We have agreements with most private hospitals that are likely to be be accessed by members. These agreements (as part of Police Health Limited) ensure that an agreed schedule of fees (including in-patient accommodation, thatre and special unit accommodation fees as appropriate) is charged by the hospital and paid by us on our member's behalf.
Please note that a member's benefit entitlements will be affected by factors such as their level and type of cover and the financial status of their membership. This will affect the amount we will reimburse to the hospital. We strongly recommend you contact us on 1300 703 703 to confirm your benefit entitlement prior to recieving hospital treatment. If you choose a non-agreement hospital you may incur out-of-pocket expenses for hospital related sevices irrespective of your level of cover.
Important information about our Hospital cover.
What's not covered?
- Services incurred before waiting periods have been served.
- Treatment for which Medicare does not pay a benefit, including cosmetic surgery. (Some benefits may be payable for hospital treatment following this surgery. Please call us for more details.)
- Services that are provided outside of the Commonwealth of Australia.
- Services where an entitlement exists or may exist under any compensation, sports club or third party insurance.
- A claim for a service that is submitted more than two years after the date of service.
- Outpatient services, unless there is an agreement between Emergency Services Health and the hospital.
- Pharmaceuticals not related to the reason for hospitalisation or not covered under the agreement with the hospital or provided on discharge.
- Exceptional high-cost drugs where no or limited benefits are paid.
- Prostheses items that are not included on the Federal Government approved list.
- Charges greater than the benefit defined in the Federal Government’s Prostheses List.
- Personal and take-home items, e.g. newspapers, toiletries, television, hairdressing, manicure, etc.
- Treatment provided to a person in a private hospital emergency department.
- Aged care and accommodation in an aged care facility.
- If you’re in hospital for more than 35 consecutive days and not classified as an acute care patient, your benefits will significantly reduce.
- Benefits for ambulance services covered by a third party arrangement such as a State/Territory transportation scheme.
* This provides a general description of what is not covered. These are not “excluded or restricted” hospital treatments or services. Should you require information about a particular treatment or benefit please call us on 1300 703 703.