Programs, Forms & Other Info
A waiting period is an amount of time that you must wait prior to being able to claim benefits on your private health insurance. In some cases, you may need to serve waiting periods before you can claim on your iSelf cover.
- 12-months for pre-existing conditions excluding Hospital Psychiatric services, Rehabilitation, and Palliative care.
- 12-months for pregnancy, birth, and assisted reproductive services.
- 2-months for Hospital Psychiatric services, Rehabilitation and Palliative care (whether or not these are pre-existing conditions)
- 2-months for all other conditions requiring a hospital admission (that are not considered pre-existing), and Hospital care programs.
- 12-months for Major Dental, Orthodontics, Aids to Recovery, and Hearing Aids.
- 6-months for Optical.
- 2-months for all other extras services.
Ambulance services have only a 1-day waiting period, so you’ll have peace of mind from the time of joining.
New to Private Health Insurance? If you are new to private health insurance or have been without cover for more than 30 days when you join iSelf, full waiting periods will apply before you qualify to claim.
Transferring from another fund? When you transfer from another fund, you don’t have to re-serve your waiting periods for equivalent cover. Waiting periods only apply if you are new to private health insurance, when you upgrade your cover, to any exclusions you may have had with a previous fund, or if you haven’t finished serving your waiting periods.
Upgrading your cover? When you upgrade your cover (either as a current iSelf member, or when your transferring to iSelf) waiting periods will apply to any increased benefits, limits and services, including to any upgrade in excess and or co-payments. While waiting periods are being served, benefits will continue to be paid at the previous level of cover, where available. If you downgrade your cover and then decide to upgrade to a higher level of cover again in the future, waiting periods will again apply to any upgrades in cover.
What is a pre-existing condition? The pre-existing rule only applies if you are new to private health insurance or you have upgraded your cover. A pre-existing condition is any ailment that, in the opinion of a Medical Practitioner appointed by iSelf, existed at any point in the 6 months prior to taking out cover. For us to determine whether the condition is pre-existing or not, we may require information from your treating GP and Specialist, that will be assessed by an independent Medical Practitioner appointed by iSelf.
No waits on accident coverage. Where an accident occurs after joining iSelf Hospital cover, we will waive the waiting periods for treatment of that condition.
Medical Gap & Access Gap Cover
When you are hospitalised as a private patient, your admission is billed in two main parts: your hospital accommodation and your medical treatment by your Doctor or Specialist.
When it comes to your medical treatment, Medicare sets a scheduled fee - called the Medicare Benefit Schedule or MBS, for each item number raised by your Doctor or Specialist.
For each item number raised, Medicare pays 75% of the scheduled fee, and iSelf is permitted to pay the remaining 25%. If your Doctor or Specialist charges any amount above the scheduled fee, it is the patient’s responsibility to cover this cost.
Enter the Access Gap Cover provided via your iSelf Policy. Where a Doctor or Specialist participates in Access Gap Cover, iSelf is permitted to pay a benefit towards the amount charged above the scheduled fee - which means that your out-of-pocket costs will be reduced or eliminated! Effective 1st July 2020, the maximum gap a participating Doctor or Specialist will be able to charge is $500.
The Access Gap Cover provided by iSelf currently has agreements with over 36,000 Doctors and, or Specialists who participate in the scheme. However, participation is at the Doctors or Specialists discretion and is on a patient by patient basis, so we always strongly suggest that you ask your Doctor or Specialist whether they will participate for your treatment.
Always remember to contact us prior to your appointment. We can provide you with some questions to ask your Doctor or Specialist, to help you make the best decision for yourself.
Looking for a Doctor or Specialist? Check out our Provider Search.
Going to Hospital
Reducing or removing your out-of-pocket expenses when you go to hospital is what we love to do!
Before you have any treatment, we recommend you ask your Doctor or Specialist the following questions;
- Will they participate in the Access Gap Cover scheme offered by iSelf?
- Will you have any out-of-pocket expenses, and if so, how much? Ask you Doctors or Specialists to explain any costs involved for your hospital admission, any fees or gaps you may be charged, including for anaesthetist and assistant surgeons. If there are any gaps for you to pay, ask for a written cost estimate. This is known as Informed Financial Consent.
- If any assisting Doctors or Specialists will use Access Gap Cover, and if so, how can you obtain a quote for their service?
If you have an upcoming hospitalisation, make sure you contact us as early in the process as you can. This way we can confirm your cover, advise if you have any excess or co-payments to pay the hospital, provide you with information that may be helpful, and even check if you qualify for additional pre or post-hospital services. We can also assist you in completing any paperwork.
At iSelf we are here to help you.
We offer a 30-day cooling-off period on all covers, to ensure that you are satisfied with your decision. If you are a new member and have not made any claims on your membership, you can cancel your membership within the first 30 days at no penalty. All contributions paid will be refunded to you.
If you are an existing member and you change your level of cover, if within the first 30 days you change your mind, provided no claims have been made on your new level of cover, you can change back to your previous level of cover at no penalty.
If a claim has been made within the 30-day cooling-off period, we can either cancel your membership the day after the claim was paid, or you can reimburse us the benefit you received, and we can cancel your membership in full and refund any overpaid contributions.
Direct Debit - paying your membership premiums by setting up a direct debit makes things so easy!
The iSelf Team can help you set up your direct debit by calling us on 1800 467 353 or emailing email@example.com. You can choose to have your premiums deducted weekly, fortnightly, monthly, quarterly, or yearly from your preferred bank account, VISA or Mastercard - how convenient is that!
Alternatively, you can also pay your premiums via;
Online Member Services (“OMS”) - simply log into your OMS portal and pay your account manually by credit card;
BPAY - using our biller code 91025 and quoting your reference number located on your account statement; or
Phone - Call 1800 467 353 and pay over the phone by Credit Card.