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. The items that we do not pay extras benefits for include, but are not limited to

• services where a benefit is payable by Medicare

• treatments by providers not recognised by us for benefit purposes

• services that took place two years or more before the date you lodge the claim

• Pharmacy/vaccinations where the fee is less than the PBS patient co-payment amount

• overseas products, treatments or services

• telephone and email consultations or letters of advice by providers

• treatment by a provider who is a family member, including (but not restricted to) treatment by yourself or your partner, parent, sibling, child, or other insured person on the policy

• midwife services at a home birth

• vitamins and supplements.

Restrictions may apply for multiple treatments on the same day.

Want to know about claiming for Extras? Click here