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Friday, December 18, 2015

Does Your Health Insurance Cover You Outside of Your State?

For most people the Christmas period means holidays and leaving the everyday grind behind for a few weeks. Lots of people take advantage of the extended school holidays and time off work to go on family vacations {we did when I was 12 and went to England to visit my Aunty & Uncle}. There are obvious insurance plans that need to be put in place when travelling overseas should something go wrong, however travelling within Australia can have insurance implications as well. Today the team at are guest posting to help shed some light on insurance questions you should ask before travelling over the holiday period.

Does Your Health Insurance Cover You Outside of Your State?

Visiting family in another part of Australia can be a great change of scene during the holiday season but it can be a potential nightmare if circumstances mean you have to seek treatment there and your health insurance doesn't cover you in this location. Depending on your health fund, you may be covered throughout Australia but this won’t necessarily be the case. Here’s what you need to know about accessing hospital and ambulance services when you’re away from home.

Are You Covered?

Some health funds will cover you for treatment in any hospital that they have an agreement with, even if it isn’t local to you. If your health fund has agreements with lots of private hospitals across Australia, there is a very good chance that you will be covered for treatment outside of your state. If you know that you’re going to be away for home for more than a day or two, it’s always worth checking to see whether your health fund has agreements with private hospitals in the area.

Assuming that you can use a participating agreement hospital, you’ll be covered for the same level of benefits in line with your policy. Basically, you won’t be covered for anything that your policy doesn’t include but at the same time, you won’t usually receive lesser benefits.

What If Your Health Fund Doesn’t Have an Agreement with the Hospital?

If you do have to be admitted to a hospital that your health fund does not have an agreement with, you may not be covered for very much or anything at all and can expect to pay out-of-pocket costs for treatment.

What About Ambulance Transport?

Emergency ambulance services are included by some health funds in Hospital or Extras cover. Beyond this, you can often buy standalone emergency ambulance cover through most health funds. This is usually national coverage throughout Australia. Generally speaking, “emergency” ambulance transport include cardiac arrest, severe breathing difficulties and other symptoms that strongly suggest that the patient’s life may be in danger. Non emergency ambulance transport that does not require the use of flashing lights and sirens doesn’t fall into this category and won’t be eligible for a claim.

Most state ambulance schemes only cover you within your own state but there are some exceptions to this, which can be invaluable if a member of the family requires ambulance transport while you are away from home. Some states have reciprocal agreements with one another if residents of one state need ambulance transport in the other state. NSW and ACT residents with a concession card or eligible Hospital cover with a health fund can access emergency ambulance services in most states, excluding SA and QLD. It’s a similar story in TAS, and residents are covered in all states except for SA and QLD. If you’re not sure, check with your state ambulance provider to see if they have any reciprocal arrangements in place with other states.

If there is no state ambulance scheme in your area and you don’t have any form of ambulance cover, you won’t be exempt from being able to access ambulance transport but it can be a very expensive trip (even for short journeys).

Would you like to comment?

  1. This is really interesting Toni! I'll have to check out whether ours covers us interstate or not... I'm really not sure to be honest!! Have a wonderful Christmas with your family (and I hope you get to have a bit of a relaxing break too!). xx

  2. I must confess I've never thought about this issue before Toni - I just assumed I would be covered. Thank goodness I've never had to test this out!

  3. This never occurred to me. I have a child with epilepsy so it always plays on my mind but I assumed I would be covered. Time to look.

  4. With us moving constantly across the country, we've always been on top of our health insurance. We took out extra ambulance cover as well but never thought about the travel side of things. Possibly because there really hasn't been much chance for travel.

    1. I've never really thought about it because we have ambulance cover here in QLD so I just assumed it would be the same everywhere else, but apparently not.