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 a fixed daily amount that you pay if you go to any hospital or day surgery. It applies to each person covered on your policy for the first two days of hospitalisation, each membership year.

How much to pay?

The co-payment amounts and limits for each of our hospital covers are listed below, effective 1 May 2008.

Please note that all amounts listed are per membership year.

*Co-payment waiver

If you have Top Hospital Level 5 or Top Hospital Level 8, the co-payment will be waived for:

• Child, adult child and student dependants on your policy who require a hospitalisation
• The first admission in relation to a non-compensable accident for any person on the policy.

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 $500 co-payment. He is re-admitted in the same membership year but doesn't need to pay the co-payment because he reached his limit.
• 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 per person membership year maximum.
• Their son is also hospitalised in the same membership year for four days, so the co-payment is $500. He has then reached the $500 per person membership year maximum.

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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 $500 co-payment. He is re-admitted in the same membership year but doesn't need to pay the co-payment because he reached his limit.
• 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 per person membership year maximum and the family has reached its $1000 membership year maximum.
• 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.

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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 his limit.
• 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 per person membership year maximum and the family has reached its $1000 membership year maximum.

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