Private health insurers generally calculate an average charge for services and set their benefits based on those amounts.
Emergency Services Health goes further and in the majority of cases recognises charges up to 10% higher than the calculated average. This means that when members make a claim for extras with Emergency Services Health, they tend to get more back - 80% in the majority of cases.
If the service charge is higher than the fee we recognise, the percentage amount you receive will reduce accordingly.
Our 80% benefit applies to the net amount payable on an account, inclusive of any discounts the provider might be offering; this may vary where, for the benefit of our members, Emergency Services Health has negotiated specific agreements with selected providers. To see examples of benefits paid please download a copy of our State Premiums & Benefits Guide.