A summary of your cover
The information below explains what’s included and not included under your policy.
You have chosen
Base Cover
An affordable option for those seeking a high level of hospital cover.
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Choice of $500 or $750 excess
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Emergency ambulance
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Repatriation or funeral expenses
We may pay a repatriation benefit of up to $100,000 for a medical repatriation to your home country. From 15 October 2025, the maximum benefit amount will reduce to $50,000. In the event of the death of someone on the membership, we may pay a benefit of up to $10,000 for funeral expenses. Conditions apply. Please see your Member Guide and Fact Sheet for further details.
A breakdown of your cover
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Rehabilitation
Hospital treatment for physical rehabilitation for a patient related to surgery or illness. -
Hospital psychiatric services (Will be restricted from 15 October 2025)
Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders. -
Palliative care
Hospital treatment for care where the intent is primarily providing quality of life for a patient with a terminal illness, including treatment to alleviate and manage pain. -
Brain and nervous system
Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system. -
Heart and vascular system
Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system. -
Lung and chest
Hospital treatment for the investigation and treatment of the lungs, lung-related conditions, mediastinum and chest. -
Ear, nose and throat
Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck. -
Back, neck and spine
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion. -
Blood
Hospital treatment for the investigation and treatment of blood and blood-related conditions. -
Bone, joint and muscle
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system. -
Breast surgery (medically necessary)
Hospital treatment for the investigation and treatment of breast disorders and associated lymph nodes, and reconstruction and/or reduction following breast surgery or a preventative mastectomy. -
Cataracts
Hospital treatment for surgery to remove a cataract and replace with an artificial lens. -
Chemotherapy, radiotherapy and immunotherapy for cancer
Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. -
Dental surgery
Hospital treatment for surgery to the teeth and gums. -
Dialysis for chronic kidney failure
Hospital treatment for dialysis treatment for chronic kidney failure. -
Diabetes management (excluding insulin pumps)
Hospital treatment for the investigation and management of diabetes. -
Digestive system
Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel. -
Eye (not cataracts)
Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket. -
Gastrointestinal endoscopy
Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope. -
Gynaecology
Hospital treatment for the investigation and treatment of the female reproductive system. -
Hernia and appendix
Hospital treatment for the investigation and treatment of a hernia or appendicitis. -
Implantation of hearing devices
Hospital treatment to correct hearing loss, including implantation of a prosthetic hearing device. -
Insulin pumps
Hospital treatment for the provision and replacement of insulin pumps for treatment of diabetes. -
Joint reconstructions
Hospital treatment for surgery for joint reconstructions. -
Joint replacements
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. -
Kidney and bladder
Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder. -
Pregnancy and birth (Will be restricted from 15 October 2025)
Hospital treatment for investigation and treatment of conditions associated with pregnancy and child birth. Treatment for the baby is covered under the clinical category relevant to their condition. For example, respiratory conditions are covered under Lung and chest. -
Male reproductive system
Hospital treatment for the investigation and treatment of the male reproductive system including the prostate. -
Miscarriage and termination of pregnancy
Hospital treatment for the investigation and treatment of a miscarriage or for termination of pregnancy. -
Pain management
Hospital treatment for pain management that does not require the insertion or surgical management of a device. -
Pain management with device
Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain. -
Plastic and reconstructive surgery (medically necessary)
Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital. -
Podiatric surgery (provided by a registered podiatric surgeon)
Hospital treatment for the investigation and treatment of conditions affecting the foot and/or ankle, provided by a registered podiatric surgeon, but limited to cover for accommodation and the cost of a prosthesis as listed in the prostheses list set out in the Private Health Insurance (Prostheses) Rules, as in force from time to time. -
Skin
Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is included. -
Sleep studies
Hospital treatment for the investigation of sleep patterns and anomalies. -
Tonsils, adenoids and grommets
Hospital treatment of the tonsils, adenoids and insertion or removal of grommets. -
Weight loss surgery
Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure. -
Assisted reproductive services
Hospital treatment for fertility treatments or procedures. -
Bone marrow transfusion or transplant
A bone marrow transplant is a procedure that infuses healthy blood-forming stem cells into your body to replace bone marrow that's not producing enough healthy blood cells. Bone marrow transplant recipients require intensive transfusion support preceding the marrow infusion. -
Cosmetic surgery
A cosmetic treatment is one which is concerned with altering the appearance of a body part or tissue which lies within the bounds of normal variation. Examples of Cosmetic Surgery: Rhinoplasty (nose reconstruction) without previous trauma or congenital defect, breast enlargement, liposuction. -
Organ transplant
An organ transplant involves removing an organ from a donor and putting it into someone who is unwell with organ failure. Organs and tissues that can be transplanted include the heart, lungs, kidneys, liver, skin and parts of the eye.
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Accidental injury
All AIA Health products include cover to be treated in an agreement private hospital for injuries sustained through an accident. -
In-hospital medical services provided as part of an included service
100% of the MBS (Medicare Benefits Schedule) fee for in-hospital medical services provided as part of an included service (e.g. surgeon and anaesthetist fees).
100% of MBS Fee -
In-hospital pharmaceuticals
AIA Health will pay towards the cost of eligible pharmaceuticals provided as part of your treatment in hospital for an included service, after a contribution amount has been deducted. A contribution amount is an amount you are required to pay towards the cost of an eligible pharmaceutical item, which is aligned to the PBS co-payment and indexed annually. -
Surgically implanted prosthesis
For an included service, AIA Health will pay the minimum benefit as listed in the Australian Government’s Prostheses List. -
Public hospital accident and emergency departments facility fee if admitted
100% of the facility fee charged by a public hospital for attending their accident and emergency department if admitted. -
Public hospital accident and emergency departments facility fee if not admitted (Will be excluded from 15 October 2025)
100% of the facility fee charged by a public hospital for attending their accident and emergency department if not admitted. -
Private hospital accident and emergency departments facility fee if admitted (covered from 15 October 2025)
From 15 October 2025, we will cover 100% of the facility fee charged by a private hospital for attending their accident and emergency department if admitted. -
Private hospital accident and emergency departments facility fee if not admitted
We do not cover any of the facility fee charged by a private hospital for attending their accident and emergency department if you are not admitted.
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General practitioner
100% of the MBS (Medicare Benefits Schedule) Fee for consultations with a General Practitioner (GP). -
Specialist consultations
100% of the MBS (Medicare Benefits Schedule) Fee for specialist consultations provided out-of-hospital, except where that service is excluded under your Hospital cover. -
Allied health services
100% of the MBS (Medicare Benefits Schedule) Fee for Allied health services billed with an MBS item number (e.g. eye checks and services related to chronic disease management plans), excluding psychology services. -
Out-of-hospital pharmaceuticals
Up to $40 per item, after the PBS threshold, for all non-PBS Pharmaceuticals and travel vaccines up to your annual limits. Pharmaceuticals are only payable on drugs that are a Schedule 4 or Schedule 8 class. -
Pathology (e.g. blood tests)
100% of the MBS (Medicare Benefits Schedule) Fee for pathology services provided out-of-hospital, except where that service is excluded under your Hospital cover. -
Radiology (e.g. x-ray scans)
100% of the MBS (Medicare Benefits Schedule) Fee 100% for x-rays provided out-of-hospital, except where that service is excluded under your Hospital cover. -
Outpatient pregnancy services
Medical consultations or treatment associated with pregnancy without the need to be admitted into the hospital (e.g. Obstetrician, midwife, antenatal consultations, ultrasounds etc). This includes hospital outpatient clinics where you are not admitted as a patient. -
Outpatient psychiatric services
Psychiatric services provided out-of-hospital, including hospital outpatient clinics where you are not admitted as a patient. -
CPAP-type device
Up to $500 benefit per member every 5 years towards the hire or purchase of an approved Continuous Positive Airway Pressure (CPAP)-type device. Conditions apply, refer to your Member Guide.
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Ambulance services
AIA Health will cover you for ambulance transportation when medically necessary for admission to hospital, emergency treatment onsite, or inter-hospital transfer for emergency treatment. This includes inter-hospital transfers that are necessary because the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences. -
No excess for kids
You will not be charged a Hospital Excess for children or student dependents covered under a family or single parent policy. -
Choice of treating doctor or specialist
You can choose your doctor or specialist when you are treated in hospital as a private patient. -
Funeral expenses
In the unfortunate event of a member's death, AIA Health will pay up to $10,000 towards the reasonable costs of their funeral in Australia, where the deceased is being buried or cremated in Australia. -
Repatriation
If you or any person on your membership sustains a substantial life-altering disability or a serious medical condition, as determined by AIA Health, and needs to return to their home country, AIA Health may pay up to $100,000 (reducing to $50,000 for Base Cover from 15 October 2025) towards the reasonable cost of travel with appropriate medical supervision. In the unfortunate event of death, AIA Health will pay up to $10,000 towards the reasonable cost for the repatriation of mortal remains (excluding ashes following a cremation) of you or anyone else on your membership to that person’s home country if legally permissible. -
Travel and accommodation
Under this benefit, AIA Health will pay towards the travel and accommodation costs of either yourself or a carer (if applicable) if you are admitted to a hospital far away from your home. Benefits are only eligible where the round trip is at least 200km within Australia. Benefits are capped at $50 per day for accommodation and 15 cents/km for travel for you and your carer. -
24/7 Health line access
Receive care and assistance at any time of the day with our trusted partner Nationwide Helpline Services (NHS). Calls to our Health Line are free, providing AIA Health OVHC members access to medical assistance and support and translation services when they need it.
Waiting periods
Commence on cover start date unless otherwise noted
Accident cover
1 day (from the date that you apply for cover)
Ambulance Services
1 day
Hospital psychiatric services, Rehabilitation and Palliative care (including those which are pre-existing conditions)
2 Months
Repatriation and funeral expenses
2 months (or 12 months when relating to pre-existing conditions)
Pre-existing conditions
12 Months
Pregnancy and birth
12 Months
CPAP type devices
12 Months
Base Cover
AUD /
Additional information
For full details about your chosen cover, click on the links below: