HCi Hospital Cover

// HCi HOSPITAL COVER

HCi hospital cover helps pay for any necessary hospital treatment for your and your dependants. And you choose the level of cover to suit your needs.

Solid orange icon of an hospital for HCi hospital cover ​HCi’s Gold Hospital has got you covered with a range of excess options, no exclusions, no restrictions and no benefit limitations. You can have confidence that if you go to hospital, you can concentrate on getting better, knowing we’ll take care of the rest.

Accident cover

If you have an accident that requires admission to hospital for a treatment not related to any pre-existing illness, injury or condition, HCi will pay towards your treatment and accommodation fees.

For full details of HCi hospital cover options, including all terms and conditions, definitions and exclusions, please refer to our Guide to Cover.

You can combine Gold Hospital, Silver Plus Hospital, Bronze Hospital or Basic Hospital with our Extras cover for a more comprehensive package.

Procedure

Gold


Silver Plus


Bronze


Basic
Rehabilitation ✔ (R) ✔ (R) ✔ (R)
Hospital psychiatric services ✔ (R) ✔ (R) ✔ (R)
Palliative care ✔ (R) ✔ (R)
Brain and nervous system
Eye (not cataracts)
Ear, nose and throat
Tonsils, adenoids and grommets
Bone, joint and muscle
Joint reconstructions
Kidney and bladder
Male reproductive system
Digestive system
Hernia and appendix
Gastrointestinal endoscopy
Gynaecology
Miscarriage and termination of pregnancy
Chemotherapy, radiotherapy and immunotherapy for cancer
Pain management
Skin
Breast surgery (medically necessary)
Diabetes management (excluding insulin pumps)
Heart and vascular system
Lung and chest
Blood
Back, neck and spine
Plastic and reconstructive surgery (medically necessary) ✘*
Dental surgery
Podiatry surgery (provided by a registered podiatric surgeon)
Implantation of hearing devices
Cataracts
Joint replacements
Dialysis for chronic kidney failure
Pregnancy and birth
Assisted reproductive services
Weight loss surgery
Insulin pumps
Pain management with device
Sleep studies
All other inpatient services where Medicare pays a benefit

(R) This is a Restricted Service.
* For Bronze Hospital, plastic surgery which is medically necessary and related to the treatment of a skin-related condition is covered under the “Skin” clinical category.

Basic Hospital includes Accident Cover to help you pay for any necessary hospital admission because of an accident. An accident is any unforeseen event due to chance or caused by an external force or object, which results in an involuntary injury to the body requiring immediate or urgent medical treatment in hospital.

For covered services (see table above)

  • Up to 100% of hospital accommodation costs and theatre fees in all contracted hospitals and day surgery facilities in Australia.
  • Up to 100% of the cost of surgically implanted prostheses (as listed by the Federal Government).
  • Private room accommodation (if available).
  • Up to 100% of the cost of most hospital prescriptions relating to the admission. (Subject to hospital agreement details).
  • Dental theatre costs for surgical tooth extraction by an oral surgeon.
  • 100% of the cost of the difference between the Medicare refund and the Commonwealth Medical Benefit Scheme (CMBS) fee for medical services provided during a hospital admission.
  • Up to 100% of the cost of medical services provided during a hospital admission where the doctor charges above the Commonwealth Medical Benefit Scheme (CMBS) fee and chooses to use Access Gap Cover.

All the above applies to you and any dependants listed as part of your membership.

  • Cosmetic surgery
  • Extra services beyond the hospital treatment plan
  • Personal expenses like phone calls, newspapers and TV rental
  • Hospital services not eligible for Medicare benefits
  • Pharmaceutical items supplied or prescribed on discharge
  • Medicare gap (ie out of pocket expenses)
  • Surgically implemented prosthesis gap
  • Medical treatment provided in a doctor’s rooms out of hospital

It’s important to remember that as an Australian resident, Medicare covers public hospital treatment and emergency patients will normally go to a public hospital with Intensive Care Units.

With HCi hospital cover, you can elect to be a private patient into a public hospital.

You can choose your doctor and have a private room if available. You will still be subject to waiting lists for elective procedures.

Medical fees

Under the Commonwealth Medical Benefits Schedule (CMBS) fees are determined and accordingly split between HCi and Medicare. It is important to discuss fees with your doctor prior to treatment as there may be out of pocket expenses. If your doctor charges above the CMBS fee, HCi does not cover these expenses. Read our factsheet on The Gap for more information.

HCi hospital cover enables you to get full private hospital access to services, a doctor of your choosing at a convenient time with no waiting periods.

HCi has relationships with over 500 private hospitals and day hospital facilities around Australia. For a comprehensive list of our contracted hospitals in your local area click here

If you need specialist care in hospital your doctor can use HCi’s Access Gap Cover – a much simpler billing system to eliminate out of pocket expenses altogether or let you know exactly what you have to pay prior to treatment.

Remember to ask your doctor:

  • Will you treat me under HCi’s Access Gap?
  • Will I have any out-of-pocket expenses? Please provide a formal quote of these costs.
  • Will any assisting doctors also use Access Gap Cover and if so, how can I obtain a quote for their services?
  • Will you to send the bill to HCi directly?

See here for participating doctors.

Gap Cover and surgically implanted prostheses:

Surgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.

For medical procedures covered by Medicare, HCi fully covers the cost of at least one prostheses – this is referred to as a ‘no gap’ prostheses. However, some items listed on the Prostheses Schedule are not or only partially covered. Please review the list with your doctor prior to surgery.

  $250 Excess $500 Excess $750 Excess
Gold
Silver Plus
Bronze
Basic

HCi has arrangements with the following private hospitals to minimise your out-of-pocket expenses

About the Hospital Search

HCi has agreements with most private hospitals that are likely to be accessed by members. 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 HCi on your behalf. Please note your entitlements are affected by factors such as your level and type of cover, and the financial status of your membership. This will affect the amount HCi reimburses to the hospital.

HCi strongly recommends you contact us on 1800 804 950 to confirm your entitlement prior to receiving hospital treatment.

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

Please note that search results will include any private hospitals HCi has previously accepted contracts with, until HCi  terminates a contract. Thus the search results will display information relating to a private hospital where the relevant contract is up for renewal but HCi has not yet decided whether or not to renew the contract. HCi uses its best endeavours to respond promptly to renewals so that search results are as accurate as is reasonably possible.

Get access to more than

30,000+ Doctors

It’s not just when you’re sick

Access HCi health programs and support

Get access to more than

30,000+ Doctors