For Australian residents and citizens who hold Medicare, private health insurance cannot cover you for outpatient services.
An outpatient is someone who has received medical treatment (services) in a doctor’s surgery or emergency department (as well as X-rays and blood tests). It’s important to note that benefits for outpatient services are only payable by Medicare Australia, unless, of course, you’re an overseas visitor and therefore not eligible for Medicare.
For inpatient services, private health insurance will not cover you for services excluded in your policy and also for services where Medicare does not pay a benefit (e.g. cosmetic surgery not medically necessary).
If you're an overseas visitor and not eligible for Medicare, a benefit towards outpatient services may be provided on our Intermediate Working Visa, Comprehensive Working Visa, and Visitor Saver Non-Working Visa product.
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