Hospital cover helps to cover the cost of treatment you receive in hospital. Each level of AIA Health Insurance Hospital Cover (from Basic to Gold) is differentiated by the list of treatments that are included. For example, cover to be treated in a Private Hospital for pregnancy is only available on our Gold Hospital cover.
Why should I take out Hospital cover?
Hospital cover helps to cover the costs of being treated in hospital. Having Hospital cover means you can be treated in a private hospital and avoid public hospital waiting lists. You get more control over where you're treated, and who treats you.
What is Extras cover - and should I take this out too?
Extras cover is for treatments that do not take place in a hospital, like visits to the dentist, physiotherapy or optical services. AIA Health Insurance Extras cover can only be taken with Hospital cover. The types of services you can claim under your Extras cover will depend on the level of cover you take out, but essentially this type of cover is to help with services and treatments received out-of-hospital, that aren't covered by Medicare.
While we're at it, what's combined cover?
Combined cover is when you take out both Hospital and Extras cover. That's why you'll hear the term 'Hospital and Extras' thrown around so much when it comes to health insurance - it's a popular choice.
This rebate on private health insurance sounds good. How do I get it?
Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums, either as:
A reduction of your AIA Health Insurance premium; or
A lump sum payment when lodging your tax return.
The level of your rebate depends on your income and your age. To find out more and to find out how much you could get back head to the Private Health Insurance Rebate Calculator on the Australian Taxation Office website.
What is the Medicare Levy Surcharge (MLS)?
The MLS is simply an extra tax that people above a certain income threshold have to pay if they don't have eligible private hospital cover. It's calculated in three tiers for singles and couples/families. You can find out more about that here.
What is Lifetime Health Cover (LHC) loading?
The Lifetime Health Cover (LHC) loading is a Government loading on your private hospital cover premiums. It was introduced on 1 July 2000, to encourage people to take out private hospital cover earlier in life and encourage them to maintain it. LHC is a 2% loading on top of your premium for every year you don't have hospital cover after you turn 30. The maximum loading is 70%. You can find out more here.
What is a waiting period?
A waiting period is the time between joining or upgrading your level of cover and the date from which you're allowed to start claiming. Waiting periods exist for all services within both hospital and extras covers and apply to:
Additional members to a membership (unless the new member/s has/have previously served all waiting periods on equivalent cover with AIA Health or another fund) except for newborns, adopted and permanent foster children where the family membership has been in existence for at least two months
Existing members who upgrade their cover to a higher level of cover
Members who transfer to AIA Health Insurance from another fund to a higher level of cover than that of their previous fund
Treatment for a pre-existing condition.
Waiting periods for Hospital treatment range from one day to 12 months.
There is a one day waiting period for ambulance cover and treatment resulting from an accident
A 12 month waiting period for pregnancy
A 12 month waiting period for pre-existing ailment, illness or condition (except for psychiatric, rehabilitation and palliative care)
A two month waiting period for any other hospital treatment.
Waiting periods for Extras treatments vary by the treatments vary from two to 12 months, depending on the type of service. These are listed below:
Other including: Bowel cancer identification kits (one every two years), Melanoma Surveillance Photography (one per year) - two months.
What is a agreement private hospital or day surgery?
We have agreements with hundreds of private hospitals and day surgeries in Australia - that's what we're talking about when we say participating private hospital. To find out whether your hospital is a participating one call us on 1800 333 004. If you're admitted to a private hospital that's not on our list you may have to pay higher out-of-pocket fees.
What is a non-agreement hospital?
AIA Health Insurance is a member of the Australian Health Services Alliance (AHSA). A non-agreement hospital is a hospital that has not signed an agreement with the AHSA. If you receive treatment from one of these you may incur large out-of-pocket expenses. Call us on 1800 333 004 or email us at health.memberservices@AIA.com.au to find out if the hospital you want to be treated at is a participating hospital so you can avoid these costs.
What is a pre-existing condition?
A pre-existing condition is a condition - assessed by one of our medical practitioners - that you've had or shown symptoms of having within the past six months before you joined us, or changed your cover. This affects your cover quite a bit, and there's more on this in our member guide.
What is Medical Gap Cover?
The Federal Government sets a schedule of fees for eligible services provided by doctors to inpatients in hospital. Medicare pays 75% of these fees and health funds like AIA Health Insurance pay the remaining 25%. Doctors and providers are not restricted to charging this fee and are able to set their own fees, which can be higher than the scheduled fees. If your doctor chooses to charge a higher fee, there will be a gap between what the doctor charges and what the Government and AIA Health Insurance will pay. This is the 'Gap' and can leave you with significant out-of-pocket expenses. If your doctor participates in AIA Health's Access Gap Cover, we'll pay more than the 25% of the schedule fee - leaving you with drastically reduced, or even eliminated out-of-pocket expenses. The best way to find out if your doctor is registered for Access Gap Cover is to ask them.
Does my cover include ambulance cover?
AIA Health Insurance covers you for all clinically necessary ambulance services for emergencies in Australia. Emergencies are circumstances when immediate hospital treatment is required for a serious and acute injury or condition where the viability or function of an organ or body part is threatened. Check with your state Ambulance authority to ensure you have the right level of cover for non-emergency ambulance transport within Australia.
What are Private Health Information Statements (PHIS)?
A Private Health Information Statement (PHIS) is a summary of the key product features of your cover. You will receive a link to download a copy of your PHIS when you join AIA Health Insurance and it is available to download from our Online Member Services portal.
Select 'Correspondence' from the left hand side menu.
Underneath this, select 'All Correspondence'.
Under 'Subject Area', click on [+] next to 'General Messages'.
Scroll down to the earliest message, find the message titled "Welcome to AIA Health Insurance".
Under 'View', find links to view/download your Private Health Information Statement and relevant policy fact sheet.
When should I let you know I'm going to hospital?
If you have less than 12 months membership on your current hospital cover, you’ll need to contact us by phone on 1800 333 004 or by email at health.memberservices@AIA.com.au before being admitted so we can determine whether the waiting period for pre-existing conditions applies.
It can take up to five working days to complete this assessment, so make sure you factor this in when you book your stay. If you go ahead with your admission without confirming your entitlements and we subsequently determine your condition to be pre-existing, you’ll have to pay all outstanding hospital and medical charges not covered by Medicare.
Is my doctor registered for Access Gap Cover?
The best way to find out is to ask them. Every doctor is different and some will even opt in or out on a patient-by-patient basis. If your doctor participates in AIA Health Insurance's Access Gap Cover they can either choose to participate as a no gap charge or a known gap as follows;
No Gap’: Your doctor participates in Access Gap Cover and charges you no out-of-pocket for the treatment you received as an inpatient, or
‘Known Gap’: Your doctor participates in Access Gap Cover and charges you a reduced out-of-pocket fee for the treatment you've received as an inpatient. You will be aware of the costs before surgery.
Just remember to check with your doctor before agreeing to any treatment.
How can I save on dental treatments with smile.com.au?
Members with extras cover with dental are eligible to save between 15-40% off dental treatments performed by a smile.com.au approved dentist. Read more.
Is AIA Vitality a type of health insurance?
No. AIA Vitality is a science-backed program that helps you learn about your health, improve it and stay motivated with rewards. Find out more.
I think I have to switch health insurers. How do I do this?
This one's on us. All you need to do is give us the details of your current insurer and we'll take care of the rest.
When does my cover start?
Your cover starts as soon as we receive your first payment and you can begin claiming as soon as any applicable waiting periods are over.
How do I change my personal details?
You can amend your details at any time by logging in to the Online Member Services portal and editing your AIA Health Insurance profile. Alternatively, you can give us a call on 1800 333 004. This goes for changing your address details, payment details or if you change your name when you get married.
Who can make changes to my cover?
Only the member - the person whose name the policy is under - and anyone the member authorises can make changes to your cover.
What happens if I need to go to hospital?
We recommend you contact us prior to your admission to find out if the hospital you are to be admitted to is on our participating hospital list and to confirm that you have the right level of cover for the treatment you are seeking. If the hospital you are admitted to isn’t one of our participating hospitals, you may not be covered in full for your accommodation or theatre costs. Contacting us first means you will know what types of benefits you will receive and what your out-of of-pocket costs will be.
When you are admitted to hospital, the hospital will ask if you have private health insurance and will check your eligibility with us. All AIA Health Insurance hospital covers includes an excess cost to help lower your premium and you will be asked to pay the excess when you are admitted to hospital.
What are the payment methods available?
You can choose to pay via direct credit with a credit card or direct debit via your bank. Each method and its benefits are detailed in our member guide. Payment cycles are weekly, monthly or annually. Please call us on 1800 333 004 if you want to change how you pay your premium.
What happens if we're planning to have a baby?
If you’re planning to start or grow your family and your hospital cover doesn’t include pregnancy, you’ll have to upgrade your cover at least 12 months before giving birth to ensure all waiting periods have been served. Newborn babies aren’t admitted as patients in hospitals unless there are complications or your baby requires medical attention. In these instances your baby will be covered provided they are added to the policy. Adding a newborn is easy; you can do this yourself through the membership portal or give us a call and we will add the baby for you.
How can I get a new member card?
If your card is lost or stolen you should contact us as soon as possible to avoid fraudulent claims and we'll send you a brand new one. Remember, whenever you get a new card from us, your old one automatically becomes invalid so throw it away to avoid any confusion.
What is an excess?
An excess is an upfront payment that you are required to make when submitting a hospital claim. A higher excess will reduce your premium. A lower excess means you’ll pay less on admission to hospital, but your premium will be higher. Some AIA Health Insurance products offer you a choice of excess options, either $500 or $750 for an individual. The excess applies to the policyholder (and partner where applicable) once per person, per calendar year. Child dependants covered on a family policy are not required to pay an excess.
How do I get a 100% refund on my hospital excess?
Where your policy includes an Excess Refund, it means that if you hold this policy or another eligible policy for at least six months and hold Silver AIA Vitality status or higher, AIA Health Insurance will refund 100% of your hospital excess.
You will need to pay your excess when you’re admitted to hospital and then you can claim this amount back. See your member guide for more details.
Can I claim on orthotic and orthopaedic appliances?
To qualify for benefit payments, these must be custom-made by practitioner podiatrist or orthotist. For an orthosis to be custom made, a plaster cast or mould must be taken. Please note that customising, heat moulding, trimming or adjusting an existing ‘off the shelf’ appliance does not constitute a custom-made appliance. Orthopaedic appliances attract benefits where the application of which has resulted from, and is required immediately following, the injury or surgery, and a doctor's letter of recommendation is required prior to claiming.
Am I covered for health appliances?
AIA Health Insurance does not pay benefits for the hire of any health appliance or equipment. We will, however, fund a percentage of the purchase of the following appliances up to your annual limits, providing you lodge a doctor’s letter of recommendation with your claim:
Blood glucose monitor
Sleep apnoea monitor
AIA Health Insurance approved orthopaedic appliances
What are benefit replacement periods?
A benefit replacement rule applies to some items/services covered by AIA Health Insurance’s extras cover. This means that after you claim for an item, you must wait a specified period before you can lodge another claim for the same type of item. Call our Member Service Team on 1800 333 004 to find out which treatments have benefit replacement periods.
Can I claim for weight loss programs?
You can claim for weight loss programs under our Dietetics Extras cover but only when it has been recommended, in writing, by a doctor for preventing or improving a specific health condition. Also, the weight loss provider must be a member of the Weight Management Council of Australia and agree to abide by the Weight Management Code of Practice.
Here are some well-known providers that we’re happy to approve:
Weight Watchers Australia
Jenny Craig Weight Loss Centres Pty Ltd
Simplicity Weight Loss
Please note that we only cover weight loss program fees and will not provide any benefits for meals, groceries or exercise components.
Where can I find recognised Extras providers?
You can only claim extras benefits where treatment is received in person from a recognised health practitioner, received in Australia. To find out if your practitioner is recognised you can ask your practitioner before you make your appointment or call us on 1800 333 004 (we’re open from 8am to 6pm AEST). You cannot claim for treatments you provide to yourself or to members of our family or business partners and members of their family.
Can I claim for Extras purchased over the internet?
Yes - but only when purchased online from Australian optical and pharmaceutical providers when a script is provided. For a company to be considered an Australian provider, an ABN needs to be visible on the company’s website. Benefits for services, treatments and other costs received overseas are excluded and will not receive any benefit.
I have adult children who are still studying - are they covered by my family policy?
Family cover provides cover for the member, their partner and their children including dependant students up to the age of 25. Cover for child dependants ceases once they turn 21, unless they qualify to remain on the policy as a student dependant. When a child dependant turns 21, they have two months to get their own cover and not have to serve any waiting periods if moving to equivalent or lower cover. Student dependants also have two months from either turning 25 or ceasing to be a student to get their own cover. For mid-year school, apprenticeship and traineeship leavers who transfer from their parent’s AIA Health Insurance policy within two months of leaving school or finishing an eligible apprenticeship or traineeship through a registered training group will not have to serve waiting periods if they transfer to an equivalent or lower level of cover. A letter from their school or registered training group confirming the date of completion is required. For end of year school, apprenticeship and traineeship leavers, they are covered until 31 March of the following year and will not have to serve waiting periods if they transfer to an equivalent or lower level of cover.
Are there some Extras I can't claim for?
You can only claim on Extras treatments that are specifically included in your cover. Here’s a list of some of the treatments (not all) that aren’t covered:
Services or treatment for which anyone covered has a right to claim damages or compensation from any other person or body
Treatment where the member and/or dependant is eligible for free treatment under any Commonwealth or State Government Act
Services or treatment rendered more than two years prior to the date of claiming
Services or treatment not covered by your membership and/or is rendered while the membership is in arrears or is suspended
Services or treatment rendered by a practitioner not in private practice and/ or not recognised by bodies approved by AIA Health Insurance.
Contraceptive, fertility and IVF drugs available through the Pharmaceutical Benefits Scheme (PBS)
Pharmacy items, where they are available over the counter and purchased with or without prescription
Liquid filled Temazepam capsules
Drugs purchased overseas
Mass immunisation, services rendered in the course of the carrying out of a mass immunisation
Pharmaceuticals that are not considered an S4 or S8 drug.
Dental procedures where a limit on the number you can have has been exceeded
Dental procedures unless tooth Identifications (ID) are supplied by the provider
Dental procedures carried out and charged by a dental mechanic, other than an advanced dental technician
A range of dental procedures when provided on the same day for example a filling on a tooth that has been removed. Please contact us for further information relating to these exclusions
A benefit will only be paid for a single crown per tooth every five years.
Any procedure provided by a physiotherapist or chiropractor.
AIA Health Insurance specified and approved orthopaedic appliances purchased for support purposes only.
Pressure garments purchased for reasons other than the treatment of burns, varicose veins, lymphedema or post-operative surgery up to 60 days from hospital discharge only.
When you join us you'll receive a full welcome pack with all you need to make the most of your cover. If you can't see what you're looking for above, take a look at our member guide or call us on 1800 333 004.
What does Travel and Accommodation cover me for?
Where your policy includes a travel and accommodation benefit this can be used to claim towards the travel and accommodation costs of either yourself or a carer (if applicable) for a hospital admission.
Benefits are only eligible where the round trip is at least 200km within Australia. Benefits are capped at $50 per day for accommodation and 15 cents/km for travel for you and your carer.
There are lots of ways to make a claim. You'll just need to make sure you've served all your waiting periods before you start the claims process. Then, if you have Extras cover, you can simply use your membership card. Alternatively, you can use our member portal, or even claim by post. We've detailed the ins and outs in the member guide (plus some extra process info that may come in handy).
Where can I see the claims I've made?
You can see them all online. Simply log in to our member portal and head to the Claims section to look at your history.
Why wasn't my claim paid?
It doesn’t happen often, but there are instances where benefits are not paid at all or are paid at a lower level. These are when:
The treatment is not covered under your policy
The treatment was not provided by a recognised provider
The treatment was not provided in Australia
You’ve already claimed the maximum allowable benefits during a specified period
You’ve transferred to AIA Health Insurance from another fund and have already claimed for that treatment
It’s been more than two years since the treatment you’re claiming for
The health care account has been incorrectly itemised
You have an excess to pay on your chosen level of cover
The service is subject to a waiting period or another limit
You’re claiming for treatments carried out overseas
Treatment was provided to or from a family member or business associate
If AIA Health Insurance believes that you are not receiving acute care after 35 days of continual hospitalisation
Surgery is performed in hospital by a registered podiatrist/podiatric surgeon
When no MBS item number is provided by the health practitioner
If the MBS item is being performed for a cosmetic reason and not medical
The treatment was the second treatment performed on you in a day by a single practitioner.
To find out more, we recommend checking out your cover’s detailed terms and conditions published in our Fund Rules. These are available by calling us on 1800 333 004.
We thought you'd never ask. AIA Vitality is what makes us different. For all the details on how the program can boost your wellbeing and help you to maintain a level of good health, head to the AIA Vitality page.
We always want to make sure our members are being treated well and we're happy to receive any feedback you may have. We aim to resolve problems at the first point of contact. If you need to make a complaint, here’s how you can go about it.
Phone us on 1800 333 004, Monday to Friday between 8am and 6pm AEST.
We’re committed to a quick and fair resolution of all complaints so this is what you can expect from us:
We’ll acknowledge receipt of complaints within two business days (where they aren’t resolved immediately). This acknowledgment will include a reference number for your records.
If we are unable to deal with your complaint we’ll advise you as soon as possible and provide advice on who you can go to next.
If there are any delays in us responding to you when we say we will, we’ll advise you and provide a reason.
If one of our Member Service Consultants can’t resolve your problem, then it will be escalated to our Member Service Manager (or someone with equivalent decision-making authority) and finally to our Chief Health Insurance Officer. If the problem is still unresolved the matter can be taken to the Private Health Insurance Industry Ombudsman.
What are the Private Health Insurance health reforms?
The Australian Government has introduced a range of changes to how private health insurance operates to make it simpler and more affordable. The main changes are: the introduction of Gold, Silver, Bronze and Basic levels of cover; standard clinical definitions of what is included in your cover; higher excess options to make your premium lower; the exclusion of some natural therapies from cover and the option to offer a discount of up to 10% for people who are aged 18-29. These changes will make it easier to compare cover across different health funds and in some cases make cover more affordable.
Why has the name of my product changed (new product tiers)?
One of the recent reforms that Australian Government made to health insurance is for all covers to be grouped into tiers: Gold, Silver, Bronze and Basic. The tier the cover is in must be included in its name, which is why our product names are changing. This means that is now easier for you to compare covers across different health funds as all Gold covers (for example) must meet a minimum set of requirements.
Why has the name of services changed (clinical definitions)?
One of the recent reforms that Australian Government made to health insurance is standardise the clinical definitions used to describe the services that are included or excluded from a cover. Because this will be uniform across all health funds, it'll be easier for you to know what is and isn't included in your cover and compare this across different health funds.
What is the Age Based Discount?
Young Australians are eligible to receive up to a 10% discount on their private hospital insurance premiums when they hold an eligible product.
The discount you receive depends on your age when you first take out an eligible hospital cover and ranges from 10% (if you take out cover before the age of 26) to 2% (if you take out cover at the age of 29).
The Age Based Discount is calculated on your base premium before the application of any Australian Government Rebate, Lifetime Health Cover loading and/or any other eligible discount. The Age Based Discount only applies to hospital cover or the hospital component of a package – it doesn’t apply to extras.
The discount is ongoing, which means if you keep your eligible hospital cover, your discount remains until you turn 41. From then, the discount will reduce by 2% per year until it reaches zero.
The discount is only available on selected products but is available to new and existing policy holders. You have to be the Principal member or Partner on a hospital cover and aged between 18-29.
What discount do I get?
The discount is based off your age when you first purchase an eligible hospital product offering the Age Based Discount.
18-25 years old - 10%
26 years old - 8%
27 years old - 6%
28 years old - 4%
29 years old - 2%
30 years old - 0%
If you’re on a couple or family hospital cover, the Age Based Discount is calculated by taking an average of the discount applied to the adults on the hospital cover. So, if the Principal member has a 10% Age Based Discount and their partner has no discount, or 0%, the discount applied overall to the hospital cover is 5% (10% ÷ 2).
Where can I find out more information?
The Department of Health has a lot of useful information and a range of helpful fact sheets.
Finding the right level of life insurance cover is different for everyone and depends on your own individual circumstances. Things to consider when deciding how much cover you need may include; what stage of life you are at, whether you look after other people, if you have any debt, and the ongoing needs of your family and loved ones.
Am I already covered by my superannuation fund for life insurance?
If you are a member of an Australian superannuation fund you might already have some life insurance cover.
However, typically default life insurance cover within a superannuation plan only provides some of the life insurance you actually need. It's important to find out what type of insurance you already have by either asking your superannuation fund or your employer. Then you'll know where you stand, and whether you need extra cover.
What factors may affect my life insurance premiums?
Depending on the product you choose, your premium may be determined by your type and level of cover, age, gender, smoking status and any discounts you may receive.
You may also be required to take out a level of cover sufficient to meet the minimum premium. The premium amount also includes government charges such as insurance duty and taxes.
Can I nominate who receives the benefit under my policy?
Yes, when you apply for Life Insurance you will be asked if you would like to nominate a beneficiary or beneficiaries for any death benefits under your policy.
Does a change in my visa status impact my AIA Priority Protection policy if it was issued based on a temporary working visa?
Yes, you need to contact AIA Australia to update your residency status and check on the specific acceptance terms to ensure you are still eligible for your cover.
What are my options if I am having difficulty meeting my premium payments?
If you are having difficulty meeting your premium payments, your financial adviser or our Client Service Team can take you through options which may be available on your policy in order to reduce your premium.
Yes. The cost of AIA Vitality is already included in the premium for all AIA Health Insurance policies and some life insurance policies.
If you’re taking out an AIA Australia Priority Protection life insurance policy, you’re able to pay an additional fee to attach an AIA Vitality membership to your policy.
Do I need to be fit to join AIA Vitality?
No, not at all. AIA Vitality’s approach is to help everyone on their journey to better health no matter your current state of health or fitness level. We encourage everyone to learn about their health and we support you to make healthier choices. Moving more is a critical component of an overall approach to improving your health – and includes activities of daily living such as walking the dog, increasing the number of steps you do each day and taking the stairs instead of the lift.
How long will my membership take to activate?
If you’ve purchased an AIA Health Insurance policy, you’ll receive an email shortly after your first payment, inviting you to activate your AIA Vitality membership. As soon as you activate, you’ll be able to start your AIA Vitality journey to a healthier, longer, better life.
If you’re taking out an AIA Australia Priority Protection policy and have asked to attach an AIA Vitality membership to your policy, your activation email will be sent to you once your policy is in place.