With High65, up to your annual cap, you'll get 65% of the fee back from the provider of your choice every time you see them. That's your choice of provider, not ours.
We cover you for such things as: accidents, pregnancy and assisted reproductive services, removal of tonsils, adenoids, wisdom teeth and the appendix; arthroscopies and colonoscopies; shoulder and back surgery; knee reconstructions; and cardiac related services. As you would expect from our top level policy cataract removal, dental surgery, psychiatric services, rehabilitation, kidney dialysis, major joint replacement, and plastic (not cosmetic) and reconstructive surgery are all covered. You can be treated as a private patient in both a public and private hospital, except for lap band surgery.
Limitations on Hospital Services
Bariatric (lap band) surgery is only covered to a minimum level. For this service High Hospital is only enough to be treated as a private patient in a public hospital, not a private hospital.
We cover you for practically everything else, but we don't cover you for cosmetic surgery or any other services where no Medicare benefit is payable.
We will pay for medically necessary ambulance transport.
So you can lower the cost of your premiums, we give you a choice of three excess amounts: $500, $250 or $0 (no excess). Excess apply per person for each hospital admission, but there is an annual cap to limit your expense. If you have dependent children on your policy there is no excess payable for them. There is also no excess with Extras or ambulance.
All health insurance providers impose waiting periods. Ours are:
- 2 months - All services including psychiatric, rehabilitation, and palliative care, except the ones listed below
- 12 months - orthodontics, major dental, pregnancy, hearing aids, blood glucose monitors and other health appliances, and any pre-existing conditions
If you are joining us from another health insurer, any waiting periods that you have already served will be recognised so that you don't have to serve them again. Waiting periods may apply for services not covered with your previous fund.
For these services only limited benefits are payable. Benefits are only enough to be treated as a private patient in a public hospital, not a private hospital.
This is only a summary of the product's features. View the High65 Features Guide for more information.
You should read this summary together
with the health.com.au Policy Guide
Out of pocket expenses, otherwise known as
Gap fees can be applied by hospitals
and or medical practitioners (for their medical
We have an agreement with nearly every private hospital in Australia.
However, if you go to a hospital that we don't have an agreement
with you're likely to have out of pocket expenses that are not
covered by the policy.
Our Access Gap Cover scheme allows you to reduce or eliminate your out of pocket expenses.
On a case by case basis medical practitioners can decide if they will participate in our scheme.
Almost 9 out of 10 medical services under the Access Gap Cover scheme have no out of pocket expenses.
If your medical practitioner chooses not to participate then health.com.au is only able, by law,
to pay 25% of the Medicare Benefits Schedule (MBS) fee. Medicare pays 75% of the MBS fee.
However medical practitioners are able to charge what they like. If your bill is more than
the MBS fee you'll have to pay the difference.