Our Cover

FREEDOM TO CHOOSE your recognised doctor or health care provider.

WE'RE THE ONLY FUND in Australia which offers rollover benefits.

GENEROUS BENEFITS we pay 80% of the cost of most Extras services.

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

That's why Emergency Services Health only specialise in top-level cover for complete peace of mind. We make your private health insurance choices as simple as possible to ensure maximum value. We don’t overload you with options, or opt-ins or opt-outs. Our products are simple, high quality and designed for life.

With 80% back on most services and a unique Rollover benefit.

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Comprehensive, top-level hospital with no excesses, co-payments, exclusions or benefit limitation periods.

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It’s simple – we’ve combined our top-level hospital and extras cover to give you complete peace of mind.

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How we're different is why we're better

Each of our products include comprehensive ambulance cover.

Learn more

Most of our Extras roll with you from one calendar year to the next.

Discover more

We only offer Gold level hospital cover as we believe anything less would be a disservice to you.

Find out how

Lodging claims has never been easier with Emergency Services Health.

Discover how

Adam

"I have just signed up with Emergency Services Health and have had nothing but wonderful service so far! Lora has been great to deal with! My benefits are so much better than my previous provider! Stoked I made the change! Thanks again ESHealth!"

Find a Contracted Hospital

Our hospital cover gives you more choice on where you are treated - your hospital not ours.

Our hospital cover doesn't restrict you to any particular hospital- our benefits apply in all recognised hospitals for recognised services.

Emergency Services Health is committed to providing cover that represents the highest quality and the best value for our members. In meeting this commitment, we maintain agreements with over 500 private hospitals across Australia. These agreements 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 the Fund on the member’s behalf.

Please note that a member’s benefit entitlements may be affected by factors such as their level and type of cover and the financial status of their membership.

Search for a Contracted Hospital

We strongly recommend you contact us on 1300 703 703 prior to your admission to confirm your benefit entitlement. If you choose a non-contracted hospital you may incur out-of-pocket expenses for hospital-related services irrespective of your level of cover.

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Important information about our Hospital cover.

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.

Contracted Hospitals

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.

Non-contracted Hospitals

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.

Glossary

A - F

G - L

M - R

S - Z

A - F

Access Gap Cover

The Fund's Scheme to eliminate or reduce out-of-pocket expenses for medical services (doctors, diagnostic imaging/radiology, and pathology) during hospital stays. If the medical practice is not yet aware of us, ask them to contact our office on 1300 703 703, we are here to help.

Accident & Emergency Facility Fee

A fee charged to patients by private hospitals for the treatment in an accident and emergency department. It is not covered by Medicare or private health insurance.

Annual Maximum

The maximum benefit payable for services received during any calendar year for particular services or groups of services per person unless stated otherwise. The Annual Maximums start new on the 1st of January each year (orthodontics maximum is determined by length of membership based on anniversary year).

Benefit

The amount payable by the Fund to you, or on your behalf to a service provider in respect of a claim made relating to the provision of health services, treatment, care, or goods by a recognised provider.

Benefit Limitations

Our hospital cover has no 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 waiting periods, then pay full benefits after this period.

Calendar Year

From January 1 to December 31.

Claim

A request submitted by a member to the Fund for the payment of benefits for hospital treatment, in-patient medical treatment or extras treatment. All claims must be made within two years of receiving treatment.

Contributor

A Contributor in the Fund Rules refers to the person who is registered as the Contributor of the policy, in which the policy holds their name as the authorising contact, recipient for all written and/or electronic communications and is responsible for premiums of the policy.

Co-Payment

A co-payment is an amount that a member agrees to pay towards the cost of each day spent in hospital. Emergency Services Health does not have co-payments on its hospital coverage. However, if you transfer to Emergency Services Health and your previous cover had a co-payment component, you’ll be required to serve waiting periods in relation to the co-payment and you may be required to pay the co-payment if you receive hospital treatment during the waiting periods.

Dependent

Our Funds literature refers to four different types of dependents: spouse/partner, child, student and non-student dependents.

Our Fund Rules refer to the Contributor and dependents. Dependents may be a spouse/partner of the Contributor and any child dependent of the Contributor or of the spouse/partner.

A child dependent is a person who is a child of the Contributor or spouse/partner of the Contributor, does not have a partner and is either under 21 years of age, or is a student dependent or is a child non-student dependent.

A student dependent means under all policies, a person who is a child of the Contributor and/or their spouse/partner who is over 21 years of age but under 25 years of age, who is considered to be a full time student of a school, college, university or other tertiary institution recognised by us.

A child non-student dependent is a person who is a child of the Contributor or the spouse/partner of the Contributor and is aged 21 years but under 25 years. Child non-student dependents can only be included in the Lifelong Combined product at the Single Parent Family Plus or Family Plus rates.

In all cases a child is taken to include a natural child, adopted child, foster child or a child who is a legal ward of the Contributor or their spouse/partner. A child ceases to be eligible as a dependent if married or in a de facto relationship.

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. Emergency Services Health does not have excesses on any of its hospital products. However, during waiting periods you may be required to pay an excess if you were subject to one under your previous policy.

Extras Cover

Generally refers to non-hospital and non-medical health services such as dental, optical, or physiotherapy. Also sometimes referred to as Ancillary cover or General Treatment.

G - L

Gap

This most commonly refers to the difference between the Medicare Benefits Schedule Fee for a medical service and the amount covered by Medicare. It can also refer to the uninsured difference between the fee charged for a service and the benefit paid by our Fund (and Medicare if applicable), in effect your out-of-pocket cost. It can also refer to the uninsured difference between the fee charged for a service and the benefit paid by our Fund (and Medicare if applicable), in effect your out-of-pocket cost.

Hospital Accommodation

Accommodation included in your hospital cover generally includes all in-hospital services such as meals, bed and nursing care. Accommodation does not include take home or personal items, e.g. toiletries, television, hairdressing, manicure etc

In-Patient

A person who has been admitted to a hospital. This does not include a person being treated in the out-patient or accident & emergency sections of a hospital.

Lifetime Limit

The maximum cumulative total benefit limits payable in the lifetime of the member on a particular service. Where lifetime limits apply, any benefits paid by your previous private health insurer are treated as part of this Lifetime Limit.

M - R

Medicare Benefits Schedule (MBS)

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

Member

The use of the words “membership” and “member” in this website relates to the policyholder (Contributor) and all dependents under the policy of the Fund. It does not imply member voting rights as described in the constitution of Police Health Limited ABN 86 135 221 519 .

Membership Arrears

When a member is not up-to-date with policy payments, the membership will be in arrears and no benefits will be paid to or on behalf of the member. The policy may be cancelled by the Fund if in arrears greater than two months.

Not-For-Profit

The Fund operates on a not-for-profit basis. This means we do not pay dividends to shareholders, and any surpluses are retained to benefit members.

Prostheses Out-of-pocket Expenses

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

Out-patient

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

Palliative Care

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

Pharmaceutical Benefits Scheme (PBS)

An Australian Government subsidy scheme that lowers the cost of prescription medicine. Health funds are not permitted to pay benefits towards medicines that receive a government subsidy except when they are supplied while an in-patient of a hospital.

Private Health Information Statements (PHIS)

PHIS are available on all private health insurance products in Australia. These are designed to assist you in reviewing and comparing different health insurance policies.

This is a Federal Government initiative and all health insurers are required to provide such statements by law. Emergency Services Health as brought to you by Police Health Limited ABN 86 135 221, PHIS are available on request.

For further information on PHIS and other detailed information on private health insurance in Australia visit the Federal Government's private health website.

Policy Holder

Our Fund's reference to a policyholder refers to the contributor of the policy (not everyone covered under the policy).

Policy/Product

This refers to a health insurance policy with the Fund and the treatment you’re insured for in exchange for a set premium. The policy is governed by the Fund Rules.

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 the six months before you purchased your policy or upgraded to a higher level of cover.

Premium

The amount you pay for your hospital, extras or combined cover policy. You must pay the premium that applies to your policy in the state in which you live. This means that if you move states, different premiums will apply.

Prostheses

Prostheses include screws and plates, intraocular lenses, replacement joints, cardiac stents, defibrillators and other devices that are surgically implanted during your stay in hospital.

Provider

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

Recognised health providers

Recognised health providers are those who are in private practice in Australia and recognised by us. We only pay benefits for services by these providers. If you wish to ensure that your provider is covered please speak to us prior to treatment.

Restricted Membership Access

Emergency Services Health as brought to you by Police Health Limited ABN 86 135 221 is a restricted membership private health insurer, meaning that people must meet certain criteria to be eligible to become a member.

S - Z

State of Residence

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

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 (conditions apply).

Waiting Periods

A ‘waiting period’ in the context of private health insurance means 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).

Brochures / Forms / Policy Documents

Please click on the links below to access the resource you are after.

Brochures

• Introducing Emergency Services Health

• Pregnancy Guide

• IVF & Assisted Reproductive Services Guide

• Pharmacy Guide

• Understanding Waiting Periods Guide

Products and Benefits

• National Products & Benefits Guide

• SA State Premiums & Benefits Guide

• NSW State Premiums & Benefits Guide

• ACT State Premiums & Benefits Guide

• QLD State Premiums & Benefits Guide

• VIC State Premiums & Benefits Guide

• NT State Premiums & Benefits Guide

• WA State Premiums & Benefits Guide

• TAS State Premiums & Benefits Guide

Forms and Agreements

• Application Form & Variation Form

• Claims Form

• Claims Consent Form

• Application to Suspend Form

• Direct Debit Request Form

• Direct Debit Request Service Agreement

• Student Dependent Form

• PHI Cancellation Request Form

• Registering Individual Details Form

• Provisional Payment Application Form

Policy Documents

• Three Important Policies (Privacy Policy / Cooling Off Period Policy / Complaints Policy)

• Clear and Complete Documentation Policy

• Changes to Benefits Policy

Please note: These brochures and policies do not replace the Fund Rules, which outline the terms and conditions of your cover, to find out more please contact us 1300 703 703.

Terms and Conditions

The website and mobile application or “App” (collectively, online services) are owned by Police Health Limited ABN 86 135 221 519 © Copyright Police Health Limited.

By opening, viewing or using these online services, you acknowledge that you have read and unreservedly accept these Terms and Conditions.

1. Reliance on information and other content

You accept that information contained within these online services is for general purposes only. We do not warrant the accuracy, completeness or currency of the information or other content. We have absolute discretion and without any obligation whatsoever to add, delete, amend, alter, change, correct, update or otherwise deal with any information or other content, including these Terms and Conditions, at any time and without notice. Calculations of premiums are simulations, subject to variation depending on your personal circumstances and indicative only and are subject to confirmation and the Fund Rules. No information appearing on these online services is to be taken as a quote, an offer or as having qualified for cover. All information relating to health insurance policies is subject to the Fund Rules, which can be provided to members on request. Fund Rules and benefits are subject to change. Where there is a discrepancy between the Fund Rules and information appearing on these online services, the Fund Rules will prevail. No person should act or fail to act on the basis of the information or other content appearing on these online services.

A person cannot be covered under a health insurance policy unless eligibility requirements are met and the person is accepted by us for health insurance purposes.

We may collect, use and disclose your personal and sensitive information in accordance with the Privacy Policy.

2. Transmission over the internet

You acknowledge that the Internet is not a secure environment. We cannot guarantee the security of information you send and receive by electronic means, and hence electronic exchanges are undertaken at your own risk.

You accept that it is your responsibility to protect yourself from exposure to damage to your computer systems, such as from viruses and other malware, or unauthorised access to your computer systems and your information.

You agree to provide us, through the online services, only with information that you are legally entitled to provide.

You must not, nor permit any other person to, disrupt or interfere with or attempt to disrupt or interfere with the operation of the online services in any manner whatsoever. This includes, but is not limited to, acts or attempts to knowingly transmit viruses or other malware, or make unauthorised access to the online services and/or change the content. Inappropriate conduct may result you being restricted from accessing or using part of or all of the online services.

3. Third Parties and Third Party sites

We provides links to third party websites. These websites are not under the control of us and you acknowledge that we are not responsible for any practices, content or risks associated with the use of third party websites.

We provide a search facility for third party providers and may publish a name or logo in respect of a third party. We do not warrant the products or services of these third parties in any manner whatsoever, and service or product issues must be taken up with these third parties directly. Furthermore, we do not warrant or make any representation as to the currency or accuracy of any third party information contained in or produced by the search facilities online.

4. Health and health related information

All health or health related information on this website is provided for general purposes only and does not replace advice or treatment from health professionals.

5. Online member services portal and Claiming on Mobile Application

We will provide Contributors to a health insurance policy with online access to their health information when registered through the website. Information available through the online services may not be up to date, mainly due to timing differences between receipt and processing information.
We reserve the sole right and discretion:

To determine a Contributor's eligibility to on-line services, the extent of that access and the level of on-line services that will or will not be made available.
To determine what information is displayed in relation to an individual on the policy.
To cancel or terminate a Contributor's access, PIN/password or de-activate the on-line account.
To discontinue or modify, on a permanent or temporary basis, all or any part of the on-line services, with or without notice.

By registering to use and by using the our online services, you agree to:

First register through the website, following the registration process and provide your true name, date of birth and email address.
Take entire responsibility for the security and confidentiality of your PIN/password and you accept that we will assume that you are the user whenever the PIN/password is used to access the on-line services.
Not disclose your PIN/password to any other person or body, and take full responsibility for any consequences arising from such disclosure.
Advise us immediately upon becoming aware that your PIN/password has been compromised or there has been unauthorised use, and change your PIN/password through this website.
Logout of sessions when not using the on-line service.
Advise other persons on your health insurance policy of your on-line access to their personal information.
Advise other persons on your health insurance policy who are 14 years and older (and upon turning 14 years of age) that they may contact us and request their claims information not to be displayed.
Unless permitted by us or authorised by the person involved, not access the information or perform services related to another person.

You agree that:

You are responsible for all the content you upload or provide to us and that information is true, accurate, current and complete.
If you provide, or we have reasonable cause to believe you have supplied, false and/or misleading information, then we have the right to suspend or terminate access.
Access and use of the on-line service is entirely at your own risk.
Individuals on your health insurance policy may have a right to contact Eus and request that their claims information not be displayed.

6. Intellectual property

Police Health Limited ABN 86 135 221 519, owns all intellectual property rights, including but not limited to copyright and confidential information, in the content of the online services (including in all information, text, software, design and graphics, logos and images), subject to any third party rights, and:

You must not modify, copy, reproduce, download, upload or transmit the content of the online services, or any part of it, for any purpose whatsoever other than for personal use without the written permission by us.
Trademarks and logos are acknowledged to be proprietary to their respective owners and protected by applicable laws.

7. Limitation of liability

To the maximum extent possible under the law, we and its officers, directors, employees, agents or representatives:

Disclaims all and any liability whatsoever (including liability for negligence) to you or any other party for any loss or damage (whether direct, indirect, consequential, incidental, or special) arising out of any action or arising from any failure to act by you or any other party in opening, viewing, using, downloading, uploading, or relying on or dealing in any way with information or other content from the online services or other websites.
Excludes any conditions or warranties (express, implied or statutory) relating in any way to the use or non-use of the online services.
Does not accept any responsibility whatsoever for any interference or damage, or any unauthorised access to, your software, hardware or any computer systems in connection with the use of this website.

In using this website, the mobile application or third party websites:

You accept all risks and responsibility for any loss, damages, costs or other consequences.
You agree not to not hold us, its officers, directors, employees, agents or representatives liable for any unauthorised access, disclosure, damage, corruption or loss of information or other content.
You agree that we are not liable to you or to any other party for any restriction or termination of access to, or modifying, suspending or discontinuing all or part of the on-line services.

8. Law and Jurisdiction

These Terms and Conditions are governed by, and must be construed in accordance with, the laws of South Australia and by opening, viewing or using our website, you unconditionally submit to the jurisdiction of the Courts of South Australia.

Privacy Policy

Background

In this Privacy Policy, reference to “we”, “us” or “our” is reference to Police Health Limited (ABN 86 135 221 519), a registered not for profit, restricted access private health insurer, including the brands Police Health and Emergency Services Health. Reference to “you” or “your” is reference to a customer or a person insured under a private health insurance policy or having any contact or dealing with us.

Our 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.

We are committed to maintaining the privacy of individuals whose information we collect in accordance with the Australian Privacy Principles (APPs) contained in the Privacy Act 1988. We aim to manage personal information that we collect in an open and transparent way. This Privacy Policy describes how we manage personal information. If you have any queries about the Policy or the manner in which personal information is managed, you may contact us for further information (contact details appear at the end of this Policy).

Collecting and holding personal information

We collect and hold personal information about people insured or interested in becoming insured under a health insurance policy, providers of health services, suppliers, contractors, people attending functions or events and other contacts to conduct our activities, understand and meet stakeholder needs and meet our legal obligations. If you do not provide us with the information we ask for, we may not be able to perform these activities and functions, in particular relating to applications for health insurance cover, administering health insurance policies, providing relevant services, assessing and paying claims and meeting statutory reporting requirements.

An individual may deal anonymously with us when seeking general information about us and our products. However, it is not practicable for individuals not to identify themselves, or to use a pseudonym, when dealing with us in relation to health insurance or claims.
We collect and hold the minimum personal information required to perform our functions and activities.

This information may include:

Contact and identity information, such as names, addresses, age, gender, marital status and relationship details, employment details, government identifiers, passwords, telephone, mobile and facsimile numbers and email addresses.
Financial information, such as premiums, income, Australian Government Rebate on private health insurance tier level, bank account details, and employment details.
Sensitive information, such as information about claims, health services provided to you and your health.
Correspondence or correspondence details, verbal and written, hard copy or electronic.
Provider information, relating to their scope of practice.

Where possible, the information is collected from you, from a person or organisation authorised to provide the information on your behalf or from another person insured on your health insurance policy. Information may also be collected from government agencies, business partners, contractors, employers, other private health insurers, other insurers and service providers.

In particular, when you make a claim, you consent to us collecting sensitive (health) information directly from third parties, or if the information relates to someone other than you on the health insurance policy, you give consent on behalf of that person and you must be authorised to do so.

Where you receive treatment at or by a hospital, our contracted third party, the Australian Health Service Alliance (www.ahsa.com.au) collects personal information about your claim to assist us in assessing and paying your claim and assisting us in meeting our statutory reporting requirements.

Personal information may be collected from a person acting on behalf of an insured person or from an organisation or person when authorised by a person acting on behalf of the insured person. The circumstances of this collection usually relate to an application for a health insurance policy, amendments or additions to a health insurance policy, amendments or changes to personal details and when making claims under a health insurance policy.

Information may be collected by us by voice, electronically or in hard copy and is stored by us either electronically, in hard copy or both electronically and in hard copy.

HAMB Systems Ltd supports our membership management and claims processing system by the provision of software and hosting services. Personal information is held on systems hosted by HAMB Systems Ltd at its sites. Third party suppliers host voice recordings and related material. Data may be held on systems owned and managed by “cloud” service providers. These and other service providers that host personal information are subject to the Privacy Act, and agreements ensure the integrity and security of personal information and management of the information in accordance with this Privacy Policy and the Australian Privacy Principles.

We collect personal information on a recurring basis, in particular relating to managing your health insurance with us and when making a claim. This is your notification that we will collect your personal information on a recurring basis. When you or your authorized representative interact with us and when you receive treatment for which a claim is made on your health insurance policy, it is reasonable for you to expect that we will collect your personal information.

If you are the Contributor of a health insurance policy with us, you are responsible for ensuring that every person on the health insurance policy is aware of this Privacy Policy, particularly as it relates to the collection, holding, use and disclosure of their personal information for the purposes of their cover and verifying that appropriate benefits are paid. Where you provide personal information to us about another person on the health insurance policy, you must be authorised to do so.

If you are not the Contributor of a health insurance policy with us, but are making a claim, or otherwise providing personal information, on behalf of another insured person, you must be authorised to do so.

If you or any other person on your health insurance policy does not consent to the collection and the way we use and disclose personal information, we may not be able to provide you or the other person with cover.

Use of personal information

Personal information is used for a number of reasons such as:

Administering the private health insurance fund and your private health insurance policy. This includes providing a billing and claims payment service involving assessment, processing, control, auditing, benefit review, research and system maintenance and undertaking related regulatory requirements such as Contributor communication and reporting.
Enabling us to comply with legislative requirements for the collection of and submission of data to Government agencies.
Developing and providing products and services.
Communicating to you general information about us, the health insurance industry, health and well-being or other material which we consider may be of interest to you.
Advising you of direct marketing offers, such as promotions, products and services provided or offered by us or on our behalf, or other service providers who have a relationship with us, that we consider may be of interest or benefit to you or other people insured on the same health insurance policy (where applicable). Direct marketing material may be brought to your attention by various means and includes being sent to you through electronic communications such as email or text message, mail and/or by phone. When you become a customer or become insured under a private health insurance policy, you consent to receiving marketing material for an indefinite period (including after you may cease to be insured by us). If you do not want to receive direct marketing material or offers, you can withdraw your consent by contacting us.
Resolving business or legal matters, issues or complaints.
Purchasing or providing health or health related services on your behalf, including membership of organisations.
Part of the security protocols used by staff to confirm the identity of the person being dealt with.
Undertaking surveys to improve our products and services.
Identifying persons that may benefit from risk management, health management and disease management programs and, where the person has consented or the person would reasonably expect us to do so, for the provision of these health programs.
Perform any other functions or activities.
Our functions and activities and our range of products and services may change from time to time.

Disclosure of personal information

We may disclose your personal information (including sensitive health information) to other individuals on your health insurance policy for administering the policy, including for the payment of benefits. As the Contributor is the holder of the health insurance policy, we disclose all personal information about all insured persons on the policy to the Contributor, including details of all benefits and services claimed on the policy. We send all communications on health insurance policies, including those that cover more than one person, to the address supplied by the Contributor. In addition, at the time of joining us, the Contributor authorises us to share personal information amongst individuals on the health insurance policy.

A person over the age of 14 years may request to have their sensitive information kept private from other persons insured on the policy. We will endeavour to keep the information private, but may be obliged to disclose information on request by the Contributor of the insurance policy, or a parent or guardian of the person. If any insured person aged 18 years or older wants to guarantee that their personal information (in particular sensitive information) is not disclosed to other persons on the health insurance policy, they will need to purchase their own health insurance policy.

We may need to disclose personal information to various organisations such as:

Government agencies, including Medicare, Private Health Insurance Ombudsman, the Department of Health and the Australian Prudential Regulation Authority;
Other private health insurers or other health insurance industry bodies;
Health service providers;
Professional advisers.
Persons or organisations authorised by you (this includes other people covered under the same health insurance policy) and your agents and advisers;
Insurers or legal representatives of insurers, or statutory authorities such as Return to Work SA, in relation to claims made for damages or compensation for motor vehicle or other accidents or workers compensation.
Organisations contracted by us to assist in the delivery of our functions and services. This includes our contracted third party agents such as the Australian Health Service Alliance Ltd (Note: From time to time, we disclose personal information to the Australian Health Service Alliance who provides clinical, classification and contract support in order to assist us with correctly assessing a claim for payment and to identify persons who could potentially benefit from a chronic disease management program), organisations that provide mail out services, organisations for security purposes, organisations that support our voice recording infrastructure and organisations that supply and support our information technology infrastructure;
To business partners who provide services direct to you on our behalf or business partners from which we purchase services on your behalf and this includes organisations that results in you also becoming their client and/or member (note: this may involve the retention of disclosed personal information by the business partner to deliver their services to you);
Payment system operators and financial institutions;
Your employer; and/or
Other parties to whom we are authorised or required by law to disclose information, such as auditors and actuaries.

We will not sell your contact details or add your contact details to mailing lists of third parties unrelated to your health insurance policy or with whom we do not have a relationship, without your prior consent. We will require that business partners and contractors comply with the Australian Privacy Principles.

We are not likely to disclose your personal information to overseas recipients.

Security

We undertake all reasonable steps to ensure that your personal information is kept secure and to protect your information from misuse, loss and unauthorized access, modification or disclosure. Paper documents are protected from unauthorized access through the application of a security system at our premises. Computer and network security systems include, amongst other things, the use of firewalls, encryption technology and password protection.

Social media, website analytics and electronic exchanges

When you visit our websites, a record of your browser, devices used to access the website, location, IP Address, cookies and such similar related information is made.

We use persistent and session cookies to store information entered into the websites. This information is stored on your browser until it is closed. Information is securely transferred by encryption protocols (SSL) to our server and exists within memory for the duration of the HTTPS request and associated response, upon which it is removed. You may refuse the use of cookies by selecting the appropriate settings on your browser, however please note that if you do this you may not be able to use the full functionality of the websites.

Our websites use a range of tools and services provided by third parties, including Google Analytics, a service which transmits website traffic data to various Google servers around the world, including the United States. Google Analytics does not identify individual users or associate your IP address with any other data held by Google.

We use reports provided by Google Analytics to help us understand website traffic and webpage usage.
By using our websites, you consent to the processing of data about you by Google in the manner described in Google’s Privacy Policy and for the purposes set out above. You can opt out of Google Analytics if you disable or refuse the cookie, disable JavaScript, or use the opt-out service provided by Google- external site. In addition to anonymous Data Collection Tools, we also collect identifiable information through the use of tracking pixels and cookies. This allows for the collection of information regarding the use of the web page that contains the tracking pixel/cookie. For example, if you have used Facebook on the same device, we share the tracking cookie data with Facebook who will use this to optimise advertising provided to you when using Facebook.

We provide links to third party sites, and third party applets for social media sharing.

These sites are not under our control and hence we are not responsible for any practices by these third parties that may breach your privacy. We encourage you to review the privacy policies of these third parties.

If you access or log-in to our websites through a third party social media service, we may also collect information from that social media service.

This may include:

your user name for that service;
any information or content you have permitted the social media service to share with us (such as your profile picture(s), email address, followers or friends lists); and
any other information you have made public (including other posts you make using your social media profile).

We do not collect your social media profile password. When you access our websites through your social media profile, or when you connect to your social media profile, you authorise us to collect and handle your personal information in accordance with this Privacy Policy.

We may send you push notifications from time-to-time in order to update you on our latest blogs or about current promotions which we may be offering. If you no longer wish to receive these communications, you may turn them off at any time at the device level or by visiting our websites and following the prompt. To ensure you receive proper notifications, we will need to collect certain information about your device such as operating system and user identification information.

Use and access of our websites must be in accordance with the terms and conditions published on the websites.

We provide Contributors with access to Online Member Services in accordance with the published terms and conditions.

Correcting, updating and accessing personal information

Subject to any legislation, an individual has a right to request reasonable access to their personal information and to request its correction. Generally, obtaining access, updating and correcting your personal information is undertaken by our Customer Services Officers using one of the points of contacts listed further below.

Depending on the information and how it is stored, information may be viewed at our office, accessed through the Online Member Service or sent to the requestor. We reserve the right to charge an administration fee for the provision of the information to cover costs incurred.

We have the right to withhold the release of personal information in certain circumstances.
The accuracy of your personal information is important to us. If you believe that any personal information is not accurate, complete or up to date, we should be advised in writing as soon as practicable.

Complaints

Questions about our Privacy Policy and privacy practices, requests for access and correction of personal information that you believe have not been addressed or complaints about a possible breach of privacy should be directed to the Privacy Officer using the contact details listed below.

Contact details

In relation to Police Health:
Postal Address: PO Box 6111 Adelaide SA 5000
Phone number: 1800 603 603
Facsimile number: (08) 8112 7099
Email address: enquiries@policehealth.com.au

In relation to Emergency Services Health:
Postal Address: PO Box 6111 Adelaide SA 5000
Phone number: 1300 703 703
Facsimile number: 1300 151 152
Email address: enquiries@eshealth.com.au

Information about Privacy

Information about privacy, including links to the Privacy Act 1988 and the Australian Privacy Principles can be found on the Website of the Office of the Australian Information Commissioner, www.oaic.gov.au

Privacy Policy changes

From time to time, we may modify this Privacy Policy. Where this occurs we will publish the new Privacy Policy on websites, www.policehealth.com.au and www.eshealth.com.au

Policy Administration

Policy Approved From: 20 June 2020
Policy Review Date: 31 March 2023

Oversight Responsibility: Risk Management and Compliance Committee

How to claim

Get more value and benefits from your private health insurance, without the hassle.

Lodging claims with Emergency Services Health is easy. Depending on the service and provider, there are a number of ways to claim which have been listed below.

How to claim for Extras

On the spot claims on extras services

With the majority of extras claims such as dental and optical, health providers can process your claim on the spot using EFTPOS-style claiming facilities provided by HICAPS and iSOFT HealthPoint.

These are often referred to as "On the spot" claiming. On the spot claiming has become the preferred option for most policyholders, with more than 85 percent of eligible claims being processed this way.

All you have to do is swipe your membership card and sign to validate the service. Your claim will be automatically lodged with Emergency Services Health and we pay the provider directly.

There is no need to pay the full consultation fee up-front and then wait for reimbursement of your benefit. Just present your Emergency Services Health membership card, pay any out of pocket gap and you're done.

Who offers on the spot claiming?

To find out if your health provider offers on the spot claiming simply look for the HICAPS & iSOFT logo or contact your health provider.

You can also search online for health providers that offer HICAPS.

While Emergency Services Health accepts most claims on the spot, the service is not available for orthodontic, pharmacy, health appliances (including hearing aids), counselling and eye therapy. By handling these claims manually, we are able to deliver better and fairer benefits to our members for these services.

There may also be situations where benefits cannot be processed on the spot, or where there is no benefit entitlement. In these situations, you will be asked to contact Emergency Services Health.

HICAPS Search

Emergency Services Health Mobile Claiming App

As a member of Emergency Services Health, we’ve got your back. Our Emergency Services Health App lets you manage your health cover 24/7.

Use the app to:

Easily make a claim for you or your dependents
Access benefit limits and cover details
View your claims history
Update your contact details

Who can use the Emergency Services App?

Anyone can access general fund information via the app, but to use features relating to your membership, you must be an Emergency Services Health Member and have registered your online membership account.

How to receive your benefits faster!

Claim as soon as possible - provide us with your bank account details so your benefit is paid directly to your account. Claims for services older than two years will not be accepted.

Other extras services claims

Not all extra claims can be lodged on the spot. For extras claims that cannot be lodged on the spot simply fill out an Emergency Services Health claim form and send it with the relevant accounts and receipts to any of the three options:

Email: myclaim@eshealth.com.au (include your member number in the subject email line)
Mail: Emergency Services Health, Reply Paid 84966, Halifax St, SA 5000
Free Fax: 1300 151 152

Alternatively, if you are happy for the money to be paid into your nominated contributor account you can download the Emergency Services Health Mobile Claiming App.

How to claim for Hospital

Hospital claims generally come directly to us from the hospital and we send the claim payment back to the hospital. This means you don't have to make a claim.

Payments

Cheques covering medical or extras services are made payable to you if you've paid the account or, if you haven't, to the provider of the service. In both instances, the cheques are sent to you (naturally if the payment is in your favour you can elect to have the payment direct credited to your financial institute).

If the account has not been paid, forward the cheque to the provider together with your portion of the payment.

How to fast-track your claims payments

If you have already paid the invoice from your medical or extras provider, Emergency Services Health offers PromptPay to ensure fast payment of your claim. With PromptPay your benefit is paid directly to your financial institution account as a direct credit.

Download our claim form, simply write "YES" in the box `Please Pay To My Bank Account Yes/No' and then fill in your nominated financial account details.

Download our claim form

Download our claims consent form

More Information

Guide To Hospital

Find out what you should know and what you should ask before a planned trip to the hospital.

Learn More

Waiting periods

Find out if you have waiting periods before you’re eligible to claim on certain procedures or services.

Learn more

Access Gap Cover

Under our Access Gap Cover, you may never have to pay a doctor's bill. Your doctor can forward all accounts to us.

Learn More

Contracted Hospitals

Did you know we have agreements with most private hospitals likely to be accessed by members?

Learn more

About US

Nothing is more important to us than the health and wellbeing of emergency services families

Who we are

Emergency Services Health is brought to you by Police Health Limited, a not-for-profit, member based, private health insurance fund. This means that we’re run for the benefit of members and not driven by corporate investors or overseas owners demanding shareholder dividends. The fund has stood behind the policing community for over 85 years. We bring the quality cover only police officers and their families could previously access, to our colleagues in the Emergency Services.

Our vision is to enhance the physical and mental health and wellbeing of Australia’s Emergency Services community.

Our mission is to rally behind Australia’s Emergency Services community, providing support, information and health insurance products, and services designed exclusively for the needs of our members.

We understand what it’s like to do a job that impacts on your physical and mental health while you’re protecting our community. It’s why our products and services are designed with that in mind.

Health insurance can be very confusing. We know our members appreciate that we keep it simple. With Emergency Services Health you only have to choose between our extras, hospital or combined products.

Cover like no other

Our passion drives us

We’re a passionate bunch, because we know what we’re doing, and why it matters. We are fundamentally improving the lives of first responders and their families across Australia because they deserve nothing less.

Our purpose

Everything we do is for the health and wellbeing of the communities we serve... the first responders of Australia and their families

How we do this

By offering top-level private health cover, at value for money prices and service second to none.

Our values

Our values are lived and breathed, not just words, but a real compass to how we conduct and hold ourselves accountable to our members.

We do the right thing
We are courageous
We go beyond
We listen and care
We work together

Governance

The fund is managed by a team of health insurance professionals with vast experience in the private health insurance industry. This team works under the direction of the Board of Directors, which come from both police & health insurance backgrounds - people who know, and understand the industry and care about the emergency services community.

Meet The Emergency Services Health Team

We treat our members like colleagues, because they are.

Board of Directors

Peter Shanahan

“My commitment to our members is to provide them with the best value health insurance."

CHAIRMAN

Kevin Lawton

“I am committed to advancing the health and wellbeing of our members, while maintaining our special relationship that has endured since 1935."

DEPUTY CHAIR

Linda Williams

“I am keen to assist in maintaining the solid governance, rigorous financial management and growth to strengthen member services.”

BOARD DIRECTOR

Mick O’Neill

“Our mission to care for one another and improving the health and wellbeing of our community continues to drive my commitment.”

BOARD DIRECTOR

Phil Vincent

“I will strive to contribute to the Board’s ongoing stewardship of this successful fund.”

BOARD DIRECTOR

Simon Watkins

“I am committed to ensuring we are a resilient organisation so we are always there to support you, and your family’s, health and wellbeing.”

BOARD DIRECTOR

Mark Burgess

“As the former CEO of the Police Federation of Australia and a police officer of over thirty years, I see us as being an integral part of the police and emergency services family."

BOARD DIRECTOR

Gayle Ginnane

“My experience as a former health insurance regulator and economic qualifications can add strength to the Board.”

BOARD DIRECTOR

Senior Leadership Team

Scott Williams

"After starting out in scrubs, I’ve now worked in senior healthcare roles for over 20 years and can truly empathise with our members dealing with medical emergencies. That’s why I consider it such a privilege to play my part in supporting the health and wellbeing of the emergency services community."

CHIEF EXECUTIVE OFFICER

Rebecca Chapman

"I look forward to the continued growth of Emergency Services Health, whilst maintaining an unwavering focus on our members, and their health insurance needs."

CHIEF OPERATING OFFICER & COMPANY SECRETARY

Tony Melino

"Emergency Services Health is truly aligned to the member, and decisions are made with the member top of mind."

GENERAL MANAGER RISK & COMPLIANCE

Margot Cook

"I'm proud to be part of the team at Emergency Services Health where I see a committed and professional approach with genuine interest in the health and wellbeing of our people and members."

GENERAL MANAGER PEOPLE & CULTURE

Daniel Zervaas

"With the consumer being the emergency service community I have a strong sense of satisfaction in providing a service to the members of the community who serve us all."

GENERAL MANAGER CUSTOMER EXPERIENCE

Angelo Russo

"There is a great opportunity to harness and develop the Emergency Services Health brand, member loyalty and growth as it continues to expand across Australia."

GENERAL MANAGER MARKETING & STRATEGIC RELATIONSHIPS

Call Us

Want to find out more about Emergency Service Health?

Give us a call by clicking the button below.

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

Adam

Our hospital cover gives you more choice on where you are treated - your hospital not ours.

Our hospital cover doesn't restrict you to any particular hospital- our benefits apply in all recognised hospitals for recognised services.

Important information about our Hospital cover.

What's not covered?

A - F

G - L

M - R

S - Z

A - F

G - L

M - R

S - Z

Comprehensive Ambulance cover

Important information about our Ambulance cover.

Why choose Emergency Services Health?

Jude

Please click on the links below to access the resource you are after.

Brochures

Products and Benefits Guides

Forms and Agreements

Policy Documents

Brochures

Products and Benefits

Forms and Agreements

Policy Documents

Terms and Conditions

1. Reliance on information and other content

2. Transmission over the internet

3. Third Parties and Third Party sites

4. Health and health related information

5. Online member services portal and Claiming on Mobile Application

6. Intellectual property

7. Limitation of liability

8. Law and Jurisdiction

Privacy Policy

Get more value and benefits from your private health insurance, without the hassle.

How to claim for Extras

On the spot claims on extras services

Who offers on the spot claiming?

Emergency Services Health Mobile Claiming App

How to receive your benefits faster!

Other extras services claims

How to claim for Hospital

How to fast-track your claims payments

Emergency Services Health is a restricted access private health insurer.

If you work or volunteer for an Australian emergency service, or you once did, you can move to us and so can your close relations.

Fire Response & Recovery Sector

Ambulance & Medical Response & Recovery Sector

Water Response & Recovery Sector

State Emergency Response & Recovery Sector

Jodie

Nothing is more important to us than the health and wellbeing of emergency services families

Who we are

Our passion drives us

Our purpose

How we do this

Our values

Governance

Meet The Emergency Services Health Team

We treat our members like colleagues, because they are.

Board of Directors

Peter Shanahan

CHAIRMAN

Kevin Lawton

DEPUTY CHAIR

Linda Williams

BOARD DIRECTOR

Mick O’Neill

BOARD DIRECTOR

Phil Vincent

BOARD DIRECTOR

Simon Watkins

BOARD DIRECTOR

Mark Burgess

BOARD DIRECTOR

Gayle Ginnane

BOARD DIRECTOR

Senior Leadership Team