A benefit limitation period (BLP) is an initial period of time during which we'll only pay a minimum benefit for certain treatments or procedures under any of our Top Hospital Cover products. If a BLP applies to a treatment or procedure, we'll still pay something back for these services, but it's restricted to the minimum default benefit as determined by the Minister for Health and Ageing.

These default benefits are generally not enough to cover private hospital costs. They usually fully cover shared ward costs in a public hospital. If you choose to be treated in a private facility during the applicable BLP, you'll most likely have large out of pocket expenses for the following services:

  • BLP of two years (24 months) applies to bariatric surgery (weight loss surgery) including but not limited to gastric banding, gastric sleeving/diversion and gastric bypass surgery, including replacement, repair of adjustments
  • BLP of two years (24 months) applies to hip or knee joint replacements
  • BLP of two years (24 months) applies to in-hospital psychiatric treatment for all policies commencing on or after 1 December 2015.

A BLP will not apply if you're a new Member transferring from another private health insurer or to existing Members changing their level of hospital cover, as long as you transfer within 63 days of ceasing your previous cover. If you have not served the full waiting periods under your previous health insurance, you will need to serve the balance of those waiting periods before you'll be able to claim entitlement to any benefits in a private or public hospital.

A BLP will apply on the above hospital treatments or procedures for new members joining Top Hospital Cover for the first time, or to members re-joining after a break in your private hospital cover longer than 63 days. In these cases, you will need to serve the hospital waiting periods, after which the BLP will apply to the remaining period, up to the first 24 months of membership.

After the BLP has elapsed, you will be entitled to full benefits for these treatments in a private or public hospital.