MBF Premium Hospital
This product gives you our highest level of MBF hospital cover with no excluded services, no Excess or Co-payment and Special Benefits such as meals and accommodation for parents/spouse during your hospital admission.
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)
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) where admitted to a hospital
- 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 as part of your admission
! 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
Special Benefits include:
- accommodation in hospital for parent/s, spouse or next of kin - maximum $60 a night;
- meals in hospital for parent/s, spouse or next of kin - maximum $30 per day; and
- home services directly relating to and following the admission, including post-natal care, lactation nursing,
physiotherapy, occupational therapy or speech pathology - maximum $60 per visit.
For the services listed above, the Limits are set out below. Special Benefits are not redeemable for cash.
- Under 2 years continuous membership - up to $300 per annum
- 2 years to less than 5 years continuous membership - up to $500 per annum
- 5 years to less than 10 years continuous membership - up to $1,000 per annum
- 10 years to less than 15 years continuous membership - up to $1,500 per annum
- 15 years and over continuous membership - up to $2,000 per annum.
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
| 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.
