Yes, we certainly do pay a benefit on a colonoscopy if you hold an eligible level of hospital cover and the applicable waiting period has been served.
What is a colonoscopy?
A colonoscopy is a test that allows your doctor to look at the inner lining of your large intestine (rectum and colon). A colonoscopy may be performed to find the cause of signs and symptoms including:
- Ulcers
- Colon polyps
- Tumors
- Areas of information or bleeding.
Who covers what?
Provided you’re treated as an inpatient at a contracted day facility or hospital you would be entitled to claim a benefit from both HIF and Medicare. You would also be covered at a non-contracted day facility or private hospital, however, you could have large out of pockets to pay.
How much is covered?
Essentially, the benefit that HIF is allowed to pay towards the colonoscopy and any other type of inpatient surgery or procedure is based on the Government’s Medicare Benefit Schedule (MBS). Medicare will pay 75% of the doctors’ fee up to their pre-defined limit, then we would cover the remaining 25% of the MBS. So, any out-of-pocket expenses would depend on how much your specialist is charging for their services.
That’s why, we always advise our members to provide HIF with an itemised medical estimate prior to any treatment. That way, we'll be able to confirm how much you can claim back and ensure any out-of-pockets are kept to a minimum. So you can agree to treatment with informed financial consent, make sure you obtain a medical estimate, simply ask your doctor or specialist prior to proceeding with any treatment.
Alternatively, if you’d like to find more about our AccessGap Cover, which is HIF’s medical gap cover arrangement (designed to minimise or eliminate these out of pocket expenses for medical services whilst an in-patient in a registered overnight hospital or day facility), then visit our AccessGap webpage.
Are there any waiting periods?
We always try to keep waiting periods to an absolute minimum. So, if you join us from another health fund, we’ll take your previous policy into account, so you won’t have to re-serve any waiting periods already served. Continuity in cover will not be offered if the financial date paid to with the previous health insurer is greater than 2 months from the commencement date with HIF.
If you’re new to private health insurance the following waiting periods apply for a colonoscopy:
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