MBF HealthSmart
This product is a combined package of hospital and extras cover for young singles and couples not planning to have children. It covers you for all hospital services except Pregnancy and Birth related services. The extras component covers a range of services including General and Major Dental, Optical, Physiotherapy, Complementary Therapies and Travel-related Pharmacy, but excludes services you may not need such as Orthodontics.
Hospital cover component:
Planning to have children? To ensure you and your baby are covered we recommend choosing an appropriate level of MBF Hospital cover (other than MBF Choices, MBF Budget Hospital and MBF HealthSmart) at least 12 months prior to the birth.
MBF hospital cover helps pay for in-patient hospital-related treatments (except any Excluded Services under your level of cover) at MBF Network Hospitals and public hospitals; where Medicare pays a benefit, provided the standard conditions including waiting periods are met.
All levels of MBF hospital cover help pay for in-patient treatments provided that:
- They are given while you are formally admitted in a hospital;
- They are treatments that Medicare pays a benefit for;
- They are not an Excluded Service on your level of cover; and
- You've met all the standard conditions of your policy (like serving the relevant waiting periods)
Excluded services for MBF HealthSmart
- Pregnancy and birth related services including assisted reproductive services (please note most fertility treatments are out-patient treatments and therefore not covered on any level of MBF hospital cover)
Please ensure you have read the complete MBF Hospital cover details by selecting the expand options below.
What's covered
- Emergency ambulance transport (where provided by a state or territory government service or an organisation recognised by MBF)
- Shared accommodation (single room if available)
- Same day admission (day surgery)
- Operating theatre
- Intensive care
- Most pharmaceuticals directly associated with the reason for your admission
- Certain therapies such as physiotherapy, occupational therapy and speech therapy when provided by the hospital
! At MBF Network Hospitals and public hospitals, 100% of the charges above are covered. For all charges incurred in non-Agreement hospitals you will pay the difference between the amount the hospital charges and the benefit paid by MBF, which may be substantial.
- 100% cover for most Government-approved surgically implanted prostheses. A limited number of Government-approved surgically implanted prostheses will attract a gap which you will be required to pay
What's not covered
No level of MBF hospital cover will pay for:
- Services received during the applicable waiting period
- Treatments where Medicare does not pay a benefit
- Charges above the Medicare Benefits Schedule Fee and where your doctor chooses not to opt-in to the MBF Medical Gap Cover Scheme
- Experimental treatment and some very high cost drugs
- Personal and take-home items, e.g. newspapers, toiletries and crutches
- Services not invoiced by the hospital (i.e. invoiced by a third party), e.g. a manicure and hairdressing
- Nursing Home Type Patient contribution
- Out-patient treatment other than MBF-approved programs
- Services not clinically necessary, e.g. cosmetic surgery and respite care
- Additional charges for luxury suites
- All Doctors' Charges for surgical podiatry including the accredited podiatrist's fee's
- Any service not part of a course of treatment recognised by MBF, e.g. treatment unrelated to a diagnosed medical illness or condition
- The patient contribution on PBS drugs that are not intrinsic to your hospital treatment
- Services that are excluded from your level of cover, which means no benefits are payable on hospital and Doctors Charges for those services
Excluded services
Pregnancy and birth related services including assisted reproductive services (please note most fertility treatments are out-patient treatments and therefore not covered on any level of MBF hospital cover)
Examples of treatments include:
- labour and delivery (including Caesarean)
- assisted reproductive services (such as, in vitro fertilisation, gamete intrafallopian transfer or similar procedures)
- complications of pregnancy
- ante natal attendance etc
| Doctors' Charges | 100% cover | Charges may apply |
|---|---|---|
| Each of your doctors can choose to participate in the MBF Medical Gap Cover Scheme for your hospitalisation | When each specialist chooses to opt-in to the MBF Medical Gap Cover scheme for your treatment | For those specialists who choose not to opt-in to the MBF Medical Gap Cover scheme for your treatment |
| Radiology and pathology services | Where MBF has an agreement with the practitioner | Where no MBF agreement applies |
Is outpatient treatment covered? In general, health funds do not cover out-patient treatment unless we have a specific agreement with the hospital for a service or we specify under your level of cover and we have an agreement with a provider for that treatment. Out-patient treatment includes emergency room treatment, consultations with your specialist before a labour admission and most assisted reproductive services or treatments.
Your MBF hospital cover will normally help you meet the expenses of in-patient procedures including day surgery. This means that you must be formally admitted as an in-patient to a hospital in order to receive benefits from MBF.
Extras cover component:
All Limits are per person, per calendar year unless otherwise stated and when provided anywhere in Australia by an MBF Recognised Provider.
Please Note: that where a 'per policy' Limit is stated this does not apply to Singles Cover
| Item description | Waiting period | Limits |
|---|---|---|
| Preventive Dental E.g. fluoride application, sports mouthguard |
2 months | No annual Limit |
| General Dental E.g. simple fillings, simple extractions |
2 months | $300 per person |
| Major Dental E.g. crowns and bridges, inlays, onlays, facings, endodontics, dentures and surgical extraction of teeth |
12 months | $200 per person increasing with continued preventive treatment Orthodontic treatment not covered |
| Optical Only MBF MemberCare offers 'no-gap' optical products. Prescribed optical appliances, eg frames and contact lenses |
6 months One set of frames every 2 years |
MBF MemberCare Limit $215 per person Non MemberCare Limit $185 per person |
| MBF Living Well Programs MBF-approved health management programs which include nicotine replacement therapy, some types of yoga, Pilates and gym membership fees (restrictions apply) |
6 months | $100 per person |
| Physiotherapy And Other Therapies Physiotherapy, chiropractic, osteopathy, occupational therapy, podiatry, psychology, dietetics, speech therapy, eye therapy and ante/post natal services |
2 months | $200 per person per therapy type to a maximum of $350 per person in this category Excludes speech and eye therapy |
| Pharmaceutical Most prescribed non-PBS listed drugs. PBS contribution deducted from each script, then pay 100% up to a maximum of $50 per script |
2 months | $225 per person Preventive travel-related pharmacy only |
| Complementary Therapies Acupuncture, Alexander Technique, aromatherapy, Bowen Therapy, exercise physiology, Feldenkrais, herbalist, homeopathy, iridology, kinesiology, naturopathy, reflexology, remedial massage and Shiatsu |
2 months | $150 per person per therapy type to a maximum of $450 per person in this category |
| Hearing Aids For prescribed, MBF-approved appliances excluding batteries, repairs and cleaning costs |
3 years | No benefit |
| Health Management Aids And Appliances Range of MBF-approved non-surgically-implanted prostheses and health management aids and appliances, e.g. asthma spacer, blood glucose monitor |
1 to 5 years | $750 per person Restricted range only, no orthotics |
| Accident Cover When an Accident requires urgent hospital treatment, Accident Cover pays for your MBF hospital Excess or Co-payment and can boost Limits on your MBF extras cover |
No waiting period | $2,000 per person Maximum of $2,000 per Accident |
| Emergency Ambulance Transport When provided by MBF Recognised Providers |
No waiting period | No annual Limit |
MBF MemberCare - better value from our special network of MBF MemberCare providers
When you see our MBF MemberCare logo at your next visit to a health service provider, you'll know you're getting increased Set Benefits on selected services from your MBF extras cover.
Dental
MBF members receive at least 70% of the charge back on all preventive and general dental services.*
Physiotherapy
MBF members receive at least 70% of the charge back on initial, subsequent, extended or group consultations.*
Chiropractic
MBF members receive at least 70% of the charge back on initial, subsequent, extended or group consultations.*
Optical
MBF believes that your eyesight is important and we want to help you achieve the look you're after. Through our growing MBF MemberCare optical network, not only do you receive higher Set Benefits, you can also access higher Limits. Other ways you'll receive added value include:
- a range of fixed price packages on glasses and contact lenses – which could cost you nothing, depending on your Level of Cover*. See the table below for 'no-gap' optical packages.
- up to $100 off a wide range of fashion frames
- 70%-90% back on most lenses, depending on your Level of Cover
- 20% off a wide range of sunglasses
- 20% off non-standard contacts eg colour contacts.
| No-gap optical packages | MBF HealthSmart |
|---|---|
| Glasses with single vision lens† |  |
| Glasses with single vision grind lens† |  |
| Glasses with bi-focal lens† | |
| Glasses with tri-focal lens† | |
| Glasses with progressive lens† | |
| Disposable contacts - selected 12 months' supply purchased in-store | |
| Disposable contacts - selected 12 months' supply purchased over the internet | |
†Includes any frames valued up to $199.
An easy, instant way to claim
As well as these advantages, many MBF MemberCare Providers also offer you the convenience of MBF AutoClaim. Just swipe your MBF Card to make a claim and pay any 'gap' on-the-spot. It-s that easy. To find out more about MBF MemberCare arrangements and how they work, or to find the provider nearest to you, search for an MBF MemberCare Provider.
Pharmacy
Seek out the MBF MemberCare pharmacies - they offer competitive prices to MBF members for some of the non-PBS (private script) prescriptions you need out of hospital.
Gym membership fees
At participating MBF MemberCare providers you will receive at least 70% of the charge back for gym membership fees, up to the Limits for Living Well Programs for your level of cover*.
Remember, MBF can only pay a benefit for gym membership fees where the gym program concerned is intended to prevent or relieve a specific health condition or conditions and an MBF Living Well approval form is completed by your GP or MBF Recognised Provider.
* of course any benefit you receive from these providers are subject to the terms and conditions of your chosen level of MBF cover including Limits and waiting periods.
