Comprehensive Hospital cover
Our most extensive hospital product
Comprehensive Hospital cover is our most extensive hospital product – it’s most popular with people who want complete peace of mind, paying benefits for a wide range of inpatient hospital services like pregnancy, heart-related procedures, major eye surgery and joint replacement surgery.
Best suited for couples, singles and families wanting the highest level of hospital cover.
What you're covered for
Your choice of doctor/hospital
With private hospital cover, you'll avoid potentially long public hospital waiting times and can choose to be treated by your preferred doctor.
Private hospital accommodation^
Accommodation in a private hospital for surgeries and procedures not listed as a restricted or excluded service.
^ Once all applicable waiting periods and/or Benefit Limitation Periods (BLP) have been served. Out-of-pocket expenses may apply on certain treatments during a BLP - see here for more information.
Fees that a hospital charge for the usage of the operating room and equipment.
For time required to be spent in intensive care.
Surgically implanted prostheses
Benefits for surgically implanted stents, screws and plates (for fractures) and pacemakers. Prosthesis benefits as per the Government listing.
Tonsils and adenoids removal
Surgery to remove the adenoids and tonsils.
Cover for colonoscopies
Grommets in ears
For treatment of conditions affecting the middle ear.
Cover for gynaecological treatments in hospital.
Treatment for hernias provided in hospital.
Reconstructive surgeries for shoulders, knees, etc.
Including herniated discs and vertebral fusion surgeries.
Including biopsies and craniotomy.
Pregnancy and birth-related services
Obstetric related services
Assisted reproductive services
Includes services such as IVF.
In-hospital rehabilitation services
Rehabilitation of patients with neurological, muscular skeletal, orthopaedic and other medical conditions following stabilisation of their acute medical issues.
Heart related surgeries
Cardiac and cardiac related services, e.g. open heart surgery.
Major eye surgery
Includes cataract surgery and surgery for other major eye conditions. Does not include laser surgery to restore vision.
Access Gap Cover
The Access Gap benefit, for inpatient services, is a benefit over and above the Medicare Benefits Schedule for participating doctors.
Most pharmaceuticals relating to your admission
Most pharmaceuticals (prescribed medications) relating to your surgery, procedure or hospital admission.
Nursing home type patients
We pay a benefit towards a nursing home patient. This amount is determined by the Federal Government. Certification is required.
Mammograms and bone density test
Mammograms and bene density tests are covered on our top Hospital product. A benefit up to $75, limited to 2 services for each of these tests. Claims are subject to there being no Medicare benefit payable. The Membership Year limit is $300 per person covered.
Also includes benefits for digital mammography and breast tomosynthesis.
Benefits up to $35 per day to a maximum of four days per person listed on the membership.
This is only covered under Comprehensive Hospital cover.
Treatment for kidney failure, e.g. chronic renal failure.
Public hospital accommodation as a private patient in a shared room
If you need to have treatment in a public hospital, you'll be treated as a private patient in a shared room.
Removal of the appendix.
Plastic and reconstructive surgery
Surgical specialty involving the restoration, reconstruction, or alteration of the human body (excludes cosmetic surgery).
A benefit amount is provided to use over three Membership Years based on the date of which the purchase of a hearing aid/s is made. The benefit limit applies based on your length of membership with Queensland Country. Up to 10 years $1,000, 10-15 years $1,500 and 15 years+ $2,000. Benefits are per person and are calculated at 85% of purchase cost up to the appropriate benefit limit.
Hearing aids are only covered under our Comprehensive Hospital cover.
Australian Hearing Services
Benefit of $25 per Membership Year per eligible person for the cost of a Hearing Services Card.
Nursing - Home, Bush and Special
Home and Bush nursing - benefit up to $50 per visit or $150 per day limited to $1,000 per person, per Membership Year. Special nursing - benefit of up to $150 per day $750 per person, per Membership Year.
Nursing is only covered under our Comprehensive Hospital Cover.
Mechanical aids and appliances
Benefit up to 85% of the cost or hire of mechanical aids and appliances approved by Queensland Country Health with a limit of $2,000 per person per Membership Year.
Mechanical aids and appliances are only covered under our Comprehensive Hospital cover.
^^Benefits are not available on second hand equipment or on some consumables. A benefit is payable for short term hiring (up to 3 months) of some mechanical aids. The purchase of some machines and monitors are limited to once every 3 Membership Years. Waiting periods will apply to all benefits outlined. Sub limits may apply to benefits for some aids or appliances. Refer to page 32 in our Hospital Cover brochure for more details.
Care Navigation provides assistance immediately following a period of time in hospital or for those living with one or more chronic diseases.
What is Access Gap Cover?
The Access Gap Cover scheme is designed to reduce your out-of-pocket expenses when you receive a service in a hospital.
Under the Access Gap Cover scheme, participating medical practitioners can decide to accept up to the Queensland Country Health Fund fee as full settlement of the account. This means you don’t have to make any additional payments for that particular service.
The doctor can also accept the fee as part of the payment and will inform you of any gap – called the known gap. The known gap is the additional out-of-pocket expenses you will need to pay.
If your doctor doesn’t participate in access gap, we will only cover the 25% between the 75% Medicare Rebate and the Medicare Benefits Schedule fee for inpatient services.
What is an excess?
An excess is the amount you agree to pay towards the cost of your hospital treatment when you're admitted to hospital, in exchange for a lower regular premiums.
When you choose private hospital cover, you can choose the level of excess you want to pay. The higher the level of excess, the lower your premium will be, as you agree to pay a larger sum towards your hospital costs.
At Queensland Country, you can choose an excess of $250 or $500 per person within any one membership year, regardless of the number of times you’re admitted to hospital.
Even on a family membership, regardless of the number of people covered, you’ll only pay the excess once per individual, to a maximum of two excess payments, for the entire family within your membership year. This means a maximum of $500 on a $250 excess option, or $1,000 for a $500 excess option.
|Excess level||Maximum excess per Membership year|
Also, under our Comprehensive Hospital cover, we don’t charge any excess on children aged 12 years or under if they need to be admitted to hospital for medical treatment.*
Your chosen excess applies to the full cost of hospitalisation at a public, private or day hospital facility. Once the excess has been paid, we take care of the rest, so you can enjoy the full benefits of your private health insurance.
Under Comprehensive Hospital cover a co-payment also applies for in-hospital psychiatric admissions only. Learn more about a co-payment.
*The excess exemption for children 12 years and under is NOT applicable under our Intermediate Hospital cover.
What is a pre-existing condition?
A pre-existing ailment, illness or condition is one where signs or symptoms of the condition were present at any time during the six months prior to applying for membership of Queensland Country Health Fund or an upgrade of your existing cover, determined by a Queensland Country appointed medical practitioner. You may have a pre-existing condition, ailment or illness without even being aware of it.
If we find that a pre-existing condition was present, you will need to serve a 12 month waiting period before claiming benefits for treatment. It isn’t necessary for the signs or symptoms to have been diagnosed by a doctor at the time of joining or upgrading your cover.
The 12 month waiting period for pre-existing ailments can be applied to all hospital (or hospital substitute) treatments for which we pay benefits. There are a couple of exceptions; a two month waiting period applies to the following services:
- Approved rehabilitation treatment
- Palliative care
A 12 month waiting period applies to obstetrics (pregnancy) related services. Surgery for assisted fertility programs such as IVF or GIFT, sterilisation or vasectomy and surgical extractions attract a 12 month waiting period.
The 12 month waiting period for the treatment of a pre-existing ailment can also apply to Extras services.
What are out-of-pocket expenses for hospital treatment?
Out-of-pocket expenses are the additional costs once all Medicare and private health insurance benefits have been expended. Usually, out-of-pocket expenses apply when you’re not fully covered for a particular treatment or service, or when a set benefit limit applies. Discovering you’ll be out of pocket can be a tough pill to swallow, especially after being discharged from hospital, or once your treatment is complete.
It’s your right to know if there are any out-of-pocket expenses that you might incur as part of your treatment, to avoid any surprises later. Knowing the cost of your medical treatment upfront is called Informed Financial Consent, and the Government has introduced a checklist, providing you with the questions you need to ask before going into hospital.
We recommend contacting us before going into hospital so that we can discuss what your policy provides cover for, and if any out-of-pocket expenses will apply. We’ll also supply you with a copy of the checklist. By talking to us before going into hospital, you’ll have the total picture and can avoid any unwanted surprises later.