What is a co-payment?

To keep health insurance premiums lower, our hospital covers have a range of co-payment options.

A co-payment is the fixed daily amount that you pay if you go to any hospital or day surgery. A co-payment applies to each person covered on the policy for the first two days of hospitalisation, each membership year.

How much do I pay?

The co-payment amounts and limits for each of our stand alone hospital covers are listed below.

*Co-payment waiver: If you have Top Hospital Level 5 or Top Hospital Level 8,  the co-payment won't apply for:

• The first admission in relation to a non-compensable accident for any person on the policy. An accident is defined as an unplanned or unforseen event resulting in bodily injury that requires immediate medical treatment in a hospital. We don't waive the co-payment where it's a compensable claim; and
• For child, adult child, student dependants and adult dependants on your policy who require a hospitalisation.

Examples of how the co-payment works

• Basic Hospital and Essential Hospital Level 5
• Family Hospital Level 5
• Top Hospital Level 5

Basic Hospital and Essential Hospital Level 5

The Brown family has Basic Hospital. A $250 co-payment applies daily for the first two days of any hospitalisation or same day (day only) stays each membership year. It applies to each person covered, up to a maximum of $500 per person.

• Mr Brown is hospitalised for four days and pays a $250 co-payment per day for the first two days. He is re-admitted in the same membership year but doesn't need to pay the co-payment because he reached the $500 maximum per person per membership year.
• Mrs Brown is hospitalised in the same membership year for day only surgery so she will pay $250. She has to go back to hospital for three days, so the co-payment is $250. She has then reached the $500 maximum per person per membership year.
• Their son is also hospitalised in the same membership year for four days, so the co-payment is $250 for the first two days. He has then reached the $500 maximum per person per membership year.

Back to Top

Family Hospital Level 5

The Brown family has Family Hospital Level 5. A $250 co-payment applies daily for the first two days of any hospitalisation or same day (day only) stays each membership year. It applies to each person covered, up to a maximum of $500 per person and $1000 per family each membership year.

• Mr Brown is hospitalised for four days and pays a $250 co-payment per day for the first two days. He is re-admitted in the same membership year but doesn't need to pay the co-payment because he reached the $500 maximum per person per membership year.
• Mrs Brown is hospitalised in the same membership year for day only surgery so she will pay $250. She has to go back to hospital for three days, so the co-payment is $250. She has then reached the $500 maximum per person per membership year and the family has reached its $1000 maxiumum per membership year.
• The Browns' son is also hospitalised in the same membership year for four days, so no co-payment applies because the family maximum was already reached.

Back to Top

Top Hospital Level 5

The Brown family has Top Hospital Level 5. A $250 co-payment applies daily for the first two days of any hospitalisation or same day (day only) stays each membership year. It applies to each person covered, up to a maximum of $500 per person and $1000 per family each membership year.

• Mr Brown is hospitalised for four days and pays a $500 co-payment. He is re-admitted in the same membership year but doesn't need to pay the co-payment because he reached the $500 maxiumum per person per membership year.
  
• The Browns' son is hospitalised in the same membership year for four days, but no co-payment applies because child dependants who require hospitalisation have their co-payments waived.
• Mrs Brown is injured in the same membership year while doing the gardening at home. She is hospitalised for one night, but no co-payment applies because the cause of her injury is an accident - an unforeseen event resulting in bodily injury that requires immediate medical treatment in a hospital.
• Mrs Brown is hospitalised in the same membership year for day only surgery so she will pay $250. She has to go back to hospital for three days, so the co-payment is $250. She has then reached the $500 maximum per person per membership year and the family has reached its $1000 maximum per membership year.

Back to Top

If you have a health insurance query, why not contact us.