Private Hospital and Specialist Cover
Comprehensive care when you need it
Private Hospital and Specialist Cover
Private Hospital and Specialist Cover is our most comprehensive cover, taking care of specialist consultations, diagnostics, surgery, and treatments in recognised private hospitals. Even if you're fit and healthy, it's important to have a plan in place for unexpected medical expenses to help you get access to the right support you when you need it most.
- Specialist Consultations**
- Obstetrics Benefit up to $2,000 per pregnancy**
- Cover for many pre-existing conditions after three years
- $300,000 surgical cover per person each year
- $200,000 medical and cancer cover per person each year
- Your choice of nil, $500, or $1,000 excess options
- 5% AA Member discount available if you provide a valid AA Membership number for you or someone named on your policy*
non-PHARMAC funded drugs can be lifesaving, but could possibly cost up to hundreds of thousands of dollars. The non-PHARMAC Plus option can be added to Private Hospital or Private Hospital and Specialist Cover, and helps you cover the cost of some drugs that are Medsafe approved and prescribed under the Medsafe guidelines, but aren’t funded by PHARMAC#.
With non-PHARMAC Plus, you may have access to wider treatment options and cover for approved drugs used to treat cancer and other types of health conditions.
Be confident knowing what your policy covers
We want to make sure you're confident knowing what you are and aren't covered for. That means reading your Policy Wording to understand the benefits as well as your responsibilities, and the cover limits and exclusions of your policy.
Hospital Surgical Benefit
We will pay up to a total maximum of $300,000 for each insured person every policy year, less any excess for any of the surgery related benefits under this cover.
Hospital Medical Benefit (non surgical hospitalisation)
We will pay up to a total maximum of $200,000 for each insured person every policy year, less any excess for the non-surgical (non-medical) and cancer related benefits under this cover. Individual limits may apply to each of the benefits.
Specialist Consultation Benefit
We will cover all eligible claims for specialist consultations during the cancer treatment phase (chemotherapy, brachytherapy, radiotherapy or surgery) and up to twelve registered specialist consultations for other treatments (including pre- and post- cancer treatment phase) per insured person every policy year.
|AA Health Insurance Private Hospital and Specialist||Annual Benefit limits|
|Surgery in a recognised private hospital (Hospital Surgical Benefit)||$300,000^|
|Non-surgical hospitalisation (Hospital Medical Benefit)||$200,000^|
|Included under standalone benefits***|
|Cancer treatments||$300,000 for cancer surgery;
$200,000 for cancer treatment (including up to $10,000 for cancer treatment at home)
|Non-PHARMAC cancer treatment||$10,000|
|Registered specialist skin lesion surgery||$6,000|
|CT, MRI and PET scans||$5,000|
|Intravitreal eye injections||$3,000|
|Travel and accommodation- Cancer||Up to $5,000 for travel and accommodation|
|Travel and accommodation- Surgery or Medical||Up to $2,000 for travel and $3,000 for accommodation|
|Follow-up investigation for cancer||$3,000 each year, for up to five years|
|Parent accommodation||$200 per night, up to $3,000|
|Obstetrics||$2,000 for each pregnancy|
|Post-hospital therapeutic care||$250|
|Post-hospital home nursing care||$150 per day, up to $6,000|
|ACC Top Up||Covers the difference in costs between what ACC pays for an injury and the costs incurred|
|ACC Treatment Injury||Cover for reparative treatment for any injury that occurs during treatment|
|Road ambulance transfer||Cover for cost of road ambulance transfer from a public or private hospital to the closest private hospital|
|Oral surgery||Cover for oral surgery performed by an oral surgeon / maxilla-facial surgeon, including wisdom teeth extraction.|
|Specialist consultations||Unlimited number for cancer related consultations, up to 12 for others|
|Varicose veins surgery||Cover for varicose vein treatment on recommendation from a GP or registered specialist|
|Premium Waiver||Up to 2 years|
|Suspension of cover after one year||You may choose to suspend the cover for overseas travel, parental leave and unemployment|
|Pre-existing cover for newborns||Pre-existing conditions are covered when a child is added within 4 months of birth|
|Loyalty benefit- sterilisation after two years||$1,000 (lifetime limit)|
||Four different cover levels to suit your needs:
$50,000, $100,000, $200,000 or $300,000^
Things you should know
- Benefit limits and excesses apply per person and refresh each policy year.
- 100% of your eligible cover amount can be claimed if you select a provider from the nib First Choice Network. You can still choose a provider outside of the network; you will just need to make a 'gap-payment', as these provider rates aren't standardised and regulated through the group.
- There's a 14-day cooling off period that gives you peace of mind in knowing that if you change your mind in this time, we'll refund 100% of premiums paid.
- Waiting periods apply before you can access some benefits under your policy. See the above table and Policy Wording for more information.
- Most pre-existing conditions are covered after a 3 year waiting period. Some pre-existing conditions are never covered. Please check the Policy Wording for full details.
- We won't change your premiums on an individual basis (unless you change your smoking status), however it's possible for all premiums to increase in the future. We will always give you 30 days' written notice if that happens.
- For more information on non-PHARMAC Plus, see the non-PHARMAC Plus Policy Wording.
Making claims easy
We make the claims process simple so you can focus on recovering while we look after your claim. To make your claim hassle-free, some First Choice network healthcare providers can submit pre-approvals and claims on your behalf. Plus, by choosing a First Choice network healthcare provider, you'll have 100% of your eligible costs covered (up to your benefit limit, subject to any excess payable and in line with your policy terms).
For more information on making a claim, visit our Make a claim page.