What's not covered?

Non-exhaustive list*

• 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.

You may have heard private health funds refer to agreement hospitals, contracted hospitals or even members hospitals. These are hospitals that private health funds have contracts with and generally for members to receive their full benefit entitlement they need to go to these hospitals.

Emergency Services Health has contracts with the majority of Australia's private hospitals. These contracts cover the vast majority of hospital admissions for our members and help keep the cost of your hospital insurance down. These arrangements ensure that an agreed schedule of fees (including in-patient accommodation, theatre, and special unit accommodation fees as appropriate) is charged by the hospital and paid by Emergency Services Health on the member's behalf.

However, with Emergency Services Health, if you need to be admitted to a non-contracted hospital, and unless we advise otherwise, we'll still provide you with full cover for recognised services you receive in that hospital. So you still get to choose the hospital for the treatment you require with total peace of mind.

Naturally, we'd prefer members to use one of our contracted hospitals, but as location and choice of specialist can sometimes limit your options, we'll leave that choice to you. If for any reason we cease to provide you with full cover for recognise services, we will provide details of the hospital(s) involved on our website.

In the unlikely event that we cease to recognise a hospital for full benefits, Emergency Services Health will advise members likely to be affected and publish the information on our website. 

Regrettably, following negotiations, Emergency Services Health through the AHSA have been unable to reach an agreement with Toowong Private Hospital on what we believe are fair fees. Reaching agreement on the level of fees they charge and we cover is important as it avoids unnecessary pressure being placed on your health fund premiums.

Toowong Private Hospital have now terminated our agreement effective midnight 24 August 2017. From this date, new and increased fees may be charged by them for the hospital services they provide. These fees are likely to be higher than what Police Health recognise for benefit payment purposes, resulting in a portion of their fees not being covered by us and being borne directly by you.

Transitional arrangements are in place to provide protection for our members at this hospital if before 25 August 2017:

• Treatment has commenced
• Treatment has been pre-booked and will be performed prior to 24 February 2018
• A course of treatment has commenced (includes treatments for up to 6 months)

In these circumstances the hospital will bill patients in line with the existing agreement and Police Health will pay its benefits.

A list of possible alternate hospital facilities offering mental health programs and care nearby can be found below. These are all hospitals with whom we have agreements over the fees they charge which will generally be covered by Emergency Services Health.

• Brisbane Private - Brisbane
• Belmont Private - Carina
• New Farm Clinic - New Farm
• North West Private Hospital - Everton Park
• Pine Rivers Private Hospital - Strathpine

If you require or a re-planning treatment at Toowong Private Hospital please contact us to discuss how this could affect you. Likewise, if you have any questions regarding your hospital cover, please contact us on 1300 703 703.