By law private health insurers aren’t allowed to cover out-patients’ consultations or treatments. Instead this cost will be covered by Medicare, but if you’re not bulk billed, you’ll most likely have to pay something too.
You’re considered an out-patient if you receive treatment at a doctor’s office, clinic, or emergency department (without or before being admitted to hospital). Examples include GP visits, specialist consultations, scans, injections, and minor procedures in clinics.
In these cases Medicare will pay 85% of the Medicare Scheduled Fee for these services, and you pay the remaining 15%.
An exception to this is visits to your GP. Medicare pays 100% of the Medicare Scheduled Fee for GP appointments, and you will only have to pay something if the GP charges above the Scheduled Fee (which means they don't bulk bill).
If you are thinking about having a baby, then it’s a good time for you to review your private health insurance and make sure you understand what your policy does and doesn’t cover.
Waiting Periods of up to 12 months can apply for pregnancy, birth and newborn related health services, so if you’re unsure whether you are on the right cover for your growing family, please read our pregnancy and private health insurance guide or contact us.
Why can't my partner have their own member log in?