Before taking out private health insurance with Emergency Services Health, there is some important information you need to be aware of.
Fund Rules
Fund Rules are the rules that set out your rights and responsibilities as a member of Emergency Services Health.
These include establishing the rules for payment of our benefits. All persons covered by a health insurance policy with Emergency Services Health are subject to the Fund Rules, which are subject to change.
Emergency Services Health will send a copy of the Fund Rules to an adult covered by a health insurance policy with Emergency Services Health, if it receives a written request from the person to do so.
Membership conditions
This website does not contain all Emergency Services Health benefit details or conditions of membership. These conditions are contained in the Fund Rules. In the event of any inconsistency between anything on the website and the Fund Rules, it is the Fund Rules which apply in all cases.
You can obtain a copy of the Fund Rules (excluding schedules) by contacting us.
Waiting periods
Like all private health funds, Emergency Services Health has waiting periods for new members, including people transferring from another insurer when taking out a higher level of cover. Waiting periods also apply to current members upgrading their cover.
Waiting periods are designed to protect the interest of our members. Without them it would be easy for people to join only at the times when they need cover and to receive benefits. This would lead to higher premiums for all fund members.
At Emergency Services Health the waiting periods are:
Hospital benefits of Gold Hospital and Gold Combined:
- 2 months membership for all benefits, excluding accidents
- 12 months membership for obstetric treatment
- 12 months membership for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care.
- 12 months membership for aids & appliances*.
*12 months membership for continuous positive air pressure (CPAP) machines, and goods and services under Non-surgically Implanted Prosthesis and Appliances and other aids and appliances.
Extras benefits for Rolling Extras and Gold Combined:
- 2 months membership for all benefits, excluding accidents
- 12 months membership for major dental (like crowns and dentures) and orthodontics, hearing aids, nebulisers, blood glucose & blood pressure monitors, blood coagulation monitor and for pre-existing conditions
- 12 month membership for Rollover Benefit (2 years Major Dental).
Gold Combined:
- 3 years membership for corrective laser eye surgery.
It is important to note that if you are transferring from another insurer, waiting periods only apply to the level of cover that is greater than previously held.
For instance, if you previously had a top hospital cover with the previous insurer but with an excess, the waiting period only applies to the excess when joining Police Health.
Access further information through the Private Health Insurance Ombudsman
Pre-existing conditions
If a new member has a pre-existing condition before joining Emergency Services Health, they may need to serve a 12-month waiting period under the terms of our policy before benefits are payable for the particular condition. This does not apply for psychiatric care, rehabilitation or palliative care.
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition existed at any time during the six months preceding the day on which you purchased your insurance or upgraded to a higher level of cover.
A medical practitioner appointed by Emergency Services Health (not your own doctor) is the only person authorised to decide that a condition is pre-existing. The practitioner must, however, consider any information regarding signs and symptoms provided by your own treating doctor or specialist.
Access further information through the Private Health Insurance Ombudsman
Private Health Information Statements (PHIS)
All Australian health funds are required by law to provide Private Health Information Statements (PHIS) for each product they offer. PHIS's are important tools to aid the consumers of health insurance to review their existing policy or compare private health insurance products when making a purchasing decision.
There are three types of Private Health Information Statements:
- Hospital - describes the features and limitations of hospital cover, including the type of accommodation, which medical services are covered in full, part or not covered, waiting periods and additional payments (excesses, co-payments and gaps),
- General Treatment - describes the features and limitations of general treatment cover, including which services are covered, waiting periods, benefit limits and example benefits for each type of service, and
- Combined - describes the features and limitations of a combined hospital and general treatment cover, with details as above.
A Private Health Information Statements gives a summary of the key product features only, it is a description of your cover.
You should not fully rely on the dollar amounts of premiums on the Statement as they are there for comparison purposes only, but are indicative. The actual premium may vary depending on your circumstances, for example, your age and your age when you first got health insurance. Benefits will vary depending on the details of your policy, the treatments you are having, the health service provider and the payment option you choose.
Further information is available via the below government resources;