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When you take out health insurance for the first time, switch insurers or increase your level of cover, CUA Health asks that you wait a period of time before you can claim for new or higher benefits. Take a look at the table below to find out what waiting periods apply.

With our private hospital cover you can be treated as a private patient in a private or public hospital. CUA Health has agreements with the majority of private hospitals and day surgeries where you will receive benefits for your hospital accommodation, including:

• accommodation for overnight or same-day stays
• standard single or share hospital accommodation
• operating theatre, intensive care and ward fees
• surgically implanted prostheses up to the approved benefits in the Government’s Prostheses List
• your choice of doctor or specialist

Please contact us prior to any hospital admission to make sure your hospital is in agreement with CUA Health.

• Hospital treatment for which Medicare pays no benefit, like cosmetic surgery
• In some cases your doctor’s and/or specialists’ (radiologist, anaesthetist etc) fees may still be more than the Medicare benefit plus the CUA Health gap scheme so you may be required to make an additional payment. Please check this with your doctor before consultation or treatment.
• Gap payments may apply to certain prostheses (e.g. hip and knee joint replacements, artificial heart valves, pacemaker devices and intra-ocular lenses for cataract surgery)
• Any items of a personal nature, including TV rental or phone calls while in hospital that are not part of the agreed medical costs
• You’ll need to pay any additional costs that are applied to any 'nursing home-type' patient admission into a public or private hospital. This amount is determined by the Federal Government.
• Experimental and some high cost or exceptional drugs
• Services not invoiced by the hospital
• If you go to an emergency room and are not admitted but the hospital still charges you for your visit, this charge is not covered and you’ll need to pay this yourself
• Services able to be claimed by way of compensation or damages. CUA Health reserves the right to a full and immediate reimbursement of any claims covered by way of compensation or damages from another party.
• Services provided by a family member
• Any treatment considered an outpatient service, e.g. Radium
• Benefits for products, services or treatments purchased from or provided by practitioners overseas, whether you buy them in person, by mail order or online
• Benefits in relation to sport, recreation or entertainment unless they are part of an approved chronic disease management or a health management program
• Benefits for treatment, goods or services if false or misleading information is provided
• Extras cover services for which a Medicare benefits is payable, except as allowable as hospital substitute treatment Treatment, goods or services provided during a waiting period

Please read the information carefully and retain for your future reference. If you join CUA Health, confirmation of your cover and policy information will be sent to you. If you change your mind CUA Health provides a cooling off period of 30 days from the start date of your policy. For more information including Code of Conduct and Complaints resolution refer to information for policy holders.

CUA Health insurance is provided by CUA Health Ltd 98 098 685 459 (CHL) which is not an authorised deposit-taking institution. While CUA Health Insurance may be distributed by Credit Union Australia Ltd ABN 44 087 650 959 (CUA), CUA is not liable for this product and does not stand behind CHL.

It’s important to know that we only pay a benefit for services performed by private practitioners in a private practice, provided their associations and services are recognised by us. If you’re unsure if the provider you have selected, or service you require is covered under your policy, please contact CUA Health for confirmation. The items, limits and benefits are provided as a general guide only. Please call us if any further information is required. Calendar year limits cover the period 1 January to 31 December each year.

When changing health insurers, Extras benefits paid by your old health fund will be counted towards your annual limits in your first year of membership with us.

Benefit limitation periods

During the first 24 months from joining and after waiting periods have been served, benefits paid for these treatments will be limited to the same amount you would receive in a public hospital for the same treatment. After 24 months from joining you will be eligible for the full benefits under the policy.

Public Hospital cover

If you choose our Public Hospital cover, benefits will be limited to public hospital rates. You have the option to select you own doctor or specialist, however, public hospital waiting lists still apply. This product is not design no be used in a private hospital as large out-of-pockets expenses may apply.

Medical costs

The medical charge is the cost for any services performed by doctors or specialists. This includes, but is not limited to – surgeons, anaesthetists, pathologists and assistant surgeons. Medicare sets an amount payable toward the medical costs, called the Medicare schedule fee. Medicare pays 75% of the schedule fee and CUA Health pays the remaining 25%. If the doctor or specialist chooses to charge above the schedule fee, then the difference is paid by you, unless your doctor or specialist chooses to participate in CUA Health’s Access gap cover scheme – see below for more info.

Access gap cover scheme

The Access Gap Cover Scheme will reduce or in some instances eliminate your out-of-pocket expenses for specialist care you receive while in hospital.

Doctors and specialists electing to participate in the Access Gap Cover Scheme can bill CUA Health directly. So, not only does your hospital treatment cost you less, but the billing system is made easier for you too.

Access to a complete list of doctors and specialists participating in the Access Gap Cover Scheme is available here. If your doctor or specialist chooses to use the Scheme, you will either:

• have no out-of-pocket expenses, or
• be provided with an estimate of out-of-pocket expenses before your treatment

Your doctor or specialist may choose to use the Scheme on a patient-by-patient basis. Of course, whether or not your doctor or specialist participates in the Access Gap Cover Scheme will not change the relationship you have with him or her, or affect the treatment you receive.

Excess and Co-payment

Excess: An upfront amount that you agree to pay towards the cost of hospital treatment, in exchange for lower premiums. For example, if you have 100% Private Hospital Cover with $250 excess, if you require hospital treatment you’ll pay $250 per person, per calendar year. This does not apply to day surgery or dependants listed on the policy.

Co-payment: A percentage amount that you agree to pay towards the cost of hospital treatment, in exchange for lower premiums. For example, if you choose the 90% Private Hospital Cover, you would need to pay 10% of the hospital charge, capped at a fixed amount of $500 per person, per calendar year. CUA Health would then pay the remaining hospital charge. ^ Not payable for dependant children up to 23 years old or 25 if full-time student.

Agreement hospitals

CUA Health has agreements with the majority of private hospitals and day surgeries. If your hospital or day surgery doesn’t have an agreement with CUA Health, you may be subject to large out-of-pocket expenses, in addition to any excess or co-payment. Please check with your hospital prior to admission. Access to a complete list of agreement hospitals is available here.