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Helpguide

Access Gap Cover

Access Gap Cover is a scheme to eliminate or reduce out-of-pocket expenses for medical services during hospital stays.
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Helpguide

Access Gap Cover

Emergency Services Health’s scheme to eliminate or reduce out-of-pocket expenses for medical services (doctors, radiology, and pathology) during hospital stays.
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Helpguide

Access Gap Cover (when admitted to hospital)

Under Emergency Services Health Access Gap Cover you may never have to pay a doctor’s bill.

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Helpguide

Accident and Emergency Facility Fee

Accident and Emergency Facility Fee is charged to patients by private hospitals for the treatment in an accident and emergency department.
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Helpguide

Am I covered for all ambulance services?

As a member of Emergency Services Health, you’re covered for both emergency and non-emergency ambulance services.

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Helpguide

Annual Maximum

The Annual Maximum refers to the benefit payable for services received during any calendar year.
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Helpguide

Annual Maximum

An Annual Maximum is the maximum benefit payable for services received during any calendar year for particular services or groups of services.

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Helpguide

Are there any Benefit limitation periods?

Other funds may apply benefit limitations which pay reduced benefits on one or more services for a set period of time that is no longer than normal

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Helpguide

Australian Government Rebate

An incentive whereby you’re offered a Rebate on your private health insurance premiums.
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Helpguide

Benefit

Benefit refers to the amount payable by Emergency Services Health to you.
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Helpguide

Benefit Entitlement Policy

Please take a moment to review our Benefit Entitlement Policy.

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Helpguide

Benefit Statements

Just received a benefit statement from us and want to know more? Take a look at these frequently asked questions. 

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Helpguide

Benefits limit for Extras

Private health insurers generally calculate an average charge for services and set their benefits based on those amounts.

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Helpguide

Calendar Year

Calendar year is from January 1 to December 31.
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Helpguide

Can I buy glasses online from overseas and claim them on my extras cover?

I found a great pair of spectacles from an overseas online retailer. Can I claim them on my extras cover?

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Helpguide

Can I suspend my membership?

You can apply to have your membership suspended under certain circumstances.
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Helpguide

Changes to Benefits Policy

Please take a moment to review our Changes to Benefits Policy.

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Helpguide

Claim

Claim refers to a request submitted by a member to Emergency Services Health for the payment of benefits.
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Helpguide

Claiming Made Easy

Claim most Extras on the spot

With the majority of Extras claims such as dental and optical, health providers can proces

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Helpguide

Clear and Complete Documentation Policy

Please take a moment to review our Clear and Complete Documentation Policy.

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Helpguide

Co-payment

A co-payment is an amount that a member agrees to pay towards the cost of each day spent in hospital.
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Helpguide

Co-payment

A co-payment is an amount that a member agrees to pay towards the cost of each day spent in hospital.
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Helpguide

Complaints Policy

Please take a moment to review our Complaints Policy.

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Helpguide

Complaints/ Dispute Resolution

At Emergency Services Health, we're constantly trying to improve the quality of our products, processes and services.

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Helpguide

Complementary Therapies

Emergency Services Health provides benefits for a broad range of recognised Complementary Therapies within extras cover.

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Helpguide

Contributor

Contributor refers to the person whose policy holds their name as the authorising contact.
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Helpguide

Cooling Off Period Policy

Please take a moment to review our Cooling Off Period Policy.

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Helpguide

Dependent

Emergency Services Health’s literature refers to four different types of dependents: spouse/partner, child, student and non-student dependents.
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Helpguide

Eligibility

Emergency Services Health Pty Ltd is a restricted access private health insurer for people who are or were employed (including volunteering) in the provision of emergency services, and their families.
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Helpguide

Excess

An excess is an amount that a member agrees to pay upfront before a health insurance benefit is paid towards hospital accommodation as set out under a health insurance policy, similar to a motor insurance policy.
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Helpguide

Excesses

An excess is an amount that a member agrees to pay upfront before a health insurance benefit is paid towards hospital accommodation as set out under a health insurance policy, similar to a motor insurance policy.
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Helpguide

Extras Cover

Extras or Ancillary Cover refers to health services such as dental, optical, or physiotherapy.
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Helpguide

Extras/Ancillary Cover

Extras Cover (also known as Ancillary Cover) generally refers to non-hospital and non-medical health services such as dental, optical, or physiotherapy.
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Helpguide

FAQ about Tax Statements

At the end of each financial year private health insurers, including Emergency Services Health, issue Private Health Insurance (Tax) Statements to

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Helpguide

FAQ: Premium Increase

Premiums have been reviewed by the Minister for Health and will be increasing as of 1 April 2018.

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Helpguide

FAQ: Why don't you offer different levels of cover?

The nature of health insurance is that you never know what health service you might need or when you might need it.

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Helpguide

Fund Rules

Fund Rules are the rules that set out your rights and responsibilities as a member of Emergency Services Health.
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Helpguide

Fund Rules

Rules that set out the rights and responsibilities of members of Emergency Services Health, including establishing the rules for payment of benefits.
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Helpguide

Gap

The Gap refers to the difference between the Medicare Benefits Schedule Fee for a medical service and the amount covered by Medicare.
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Helpguide

Hospital Accommodation

Accommodation-Hospital refers to the accommodation included in your hospital cover.
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Helpguide

How can I pay my premiums?

Premiums can be automatically paid fortnightly, monthly or quarterly by direct debit from your financial institution account.

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Helpguide

How health insurance works in Australia

The Australian Government provides certain incentives to encourage all Australians to take out private health insurance.

 

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Helpguide

How to make a claim

Lodging claims with Emergency Services Health is easy.

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Helpguide

I lost my membership card, what can I do?

If your membership card is lost or stolen please notify us immediately so that it can be cancelled and replaced.

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Helpguide

I need to travel long distances to access specialist medical services, am I covered?

Each state has a government sponsored travel and accommodation assistance scheme...
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Helpguide

Important Information

Before taking out private health insurance with Emergency Services Health, there is some important information you need to be aware of.

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Helpguide

In-patient

An in-patient is a person who has been admitted to a hospital.
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Helpguide

IVF and other Assisted Reproductive Services

Emergency Services Health's Lifelong Hospital and Lifelong Combined includes cover for in-hospital services relating to In vitro

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Helpguide

Lifetime Health Cover (LHC)

A Government initiative that rewards people who take out private hospital cover early in life by guaranteeing lower premiums than what would apply

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Helpguide

Lifetime Health Cover (LHC) Loading

The Lifetime Health Cover (LHC) Loading is a legislated requirement that encourages you to take out private hospital cover early on in your life.

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Helpguide

Lifetime Health Cover (LHC) Loading

A legislated requirement that encourages you to take out private hospital cover early on in your life. You’re rewarded with lower premiums for taking out cover and maintaining it.
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Helpguide

Lifetime Limit

The Lifetime Limit refers to the maximum cumulative total benefit limits payable in the lifetime of a member.
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Helpguide

Medicare Benefits Schedule (MBS)

A list of medical services and fees recognised by the Australian Government.

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Helpguide

Medicare Levy Surcharge (MLS)

Medicare Levy Surcharge (MLS) is a levy you should be aware of. Most Australian taxpayers are charged a 2% Medicare Levy.

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Helpguide

Medicare Levy Surcharge (MLS)

Most Australian taxpayers are charged a 2% Medicare Levy. However, those who do not have appropriate private hospital cover may have to pay an additional levy called the Medicare Levy Surcharge (MLS).
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Helpguide

Member

The use of the words “membership” and “member” in this website relates to the policy holder (Contributor) and all dependents under the policy of the Emergency Services Health insurance.
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Helpguide

Membership Arrears

Membership Arrears refers to when a member is not up-to-date with policy payments.
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Helpguide

Membership Conditions

This website does not contain all Emergency Services Health benefit details or conditions of membership.

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Helpguide

Non-recognised hospitals

Regrettably following negotiations, Emergency Services Health through the AHSA have been unable to reach agreement with Toowong Private Hospital on

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Helpguide

Not-for-profit

Emergency Services Health operates on a not-for-profit basis.

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Helpguide

Out-of-pocket Expenses

The portion of charges you incur that is not covered by Medicare or health fund benefits.

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Helpguide

Out-patient

A person receiving treatment at a hospital but not admitted to hospital.

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Helpguide

Palliative Care

Specialised health care to support and comfort people with life-limiting illnesses.

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Helpguide

Pharmaceutical benefits

Under extras cover you’re eligible to receive pharmaceutical benefits towards prescription items that are not eligible for subsidy under the Govern

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Helpguide

Pharmaceutical Benefits Scheme (PBS)

An Australian Government subsidy scheme that lowers the cost of prescription medicine.

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Helpguide

Policy Holder

Emergency Services Health’s reference to a policy holder refers to the contributor of the policy (not everyone covered under the policy).

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Helpguide

Policy/Product

Policy/Product refers to a health insurance policy with Emergency Services Health and the treatment you're insured for in exchange for a set premium.
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Helpguide

Pre-existing Condition

Where signs or symptoms of an ailment, illness or condition (in the opinion of a medical practitioner appointed by us) existed at any time during t

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Helpguide

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 t

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Helpguide

Pregnancy and private health insurance

If you’re thinking of starting a family, now’s a great time to review your health insurance to make sure you’re happy with, and understand, your co

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Helpguide

Premium

Premium is the amount you pay for your hospital, extras or combined cover policy.
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Helpguide

Privacy Policy

Emergency Services Health’s primary purpose for collecting information is to conduct a health insurance business and any health related business, including the provision of goods and services either directly or through a third party.
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Helpguide

Prostheses

Prostheses include screws and plates, intraocular lenses, replacement joints, cardiac stents, defibrillators and other devices that are surgically

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Helpguide

Provider

An individual or institution that provides preventive, curative, palliative or rehabilitative health care services to individuals, families or comm

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Helpguide

Reasons to join

We believe we’re the best health insurer for emergency services employees, volunteers and their families because;

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Helpguide

Recognised health providers

Recognised health providers are those who are in private practice in Australia and recognised by us.

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Helpguide

Restricted Membership Access

Restricted Membership Access means that people must meet certain criteria to be eligible to become a member.
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Helpguide

Rollover Benefit

An exciting benefit for Emergency Services Health members!
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Helpguide

Standard Information Statements (SIS)

SIS are designed to assist you in reviewing and comparing different health insurance policies.
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Helpguide

Standard Information Statements (SIS)

All Australian health funds are required by law to provide Standard Information Statements (SIS) for each product they offer.

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Helpguide

State of Residence

The state or territory where the Contributor of
the policy lives.

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Helpguide

Suspension of Private Health Cover

Under certain circumstances, such as travelling overseas, members may suspend the payment of their premiums for an agreed period of time (condition

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Helpguide

The Australian Government Rebate

The Australian Government Rebate on private health insurance (Rebate) is an incentive whereby you’re offered a Rebate on your private health insura

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Helpguide

Thinking about having a baby?

Then it’s a good time for you to review your health insurance and make sure you understand what your policy does and doesn’t cover.

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Helpguide

Understanding Medicare

How much does Medicare cover for out hospital services?

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Helpguide

Waiting Periods

A ‘waiting period’ refers to the period of time from the commencement of cover or increase in cover, to when the benefit or new benefit can be claimed by the member under their chosen cover (excludes accidents).
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Helpguide

Waiting periods

Like all private health funds, Emergency Services Health has waiting periods for new members, including people transferring from another insurer wh

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Helpguide

What do I need to know if my child needs braces?

Orthodontics can vary considerably in the period of treatment, cost and how you’re billed.
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Helpguide

What does 'Members Own' mean?

Whenever you see the Members Own symbol next to a health fund logo, you're looking at a fund that values members over profits and works hard to del

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Helpguide

What does no excess or co-payments mean?

Other funds may charge an excess (an excess is the amount you agree to pay towards the cost of hospital treatment).

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Helpguide

What does no exclusions and restrictions mean?

Other funds may apply exclusions (you agree not to be covered at all for certain treatments).

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Helpguide

Your choice of doctor

We give you freedom to choose.

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