Hospital services

Our contracted hospitals usually charge us directly. If you receive a hospital account, send it to us with a completed claim form via one of the below options for payment. 

• Claim via the member portal.

• Upload to the smartphone app along with photos of accounts/receipts.

Your claim will be paid directly into your bank account.  

Medical expenses while in hospital 

If your doctor or specialists have agreed to charge you under the Access Gap Cover Scheme, they'll charge us directly for your hospital treatment. 

If your doctor doesn't use Access Gap Cover, they may send you an account. You can take this to Medicare and then to us for payment. Just use our claim form and make sure you include the “Statement of Benefits” from Medicare with your claim. Medicare will pay 75% of the Medicare Benefits Schedule (MBS) Fee and we will pay the remaining 25% of the MBS Fee. You will need to pay any amount the doctor charges above the MBS Fee. 

What is not covered?

We pay benefits in accordance with the law and TUH Fund Rules and policies. We do not pay hospital benefits for:

• Admissions that occurred during your waiting period

• Booking fees including cancellation fees

• Treatment that is exluded from your policy

• Treatment provided as part of an aged care service

• Non-admitted services

• Elective procedures that are not considered to be medically necessary e.g. cosmetic surgery

• Treatment provided in an emergency department or associated short stay unit of a hospital

• Treatment for which you have received compensation or damages