Frank Health Insurance

Product Summary

Below is a product summary only, Frank thinks you should probably check out the product detail for all the particulars.

Frank's Best Hospital cover won a 'Best Buy' in the Full Cover, up to $1,000 excess category of a report by Australia's leading independent consumer magazine. Yay! Read more >

Some people want the works. They want total peace of mind. That means coverage for all treatment types and cushy private privileges.

Frank has just the thing.

What’s covered and what’s not

• Hospital Accommodation (shared or single room) in a public or private hospital
• Accidents
• Cardiac surgery and coronary care
• Cataract surgery
• Delivery suite
• Eye surgery
• Gastric banding and all obesity surgeries
• Intensive care
• IVF and related services
• Joint reconstruction
• Joint replacement
• Medical gap (up to the Medical Benefits Schedule fee and 20% more if your doctor is part of Frank's medical gap cover scheme. There's more about this in the FrankView video)
• Nursing home type patients
• Obstetrics
• Palliative care
• Psychiatric care
• Rehabilitation
• Renal dialysis
• Same day treatment
• Surgically implanted prostheses
• Theatre
• Other agreed charges

• Cosmetic surgery

Want to know more? See Product Detail for all the particulars.

Excess

Excess is the fee you pay in return for lower premiums.

The most you'll pay for excess each calendar year is:

• $500 for Singles
• $1,000 for Couples and Families

If one person from a Couple or Family membership goes to hospital, they will have a maximum excess of $500. It's only when more than one person from the membership is hospitalised that the maximum excess is $1,000.

Waiting Periods

No one likes waiting. Including Frank. So if you’re transferring from another fund, you’ll be fully covered from the moment you sign up. You just need to:

• Transfer to an equal or lower level of Frank cover within 30 days, and
• Provide a transfer certificate and claims history from your previous health fund within 14 days, and
• Have served all waiting periods with that fund

Otherwise, you’ll have to wait:

• 24 months - Benefit Limitation Periods apply to gastric banding and all obesity surgeries, psychiatric or renal dialysis (that means you’re covered but for public hospital benefits in a shared room after your other waiting periods have been served)
• 12 months - pre-existing conditions (except psychiatric, rehab or palliative care)
• 12 months - obstetrics and maternity care
• 2 months - psychiatric, rehab or palliative care
• 2 months - all other hospital treatment
• 0 months - accidents (bodily injuries that happen the day after you join or upgrade to a higher level of cover)

Want to know more? See Product Detail for all the particulars.

Product Detail

Below is the product details with all the particulars.

Here they are – the details. No nasty surprises. No hidden agendas. Just everything you need to know.

Click on a topic below or scroll down for more information.

What’s covered
What’s not covered
Waiting periods
Excess
Hospitals

Too much information? See Product Summary for the basics.

What’s covered

Frank's Best Hospital cover will cover you for:

• Hospital Accommodation (shared or single room) in a public or private hospital
• Accidents (ones that need a hospital not a bandaid)
• Cardiac surgery and coronary care (problems with your heart)
• Cataract surgery
• Delivery suite (for babies, not packages)
• Eye surgery
• Gastric banding and all obesity surgeries (for weight loss)
• Intensive care (1-on-1 care 24/7)
• IVF and related services
• Joint reconstruction (e.g. knee)
• Joint replacement (e.g. hip)
• Medical Gap (Frank will pay up to the Medical Benefits Schedule fee and 20% more if your doctor is a part of Frank’s medical gap cover scheme. There's more about this in the FrankView video)
• Nursing home type patients (who don’t need medical care, but still need to be looked after in hospital)
• Obstetrics (childbirth services)
• Palliative care (e.g. caring for a cancer patient)
• Psychiatric care (mental health care)
• Rehabilitation (e.g. for drug problems or accident recovery)
• Renal dialysis (for kidney disorders)
• Same day treatment (when you’re in and out of surgery on the same day)
• Surgically implanted prostheses (Government prescribed benefits)
• Theatre (surgery costs, not Shakespeare)
• Other agreed charges - additional costs that come from your hospital stay (but not phone or TV, for example)

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What’s not covered

You don’t want to pay for what you don’t use, so Best Hospital doesn’t cover:

• Cosmetic surgery (unless it’s medically necessary and your doctor provides a Medicare item number)

And in general:

• If you can claim damages or compensation from someone else, you can’t claim it from Frank.
• You can’t claim on treatment you can get free from the government, e.g. a traditional bulk billing GP visit or public hospital emergency department episode, as Medicare covers those.
• You can’t claim on treatment you had over 1 year ago.
• You can’t claim on stuff that isn’t covered by your membership. Pretty obvious, really.
• If you’re not paying Frank, Frank won’t pay you. So if you suspend your membership or don’t pay your fees, you can’t claim on treatment you get during that time.
• If you hire equipment (like crutches or an oxygen tent) Frank won’t pay for it. Unless Frank tells you otherwise.
• If you’re related to the person who treated you, or in the same family, you can’t claim for that treatment. The same goes if you and your provider are business partners. Or if you’re in the business partner’s family.
  When Frank says ‘family’ Frank means wife, husband, unmarried partner, sibling, kids, parents, grandparents, grandkids, cousins, nephews, nieces... If you’re unsure, check with Frank.
• You’re not covered for any treatment you have overseas. But Frank hopes you have a nice trip.
• If you’re given drugs in hospital, there are limits on how much Frank will pay for them. And Frank won’t pay at all if you buy them outside of the hospital (like from a chemist).
  For more information on these limits, contact Frank.
• Whoever treats you needs to be actually working in a private practice, for a registered hospital or for an organisation recognised by Frank. If not, Frank won’t cover the claim.
• If your doctor works at a public hospital, Frank will only pay the schedule fee for any treatment they give you. If the total fee is more than the schedule fee you will have to pay the gap amount.
• You can’t make a profit out of your insurance. So Frank won’t pay more than you were charged for a treatment. And if you’re claiming the same treatment from someone else too, it will affect how much Frank gives you.

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Waiting periods

Waiting periods are important - they stop people from taking advantage of Frank’s generous nature.

The standard waiting periods for Frank Hospital are:

• 24 months - Benefit Limitation Periods apply to gastric banding and all obesity surgeries, psychiatric or renal dialysis (that means you’re covered but for public hospital benefits in a shared room after your other waiting periods have been served)
• 12 months - pre-existing conditions (except psychiatric, rehab or palliative care)
• 12 months - obstetrics and maternity care
• 2 months - psychiatric, rehab or palliative care
• 2 months - any other hospital treatment
• 0 months - accidents (bodily injuries that happen the day after you join or upgrade to a higher level of cover)

Transferring from another health insurer or Frank cover?

For treatment that wasn’t covered by your old cover
You’ll need to wait the standard waiting periods listed above.

For treatment that was covered by your old cover (see Note)
If you’ve already completed the waiting periods for that treatment, you’ll be covered from day one of your new cover.

Otherwise, you’ll have to wait the remainder of any waiting period for that benefit. This includes pre-existing conditions.

E.g. If you have done 9 months of a 12 month waiting period with your old cover, you’ll have to wait 3 months with your new cover.

Note
If your new Frank cover has higher benefits than your old cover, you’ll have to serve the standard waiting periods to receive those higher benefits. You’ll be covered for your old (lower) benefits during that time though.

Adding another person to your Frank membership?

The new person will have to wait the standard waiting periods listed above. Unless:

• They are your newborn baby
• They are your adopted or permanent foster child
• They have already served the waiting periods with Frank or another fund (at an equal or higher benefit level)

In these cases, Frank will fully cover the new person from day one.

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Excess

If you’re sent to hospital, you will need to pay an excess. This is a fee that you pay in return for lower membership costs.

The most you’ll have to pay for excess each year is:

• $500 for Singles
• $1000 for Couples and Families.

If one person from a Couple or Family cover goes to hospital, they will have a maximum excess of $500. It’s only when more than one person from the cover is hospitalised that the maximum excess is $1000.

Some points worth noting:

• If you’ve paid the maximum excess in a year, you won’t have to pay it again that year. No matter how many times you may be sent to hospital.
• If you aren’t admitted to hospital you don’t have to pay an excess.
• When Frank says ‘year’ Frank means calendar year (Jan 1 to Dec 31).

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Hospitals

Private Hospitals

Best Hospital covers you for treatment in participating private hospitals.

You won’t be covered for anything listed under What’s not covered. Obviously.

Non-participating private hospitals
For private hospitals that aren’t on the participating hospitals list, there are limited benefits with Frank. That means if there is a difference between what the hospital charges and what Frank covers, you’ll have to pay.

Public hospitals

Best Hospital also covers you for treatment in public hospitals. You’ll be treated as a private patient.

It goes without saying that you won’t be covered for anything listed under What's not covered.

Shared or single room?

Best Hospital covers you for both shared and single rooms in public and participating private hospitals. If a single room is available, you’ll be entitled to that. If not, you’ll have to share.

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