More about hospital cover

What’s included?

With hospital cover, you’re covered for medically necessary treatment in Australian private hospitals that TUH has a contract with (see full list of available hospitals). For eligible private inpatient services, Medicare will cover 75% of the Medicare Benefit Schedule (MBS) fee set by the Government for doctor’s charges. TUH will cover the remaining 25%.

Your cover includes accommodation, theatre fees, intensive care, coronary care, industry approved prostheses and hospital medication allowed under law.

What’s not included?

We pay benefits in accordance with the law and TUH Fund Rules and policies. The items that we do not pay benefits for include, but are not limited to:

  • Hospital treatment that is not medically necessary or treatment which is not eligible for Medicare benefits;
  • Cosmetic surgery;
  • Outpatient treatment;
  • Visits to public or private hospital emergency departments;
  • Charges above the Medicare Benefits Schedule (MBS) fee;
  • Some pharmacy items;
  • Personal incidentals;
  • Experimental procedures/therapies;
  • High cost medications;
  • Robotic surgery consumables; 
  • Medical devices not included in hospital theatre fees as determined by law; 
  • Emergency department;
  • Procedures or services that are excluded on your cover; and
  • Treatment while you are serving a waiting period.


For further information, please refer to the Important Information Guide.

Excluded services

Some covers have excluded services for which we pay no benefit. If your cover has excluded services, these are listed in your product brochure. More information

Obstetrics (pregnancy and birth related services) 

While most of our covers include obstetrics, some don't. Please refer to the relevant product brochure to see if you have the correct cover for your needs. More information

Restricted services

Some covers have restricted services. If your cover has restricted services, these are listed in your product brochure. More information

For restricted services, we will pay the default benefit for hospital accommodation as determined by the Government. More information

Cosmetic surgery

"Cosmetic surgery" refers to procedures performed for non-medically necessary reasons. We’re unable to pay benefits for these procedures or the hospital costs associated with them. More information

Excess

An excess is an amount you elect to contribute towards the cost of your hospital treatment. Agreeing to pay an excess if you need hospitalisation reduces the amount of annual premium you pay. Not payable for dependants. More information

Pre-existing ailments or conditions

A waiting period of 12 months applies to hospital claims for any condition that existed prior to joining TUH or upgrading to a higher cover. More information