Accident Cover is a commonly misunderstood part of private health insurance. Many people assume it covers any injury or emergency, but Accident Cover is really about how waiting periods apply when hospital treatment is needed because of an accident.
At Phoenix Health, no waiting period applies to hospital treatment that is required as the result of an accident.
This article explains what Accident Cover means, what usually counts as an accident, how waiting periods are affected, and some important things to check before relying on it.
Key Points
- At Phoenix Health, no waiting period applies to hospital treatment required because of an accident.
- Accident Cover can apply even if the treatment is usually excluded on your level of hospital cover.
- Not every injury or medical event is considered an accident under fund rules.
- Accident Cover is different to Accident-Only hospital cover.
What is Accident Cover?
Accident Cover is a feature included in some private health insurance policies that allows members to access private hospital treatment for injuries caused by an accident.
For example, if someone breaks a bone after falling from a ladder or is injured playing sport, Accident Cover allows them to receive treatment as a private patient sooner than they otherwise could.
What counts as an accident?
An accident is an event that causes an injury requiring hospital treatment.
Falls, sporting injuries, cuts and burns are common examples that may be considered an accident under the Fund Rules.
Medical conditions and illnesses are not considered accidents, even when symptoms appear suddenly or require emergency treatment.
For example, back pain that develops over time, a heart condition, or an illness requiring hospital treatment would not be treated as an accident under the Fund Rules.
How does Accident Cover work at Phoenix Health?
At Phoenix Health, no waiting period applies to hospital treatment that is urgently required because of an accident.
Accident Cover can apply even where a member is still serving waiting periods or the treatment would normally be excluded under their level of hospital cover.
Whether Accident Cover applies depends on the circumstances of the injury, the treatment required and the Fund Rules.
What is the difference between Accident Cover and Accident-Only hospital cover?
Accident Cover and Accident-Only hospital cover are related, but they are not the same thing.
Accident Cover refers to how waiting periods are treated when hospital treatment is needed because of an accident.
Accident-Only hospital cover is a type of hospital policy that is designed to provide cover for treatment required as the result of an accident.
What is the difference between Accident Cover and Ambulance Cover?
Accident Cover and Ambulance Cover are separate parts of private health insurance.
Accident Cover relates to hospital treatment that is required because of an accident.
Ambulance Cover helps with the cost of ambulance transport where a member requires immediate medical attention.
Needing an ambulance does not automatically mean Accident Cover applies, and an accident requiring hospital treatment does not always involve an ambulance.
What should you check before relying on Accident Cover?
Accident Cover rules can differ between health funds and hospital policies, so it’s important to understand how your cover works before you need treatment.
Things worth checking include:
- how your fund defines an accident
- whether your policy includes hospital cover
- what treatments and services are included under your policy
- whether any exclusions or restrictions apply
- how your fund assesses accident-related admissions
If you’re unsure how Accident Cover applies to your policy, it’s always worth checking with your health fund before treatment.
Why would someone buy Accident-Only hospital cover?
Accident-Only hospital cover is designed for people who want a lower level of hospital cover that still provides benefits for treatment required because of an accident.
These policies are often chosen by younger members or people looking for a lower-cost entry point into private hospital cover.
Some people also choose this type of cover to avoid paying the Medicare Levy Surcharge or to maintain their Lifetime Health Cover loading status.
Accident-Only hospital cover does not provide the same level of cover as a standard hospital policy and usually excludes treatment that is not related to an accident.
