Frequently Asked Questions (FAQs)

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.

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). 

Emergency Services Health is open to anyone currently or previously working or volunteering in Emergency Services or the Health and Medical Field.

Emergency Services and First Responders

• Ambulance and Paramedics
• State Emergency Services
• Firefighting
• Surf Life Saving
• Police Officers
• Union or Associated Employees

Health and Medical Professionals

• Allied Health
• Medical Centre and Hospital Staff
• Doctors
• Nurses & Midwives
• Medical Supplies
• Union or Associated Employees

In addition, eligibility also extends to the following close relations of the above:

• partners, including spouse or defacto
• former partners
• dependent and adult children (including the partners and dependent children of the adult children)
• siblings (including a sibling's partner/spouse, a sibling's dependent child)
• parents
• grandchildren

Contact us if you are uncertain about your eligibility – we’d be happy to help!

Let us do the hard work. Our health insurance experts are ready to put together a personalised health insurance comparison for you, to show you how we stack up against any other cover on the market in terms of both price and benefits. Let us know who'd you'd like to compare against, or simply request a comparison against the other most popular options available, and we'll do the rest. Call us on 1300 703 703 or complete our online form.   

You won’t need to re-serve waiting periods that you’ve already served with your old fund if you switch to Emergency Services Health. 

If you’re transferring from another health insurer, we offer continuity of cover which means you won’t serve the same Waiting Periods twice. However, if you’re transferring to us from a lower level of cover, you’ll only be able to claim up to the level you were already covered for until you have served the Waiting Period.

Yes you can still take out a policy with Emergency Services Health, but you will need to serve a 12 month waiting period for pre-exisiting conditions. 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.

Further information on waiting periods for pre-existing conditions

Your cover will start as soon as your application has been approved and relevant premiums are paid. Waiting periods may apply so check how this might affect your membership before you join.

A Waiting Period is the period of time you need to be covered before you’re eligible to claim on certain procedures or services. Waiting Periods apply to new or upgraded policies, but if you're switching to Emergency Services Health you won’t need to re-serve waiting periods that you’ve already served with your old fund. Our standard Waiting Periods are as follows:

Waiting Periods for Hospital

• 2 months membership for all benefits, excluding accidents.
• 12 months membership for pregnancy and birth related (obstetrics) treatment.
• 12 months membership for pre-existing conditions, excluding psychiatric care, rehabilitation or palliative care.
• 12 months membership for continuous positive air pressure (CPAP) machines, and goods and services under Non-surgically Implanted Items and Appliances and other aids and appliances, travel and accommodation (general treatment) and home nursing.

Waiting Periods for Extras

• 2 months membership for all benefits, excluding accidents.
• 12 months membership for Major Dental (such as crowns, bridges, inlays, indirect fillings and dentures), orthodontic, hearing aids, nebulisers, blood glucose and blood pressure monitors, blood coagulation monitor and for pre existing conditions.
• 12 months membership for Rollover Benefit and access to Rollover Maximum (2 years for Major Dental).

Waiting Periods for Combined cover (in addition to the above)

• 3 years membership for corrective laser eye surgery. 

Lodging claims with Emergency Services Health is easy:

• Claim on the spot with your membership card
• Take a photo using our App
• Submit a claim via our website
• Download a claim form to email us

Read more about how to claim. 

Emergency Services Health provides a cooling off period for new members or existing members who change their level of cover. 

We will refund in full and without penalty any premiums paid during the cooling-off period, or additional premiums paid, provided that the request to cancel the new policy or cover the change is received in writing within 30 days of commencement and there have been no benefits paid relating to the new policy or cover change. 

For more information see our Cooling Off Period Policy.

We make claiming easy.

For full details visit our How to Claim guide.

With Emergency Services Health, you can choose your preferred hospital, doctor or any other service provider, such as your physiotherapist and dentist, as long as the provider is recognised by us.

Recognised Providers are different to the 'Preferred Providers' you may hear about through other health funds. When we say Recognised Providers we are simply referring to providers with the appropriate qualifications, licenses and rights to provide treatments to patients in Australia. The rest is down to your preference.  

In the case of Hospitals however, it's important to note that we recommend members visit hospitals we are in contract with to avoid unnecessary out-of-pocket expenses. See our Contracted Hospital search to learn more and find one near you. 

If you ever want to double check if your provider is recognised by us, please call us on 1300 703 703. 

Calling an Ambulance can cost around $900 depending on your state or territory.

In a medical emergency the cost of calling an ambulance is not at the front of your mind, but the bill after can be an unexpected shock if you don't have adequate ambulance cover.

The good news is that when you are insured with Emergency Services Health, all policies include ambulance cover - Australia-wide - so you always have peace of mind, no matter if you’re in your home state or visiting another part of Australia.  

We provide Comprehensive Ambulance cover for emergency transport, clinically required non-emergency transport and treatment not requiring transport (Subject to waiting periods and other conditions).

Benefits are not payable:

• For elective ambulance transport or other non-eligible ambulance service, for example when you pre-book transport between locations such as going from a hospital to a nursing home.
• When you’re covered by a third party arrangement**.  Examples include where you are covered by an ambulance subscription or if you have access to a State/Territory ambulance transportation scheme. 
• If you are still serving waiting periods.

**Third Party Arrangements:  Please note Queensland and Tasmanian residents have third party arrangement ambulance services provided by state government schemes. In some other states, Department of Veterans Affairs Gold Card, pension and healthcare card holders may be exempt from paying for ambulance services. Emergency Services Health does not pay a benefit.  If the benefit for any eligible ambulance treatment costs are not fully covered by an arrangement or scheme, Emergency Services Health will pay a benefit.

An exclusion is when you agree not to be covered at all for certain treatments. For example you may have hospital cover but it excludes joint replacements.

A restriction is when you agree to receive very limited benefits for certain treatments. For example you may be covered for joint replacements only at a public hospital, and if the joint replacement is undertaken in a private hospital, only basic accommodation benefits and no procedure benefits are paid – which may leave you with substantial out-of-pocket costs.

At Emergency Services Health our Hospital cover has no exclusions and no restrictions (other than where Waiting Periods apply for transfers before benefits or higher benefits, as applicable, are payable) because we don’t think our members should have to predict what health needs they or their family will have in the future. You wouldn’t insure just half of your house or car, so why insure just part of your health?

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.

Items that are not covered by our Hospital policy, that are not considered exclusions or restrictions, include (but are not limited to);

• Services incurred before Waiting Periods have been served.
• Outpatient services, unless there is an agreement between Emergency Services Health and the hospital.
• Treatment for which Medicare does not pay a benefit, including cosmetic surgery. (Some benefits may be payable for hospital treatment following this surgery. Please contact 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.
• 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’s approved Prostheses List.
• Charges greater than the benefit defined in the Federal Government’s approved 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 (out-patient).
• 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.
• Fees from a podiatric surgeon (benefits may be payable under our Extras cover) or related anaesthetic fees.
• Use of robotic assisted systems not covered under the hospital contract. 

Should you require information about a particular treatment or benefit please contact us. 

Other funds may charge an excess or co-payments. At Emergency Services Health our hospital cover has no excesses or co-payments (other than where a waiting period applies)

An excess is the amount you agree to pay towards the cost of hospital treatment. For example if you have an excess of $500, when you’re admitted to hospital you’ll have to pay the first $500 of the hospital costs on top of anything else not covered by your policy.

Similarly some insurers charge a co-payment, which is the agreed amount you’ll pay per day in hospital. 

When you are admitted to hospital as a private in-patient, there are usually a number of different costs involved, such as:

Access Gap Cover
Emergency Services Health and other health insurers offer an Access Gap Cover program to help control out-of-pocket fees on Medical Costs. Access Gap Cover has its own set schedule of fees, where private health insurers have agreed to pay above the MBS fee set in the Medicare Schedule and doctors are able to choose to bill health fund members at the Access Gap Schedule amount, reducing the out-of-pocket medical gap for their patient. When doctors and specialists agree to use the Access Gap Cover program (which is done on a case by case basis), it eliminates, or substantially reduces, the out-of-pocket expenses of treatment for people with private health insurance.

Our Access Gap Cover arrangements are able to be used by all doctors around Australia and, in most cases, our members will be fully covered or have a known-gap for any in-hospital medical treatment. However, it comes down to the doctor to choose the Access Gap Cover option when billing their patients, so we encourage members to discuss this option with their treating doctor as early as possible. 

Your doctor and health service providers must inform you of the costs of your proposed treatment and any potential out-of-pocket expenses, then get your consent in writing before you undergo treatment. If you’re not sure whether Access Gap Cover is being used, this is a good time to ask.

Recommendation
We strongly recommend members contact us on 1300 703 703 to confirm their Hospital benefit entitlements prior to receiving hospital treatment. Factors such as level and type of cover, waiting periods, and financial status of membership can affect benefit payments, so speaking to a member of our friendly team is the best way to get personalised advice for your situation. In terms of out-of-pocket costs, you will need to speak to your treating doctor or specialist to confirm these. Doctors are legally obligated to ensure Informed Financial Consent for all medical expenses prior to surgery, and this includes advising about out-of-pocket costs. 

An excess is the amount you agree to pay towards the cost of hospital treatment. For example if you have an excess of $500, when you’re admitted to hospital you’ll have to pay the first $500 of the hospital costs on top of anything else not covered by your policy.

A co-payment is the agreed amount you’ll pay per day in hospital.

At Emergency Services Health our hospital cover has no excesses or co-payments (other than where Waiting Periods apply for transfers) because we know that this can become a barrier to treatment when other unexpected and uncontrollable out of pocket costs hit at the same time – such as gap payments for doctors and anaesthesiologists who charge over the MBS fee, and legally uninsurable out patient consults with specialists.

These unexpected costs often hit patients at the same time that they’re dealing with a loss of income, so removing any excess or co-payments from the equation helps protect our members from the unforeseen – as we believe good insurance should. 

Emergency Services Health has agreements with most private hospitals that are likely to be accessed by members - we call these Contracted Hospitals. 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 Emergency Services Health on the member’s behalf.

Member’s benefit entitlements will be affected by factors such as their level and type of cover and the financial status of their membership. This will affect the amount Emergency Services Health will reimburse to the hospital. We strongly recommend if you contact us on 1300 703 703 to confirm your benefit entitlement prior to receiving hospital treatment.

 If you choose a non-agreement hospital may incur out-of-pocket expenses for hospital related services irrespective of your level of cover.

Find a Contracted Hospital using our online search tool, or give us a call. 

Hospital benefits are payable 365 days a year. However, if your hospital stay exceeds 35 consecutive days you must obtain and send us an Acute Care Certificate to continue receiving comprehensive benefits. 

Benefits will be reduced and out of pocket expenses apply where an Acute Care Certificate is not obtained. 

The hospital is aware of this and will usually arrange a certificate on your behalf. 

An Accident and Emergency Faciility fee is 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.

Emergency Services Health’s unique Rollover Benefit allows members to carry over any unused Annual Maximum benefit that is not claimed during the previous calendar year into the following year (Noting that claims are always paid from the current year’s Annual Maximum before the Rollover Benefit is accessed).

For example, if you go a year without claiming Optical benefits (such as new prescription glasses and/or contact lenses) your $350 Annual Maximum becomes $700 12-months later (subject to Waiting Periods).

New members are eligible for the Rollover Benefit after just 12 months.

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

Before agreeing to commence orthodontic treatment determine your payment plan with the provider. This may involve an upfront payment followed by installments during the expected treatment period. Ask the provider what options are available and for a written plan once it’s agreed to.

Should you choose to pay for the total treatment up front, please be aware Emergency Services Health benefits will be spread over the treatment period and are subject to Annual and Lifetime Maximum limits and waiting periods. For more information please call us on 1300 703 703.

Emergency Services Health does not provide cover or benefits for any services or medical items purchased from overseas. This includes overseas online retailers.

Australian Private health insurance is governed by the Private Health Insurance Act (2007), which stipulates provisions for treatment and services must occur within Australia. 

If you are the main policy holder, you can log on to our Online Member Portal to view up to date benefit entitlements. Alternatively you can view these details on our mobile app, or get in contac with us for assistance. 

If you are the main policy holder, you can update most membership details quickly and easily by logging on to our online Member Portal. You can also get in contact with us for assistance. 

There are a number of different types of dependents that can be covered by a health insurance policy with Emergency Services Health.

Our Fund Rules refer to the Contributor and dependents. Dependents are any spouse/partner and any child of the Contributor eligible to be covered under your policy.  

From the 1 April 2022, the Fund Rules collectively refer to children eligible to be covered under a policy as “dependent persons” and are made up of the following types:

• Dependent child;
• Non-classified dependent person;
• Dependent student;
• Dependent non-student; and
• Dependent person with a disability.

A Dependent Child is the term used when your child is aged under 18, and a Non-Classified Dependent Person is when your child is aged 18 and over but under 21.  Together, we refer to these two types of dependent persons as Younger Dependent Children (that is, where the child is aged less than 21 years).

A Dependent Student is a child of the Contributor who is 21 years and over,  but under 32 years of age, who is considered to be a full time student of a school, college or university recognised by Police Health.

A Dependent Non-Student is a child of the Contributor who is 21 years and over but under 25 years of age, and not eligible to be a student dependent.

A Dependent Person with a Disability is a child of the Contributor and the child is participating in the National Disability Insurance Scheme (NDIS) and hence holds an active NDIS plan.  The child may be any age 18 years and over, but would only be registered as a dependent person with a disability if they do not meet any of the other dependent person types.

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.

Other than for a dependent person with a disability, a child ceases to be eligible as a dependent on a policy if they are married or in a defacto relationship.

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

We will not accept responsibility or liability for any loss or action resulting from the use or misuse of a lost or stolen membership card.

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

Alternatively you can receive a renewal notice quarterly, 6 monthly or yearly, which can be paid by BPAY. Please note that credit card facilities are not available for premium payments. 

Important Information: Benefits will not be paid if your premium payments are in arrears. If premiums are more than two months in arrears, your cover will lapse and may be cancelled by Police Health. 

View our Direct Debit Request Service Agreement for more information.

You can apply to have your membership suspended under certain circumstances:

• Full suspension or partial suspension when you’re overseas, provided the application is made prior to the date of departure.
• Full suspension while you continue to receive short-term income maintenance through Centrelink and are eligible for and/or have a Health Care Card for a minimum of 14 days.
• To be eligible you must be covered by a health insurance policy with Emergency Services Health for a minimum of one month. The minimum period of suspension is 14 days, the maximum period of suspension is two years and the minimum period between suspensions is four months, unless we agree otherwise.

For further information on our suspension policy simply call us on 1300 703 703.