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What is health insurance?

For anything we haven't covered, head to privatehealth.gov.au.

Hospital cover helps to cover the cost of treatment you receive in hospital. Each level of RACQ Hospital Cover (from Accident to Top) are differentiated by the treatments that are excluded, or that you cannot claim on. For example, cover to be treated in a private hospital for pregnancy is only available on our Top Hospital policy.

Having hospital cover means you can be treated in a private hospital, avoid public waiting lists and have your choice of medical professionals. With hospital cover you get more control over where you're treated and who treats you.

Extras cover is for treatments that do not take place in a hospital, like visits to the dentist, physiotherapy or optical services. Extras cover can only be taken out with hospital cover.

What's included in your extras cover will depend on the policy you take out, but this type of cover helps with services and treatments that aren't covered by Medicare.

Combined cover is a term used when you take out both hospital and extras cover. That's why you'll hear the term 'Hospital and Extras' talked about so much when it comes to health insurance - it's a popular choice.

Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums.

The rebate is income tested and you can claim it, as either:

  • a reduction of your RACQ Health Insurance premium; or
  • a lump sum payment when lodging your tax return.

To find out more, including how much you could get back, head to the Private Health Insurance Rebate Calculator on the Australian Taxation Office website.

The MLS is simply an extra tax that people above a certain income threshold have to pay if they don't have eligible private hospital cover.

There’s four tiers, each identifying how much you’ll pay based on a single threshold or family threshold.

The Lifetime Health Cover (LHC) loading is a government loading on your private hospital cover premiums. It was introduced on July 1, 2000 to encourage people to take out private hospital cover earlier. LHC is a 2% loading for every year you don't have hospital cover after you turn 30. The maximum loading is 70%. Check out more on the LHC at the Australian Taxation Office.

A waiting period is the time between joining or upgrading your level of cover and when you can start claiming. Waiting periods exist for all services within both hospital and extras covers and apply to:

  • new RACQ Health Insurance memberships
  • additional RACQ Health Insurance members (unless the new RACQ Health Insurance member/s has previously served all waiting periods on equivalent cover with RACQ Health Insurance or another fund)
  • children who are not exempt from waiting periods; newborns, adopted and permanent foster children where the family membership has been in existence for at least two months
  • existing RACQ Health Insurance members who upgrade their cover to a higher level of cover
  • RACQ Health Insurance members who transfer to RACQ Health Insurance from another fund to a higher level of cover than that of their previous fund
  • treatment for a pre-existing condition.

Waiting periods for hospital treatment range from 1 day to 12 months.

  • 1 day waiting period for ambulance cover and treatment resulting from an accident.
  • 12 month waiting period for pregnancy.
  • 12 month waiting period for a pre-existing ailment, illness or condition (except for psychiatric, rehabilitation and palliative care).
  • 2 month waiting for any other hospital treatment.

Waiting periods for extras treatments vary between 2 and 12 months.

  • General Dental - 2 months.
  • Preventative dental - 2 months.
  • Major Dental - 12 months.
  • Orthodontics - 12 months.
  • Optical - 6 months.
  • Physiotherapy - 2 months.
  • Hydrotherapy - 2 months.
  • Myotherapy - 2 months.
  • Exercise Physiology - 2 months.
  • Chiropractic - 2 months.
  • Osteopathy - 2 months.
  • Naturopathy - 2 months.
  • Homeopathy - 2 months.
  • Acupuncture - 2 months.
  • Remedial massage - 2 months.
  • Podiatry - 2 months.
  • Non-PBS Pharmacy - 2 months.
  • Psychology - 2 months.
  • Audiology - 2 months.
  • Eye therapy - 2 months.
  • Speech therapy - 2 months.
  • Antenatal and postnatal - 2 months.
  • Occupational therapy - 2 months.
  • Medically Prescribed Appliances (incl. hearing aids) - 12 months.
  • Orthopaedic appliances - 2 months.
  • Swimming lessons - 2 months.
  • Dietetics - 2 months.
  • Other including: Bowel cancer identification kits (1 every 2 years), Melanoma Surveillance Photography (1 per year) - 2 months.

We've got agreements with hundreds of private hospitals and day surgeries in Australia. To find out whether your hospital is a participating health care provider, call us on 1800 291 029.

If you’re admitted to a hospital that is NOT a participating private hospital you may have to pay higher out-of-pocket fees.

A non-participating hospital is a hospital that has not signed an agreement with the Australian Health Service Alliance (AHSA). If you receive treatment from one of these you may incur large out-of-pocket expenses. Call us on 1800 291 029 or email us at Service@HealthInsurance.racq.com.au to find out if the hospital you want to be treated at is a participating hospital so you can avoid these costs.

A pre-existing condition is a condition - assessed by an appointed medical advisor - that you've had or shown symptoms of within the past six months (before you joined us, or changed your cover).

Find out more on pre-existing conditions in our RACQ Health Insurance Member Guide (PDF, 491KB).

The Federal Government sets a schedule of fees for eligible services provided by doctors in hospital. Medicare pays 75% of these fees and health funds, like RACQ Health Insurance, pay the remaining 25%.

Doctors and providers are not restricted to charging this fee and are able to set their own fees, which can be higher. If your doctor chooses to charge a higher fee there will be a gap between what the government and RACQ Health Insurance will pay. This “gap” can leave you with significant out-of-pocket expenses. If your doctor participates in Access Gap Cover we’ll pay more than the 25% of the schedule fee. This leaves you with drastically reduced, or even eliminated out-of-pocket expenses. The best way to find out if your doctor is registered for Access Gap Cover is to ask them.

RACQ Health Insurance covers you for all clinically necessary ambulance services in Australia. Emergencies are circumstances when immediate hospital treatment is required.

Check with your state ambulance authority to ensure you have the right level of cover for non-emergency ambulance transport within Australia.

A Standard Information Statement (SIS) is a summary of the key product features of your policy. You will receive a link to download a copy of your SIS when you join RACQ Health Insurance and they are available to download from our RACQ Health Insurance Portal.

If you’ve had your current hospital cover policy for less than 12 months you’ll need to contact us by phone on 1800 291 029 or by email at Service@HealthInsurance.racq.com.au before being admitted so we can determine whether any waiting period or pre-existing condition applies.

It can take up to five working days to complete this assessment so make sure you factor this in when you contact us.

If you go ahead with your admission without confirming your entitlements and your condition is considered pre-existing, you’ll pay the outstanding hospital and medical charges not covered by Medicare.

How does RACQ Health Insurance cover work?

When you join us you'll receive a full welcome pack with all you need to make the most of your cover. We’ve got information about RACQ Health Insurance in our RACQ Health Insurance Member Guide (PDF, 491KB) or you can call us on 1800 291 029.

This one's on us. All you need to do is give us the details of your current insurer and we'll take care of the rest.

Your cover starts as soon as we receive your first payment and you can begin claiming as soon as any applicable waiting periods are over.

You can amend your details at any time by logging in to the RACQ Health Insurance Portal and editing your RACQ Health Insurance profile. Alternatively, you can give us a call on 1800 291 029.

This goes for changing your address details, payment details or if you change your name when you get married.

Only the RACQ Health Insurance member, the person whose name the policy is under, and anyone the RACQ Health Insurance member authorises can make changes to your cover.

You can choose to pay via direct credit with a credit card or direct debit via your bank. Each method and its benefits are detailed in our RACQ Health Insurance Member Guide (PDF, 491KB).

Payment cycles are weekly, monthly or annually.

Please call us on 1800 291 029 if you want to change how you pay your premium.

If you’re planning to start or grow your family and your hospital cover doesn’t include pregnancy, you’ll need to upgrade your cover at least 12 months before giving birth to ensure all waiting periods have been served.

Newborn babies aren’t admitted as patients in hospitals unless there are complications or your baby requires medical attention. In this instance your baby will be covered, provided they are added to the policy.

Adding a newborn is easy; you can do this yourself through the RACQ Health Insurance Portal or give us a call and we will add the baby for you.

If your card is lost or stolen you should contact us as soon as possible to avoid fraudulent claims and we'll send you a new one. Whenever you get a new card from us your old one automatically becomes invalid.

RACQ’s range of hospital covers feature an excess to lower premiums by allowing RACQ Health Insurance members to share some of the cost of hospital admissions. The excess is calendar year based. The excess works like this: if RACQ’s full benefit for a hospital stay was $5,000 and your policy has a $500 excess on your hospital cover, the benefit would reduce to $4,500.

On couples, family or single parent cover each person (other than dependants who do not pay an excess) will only have to pay a maximum of $500 excess per calendar year and the excess is also capped at a maximum of $1,000 per calendar year for the policy. An excess is payable for all admissions to hospital.

Child dependant excess:

  • No excess applies for child dependants under 21 on all RACQ Health Insurance levels of cover.

To qualify for benefit payments, these must be custom-made by practitioner podiatrist or orthotist. For an orthosis to be custom made, a plaster cast or mould must be taken. Please note that customising, heat moulding, trimming or adjusting an existing ‘off the shelf’ appliance does not constitute a custom-made appliance.

Orthopaedic appliances attract benefits where the application of which has resulted from, and is required immediately following, the injury or surgery, and a doctor's letter of recommendation is required prior to claiming.

RACQ Health Insurance does not pay benefits for the hire of any health appliance or equipment.

We will, however, fund a percentage of the purchase of the following appliances up to your annual limits, providing you lodge a doctor’s letter of recommendation with your claim:

  • blood glucose monitor
  • extremity pump
  • nebuliser pump
  • sleep apnoea monitor
  • pressure garments
  • RACQ approved orthopaedic appliances
  • non-surgical prostheses
  • TENS monitor.
A benefit replacement rule applies to some items/services covered by RACQ’s extras cover. This means that after you claim for an item, you must wait a specified period before you can lodge another claim for the same type of item. Call our Health Insurance Team on 1800 291 029 to find out which treatments have benefit replacement periods.

You can claim for weight loss programs under our Dietetics Extras cover but only when it has been recommended, in writing, by a doctor for preventing or improving a specific health condition.

Also, the weight loss provider must be a member of the Weight Management Council of Australia and agree to abide by the Weight Management Code of Practice.

Here are some well-known providers that we’re happy to approve:

  • Weight Watchers Australia
  • Jenny Craig Weight Loss Centres Pty Ltd
  • Fernwood Food Coaching.

Please note that we only cover weight loss program fees and will not provide any benefits for meals, groceries or exercise components.

You can only claim extras benefits where treatment is received in person from a recognised health practitioner in Australia. To find out if your practitioner is recognised you can ask your practitioner before you make your appointment or call us on 1800 291 029 (we’re open from 8am to 6pm AEDT).

You cannot claim for treatments you provide to yourself or to members of your family, or business partners and members of their family.

Yes - but only when purchased online from Australian optical and pharmaceutical providers when a script is provided.

For a company to be considered an Australian provider, an ABN needs to be visible on the company’s website.

Benefits for services, treatments and other costs received overseas are excluded and will not receive any benefit.

Family cover provides cover for the RACQ Health Insurance member, their partner and their children including dependant students up to the age of 25. Cover for child dependants ceases once they turn 21, unless they qualify to remain on the policy as a student dependant.

When a child dependant turns 21, they have two months to get their own cover and not have to serve any waiting periods if moving to equivalent or lower cover. Student dependants also have two months from either turning 25 or ceasing to be a student to get their own cover.

Mid-year school, apprenticeship and traineeship leavers who transfer from their parent’s RACQ Health Insurance policy to their own do not need to reserve waiting periods if they transfer to equivalent or lower cover. A letter from their school or registered training group confirming the date of completion is required.

End of year school, apprenticeship and traineeship leavers, are covered until 31 March of the following year and will not have to serve waiting periods if they transfer to an equivalent or lower level of cover.

You can only claim on extras that are specifically included in your cover. Here’s a list of some of the treatments (not all) that aren’t covered:

General

  • Services or treatment for which anyone covered has a right to claim damages or compensation from any other person or body.
  • Treatment where the RACQ Health Insurance member and/or dependant is eligible for free treatment under any Commonwealth or State Government Act.
  • Services or treatment rendered more than two years prior to the date of claiming.
  • Services or treatment not covered by your policy and/or is rendered while the policy is in arrears or is suspended.
  • Services or treatment rendered by a practitioner not in private practice and/ or not recognised by bodies approved by RACQ Health Insurance.

Pharmacy

  • Contraceptive, fertility and IVF drugs available through the Pharmaceutical Benefits Scheme (PBS).
  • Food supplements.
  • Pharmacy items, where they are available over the counter and purchased with or without prescription.
  • Liquid filled Temazepam capsules.
  • Drugs purchased overseas.
  • Mass immunisation, services rendered in the course of the carrying out of a mass immunisation.
  • Pharmaceuticals that are not considered an S4 or S8 drug.

Dental

  • Dental procedures where a limit on the number you can have has been exceeded.
  • Dental procedures unless tooth Identifications (ID) are supplied by the provider.
  • Dental procedures carried out and charged by a dental mechanic, other than an advanced dental technician.
  • A range of dental procedures when provided on the same day for example a filling on a tooth that has been removed. Please contact us for further information relating to these exclusions.
  • A benefit will only be paid for a single crown per tooth every five years.

Foot orthotics

  • Any procedure provided by a physiotherapist or chiropractor.
  • Orthopaedic appliances.
  • RACQ Health Insurance specified and approved orthopaedic appliances purchased for support purposes only.

Pressure garments

  • Pressure garments purchased for reasons other than the treatment of burns, varicose veins, lymphedema or post-operative surgery up to 60 days from hospital discharge only.

For more information please see our RACQ Health Insurance Member Guide (PDF, 491KB).

What’s the claims process?

There are lots of ways to make a claim. You'll just need to make sure you've served all your waiting periods before you start the claims process.

Then, if you have Extras cover, you can simply use your membership card. Alternatively, you can use our RACQ Health Insurance Portal, or even claim by post.

We've detailed the ins and outs in the RACQ Health Insurance Member Guide (PDF, 491KB) (plus some extra process info that may come in handy).

You can see them all online. Simply register to use our RACQ Health Insurance Portal and head to the claims section to look at your history.

It doesn’t happen often, but there are instances where benefits are not paid at all or are paid at a lower level.

These are when:

  • the treatment is not covered under your policy
  • the treatment was not provided by a recognised provider
  • the treatment was not provided in Australia
  • you’ve already claimed the maximum allowable benefits during a specified period
  • you’ve transferred to RACQ from another fund and have already claimed for that treatment
  • it’s been more than two years since the treatment you’re claiming for
  • the health care account has been incorrectly itemised
  • you have an excess to pay on your chosen level of cover
  • the service is subject to a waiting period or another limit
  • you’re claiming for treatments carried out overseas
  • treatment was provided to or from a family member or business associate
  • RACQ believes that you are not receiving acute care after 35 days of continual hospitalisation
  • surgery is performed in hospital by a registered podiatrist/podiatric surgeon
  • no MBS item number is provided by the health practitioner
  • the MBS item is being performed for a cosmetic reason and not medical
  • the treatment was the second treatment performed on you in a day by a single practitioner.

To find out more, we recommend checking out your cover’s detailed terms and conditions published in our Fund Rules. These are available by calling us on 1800 291 029.

How do I make a complaint?

We always want to make sure our policyholders are being treated well and we're happy to have those difficult conversations when they arise. We aim to resolve problems at their first point of contact. To make a complaint, you can:

RACQ Health Insurance
PO Box 4755
Eight Mile Plains  QLD  4113

You can also use any of the methods above to request a copy of our full Complaints Handling policy.

We'll always do our best to resolve any issue you have, but if you’re not happy with our solution you can contact the Commonwealth Ombudsman:

Commonwealth Ombudsman
GPO Box 442
Canberra  ACT  2601

We’re committed to a quick and fair resolution of all complaints so this is what you can expect from us:

  • we’ll acknowledge receipt of complaints within two business days (where they aren’t resolved immediately). This acknowledgment will include a reference number for your records
  • if we are unable to resolve with your complaint we’ll advise you as soon as possible and provide advice on who you can go to next
  • if there are any delays in us responding to you when we say we will, we’ll advise you and provide a reason
  • one of our Customer Service Consultants can’t resolve your complaint problem, then it will be escalated to our Customer Service Manager (or someone with equivalent decision-making authority) and finally to our Chief Health Insurance Officer. If the problem is still unresolved the matter can be taken to the Private Health Insurance Industry Ombudsman.