benefits

{Multi-focal lenses & frames: $400}

{Single vision lenses & frames: $400}

Orthodontic

Waiting period:  9 months

Benefit limits per 12 months unless otherwise stated

{$1,700 per person}

{$3,600 lifetime limit}

{sub-limits apply}

Examples of maximum benefits

{Braces for upper & lower teeth, including removal plus fitting of retainer: $3600}

Orthotics (podiatric orthoses)

Waiting period:  12 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

Examples of maximum benefits

{Orthotics supply & fit: $400}

Osteopathy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $32}

Physiotherapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $75}

{Subsequent visit: $55}

Podiatry

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$400 per person}

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

{$500 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

{$500 per person}

{combined limit for acupuncture, chinese medicine, remedial massage & other services}

Examples of maximum benefits

{Initial visit: $45}

{Subsequent visit: $45}

Speech therapy

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$950 per person}

{combined limit for chiropractic, exercise physiology, eye therapy (orthoptics), occupational therapy, osteopathy, physiotherapy, speech therapy & other services}

Examples of maximum benefits

{Initial visit: $50}

{Subsequent visit: $40}

Vaccinations

Waiting period:  2 months

Benefit limits per 12 months unless otherwise stated

{$800 per person}

{combined limit for non pbs pharmaceuticals & vaccinations}

Examples of maximum benefits

{Per service: $100}

Natural Therapies: Naturopathy, Western Herbal Medicine, Shiatsu

This policy does not include General treatment (Extras) cover for
Health management / Healthy lifestyle

Other features of this general treatment cover: Product also covers Osteopathy, Speech Therapy, Occupational Therapy, Homeopathy, Antenatal Classes, Cardiac Rehabilitation, Confinement by Midwife, Diabetes Education, Dietetics, Home Nursing, Orthopaedic Shoes, Vitamins, Naturopathy, Western Herbal Medicine, Shiatsu, and more.

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

Ambulance cover

In WA this policy provides:

Emergency: Unlimited with no waiting period.

Call-out fees: Will be paid for each attendance, including emergency treatment without transport to hospital.

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

Insurer Details

ACA Health Benefits Fund

Bronze Essentials Hospital 500 and Complete Ancillary WA

Restricted Insurer

$550.02 / month

(Before Rebate, Discount & Loading)

Available in WA

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/J9/WAHK20

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