Other funds may apply exclusions (you agree not to be covered at all for certain treatments). For example you may have hospital cover but it excludes joint replacement.
Other funds may also apply restrictions (you agree to receive very limited benefits for certain treatments). For example you may be covered for joint replacement only at a public hospital, and if the joint replacement is undertaken in a private hospital, basic accommodation benefits and no theatre fee benefits are paid, leaving your benefit well short of the cost.
At Emergency Services Health our Gold Hospital cover has no exclusions and no restrictions.
It’s important to note that all health insurers are governed by the Private Health Insurance Act 2007. This legislation sets out what health insurers can and cannot pay benefits towards. Within the hospital as an inpatient, health insurers can only pay benefits towards treatment and procedures where Medicare pays a benefit. That means for some services, like elective cosmetic surgery, health insurers cannot pay a benefit towards this treatment, and this is not classed as a restriction or an exclusion on a policy.