Take a look through our frequently asked questions below.
How does myOwn cover work?
What is a Dental Gap Refund?
What is Travel and Accommodation?
Hospital cover helps to cover the cost of treatment you receive in hospital. Each level of myOwn Hospital Cover (from Accident Only to Top) are differentiated by the treatments that are excluded, or that you cannot claim on. For example, cover to be treated in a Private Hospital for pregnancy is only available on our Top Hospital cover.
Why should I take out Hospital cover?
Hospital cover is for when you need to be treated in a hospital. Having Hospital cover means you can be treated in a private hospital and avoid public hospital waiting lists. You get more control over where you're treated, and who treats you.
What's Extras cover - and should I take this out too?
Extras cover is for treatments that do not take place in a hospital like visits to the dentist, physiotherapy or optical services. Extras cover can only be taken with Hospital cover. What's included in your Extras cover will depend on the level of cover you take out, but essentially this type of cover is to help with services and treatments that aren't covered by Medicare.
While we're at it, what's combined cover?
Combined cover is what it says on the tin: when you take out both Hospital and Extras cover. That's why you'll hear the term 'Hospital and Extras' thrown around so much when it comes to health insurance - it's a popular choice.
This rebate on private health insurance sounds good. How do I get it?
Most Australians with private health insurance currently receive a rebate from the Australian Government to help cover the cost of their premiums.
What's the Medicare Levy Surcharge (MLS)?
The MLS is simply an extra tax that people above a certain income threshold have to pay if they don't have eligible private hospital cover. It's calculated in three tiers for singles and couples. You can find out more about that here.
What's Lifetime Health Cover Loading (LHC)?
The Lifetime Health Cover (LHC) loading is a Government loading on your private hospital cover premiums. It was introduced on July 1, 2000 to encourage people to take out private hospital cover earlier. LHC is a 2% loading for every year you don't have hospital cover after you turn 30. The maximum loading is 70%. You can find out more here.
Additional members to a membership (unless the new member/s has previously served all waiting periods on equivalent cover with myOwn or another fund) except for newborns, adopted and permanent foster children where the family membership has been in existence for at least two months.
Waiting periods for Hospital treatment range from 1 day to 12 months.
a 2 month waiting for any other hospital treatment.
What's a participating private hospital or day surgery?
We've got agreements with hundreds of private hospitals and day surgeries in Australia - that's what we're talking about when we say participating private hospital. To find out whether your hospital is a participating call us on 1300 300 338. If you're admitted to a private hospital that's not on our list you may have to pay higher out-of-pocket fees.
myOwn is a member of the Australian Health Services Alliance (AHSA). A non-participating hospital is a hospital that has not signed an agreement with the AHSA. If you receive treatment from one of these you may incur large out-of-pocket expenses. Call us on 1300 300 338 or email us at service@myown.com.au to find out if the hospital you want to be treated at is a participating hospital so you can avoid these costs.
This affects your cover quite a bit, and there's more on this in our member guide. A pre-existing condition is a condition - assessed by one of our medical practitioners - that you've had or shown symptoms of within the past six months (before you joined us, or changed your cover).
The Federal Government sets a schedule of fees for eligible services provided by Doctors to inpatients in hospital. Medicare pays 75% of these fees and health funds like myOwn pay the remaining 25%. Doctors and providers are not restricted to charging this fee and are able to set their own fees, which can be higher than the scheduled fees. If your doctor chooses to charge a higher fee there will be a gap between what the Government and myOwn will pay. This is the “Gap” and can leave you with significant out of pocket expenses, unless your doctor participates in myOwn’s Access Gap Cover where we’ll pay even more than the 25% of the schedule fee – leaving you with drastically reduced, or even eliminated out-of-pocket expenses. The best way to find out if your doctor is registered for Access Gap Cover is to ask them.
Does my cover include ambulance cover?
myOwn covers you for all clinically necessary ambulance services for emergencies in Australia. Emergencies are circumstances when immediate hospital treatment is required for a serious and acute injury or condition where the viability or function of an organs or body part is threatened. Check with your state Ambulance authority to ensure you have the right level of cover for non-emergency ambulance transport within Australia.
What are Standard Information Statements?
I'm a member. Where can I find my policy details?
Click on 'Member Login' from the header.
Log into the Member Portal.
Select 'Correspondence' from the left hand side menu.
Underneath this, select 'All Correspondence'.
Under 'Subject Area', click on [+] next to 'General Messages'.
Scroll down to the earliest message, find the message titled "Welcome to myOwn".
Under 'View', find links to view/download your Standard Information Statement and relevant policy fact sheet.
When should I let you know I'm going to hospital?
If you have less than 12 months membership on your current hospital cover, you’ll need to contact us by phone on 1300 300 338 or by email at service@myown.com.au before being admitted so we can determine whether the waiting period for pre-existing conditions applies.
It can take up to five working days to complete this assessment, so make sure you factor this in when you book your stay. If you go ahead with your admission without confirming your entitlements and we subsequently determine your condition to be pre-existing, you’ll have to pay all outstanding hospital and medical charges not covered by Medicare.
‘Known Gap’ Your doctor participates in Gap Cover and charges you a reduced out-of-pocket for the treatment you receive as an inpatient and you will be aware the costs before surgery.
Just remember to check with your doctor before agreeing to any treatment.
I think I have to switch health insurers. How do I do this?
This one's on us. All you need to do is give us the details of your current insurer and we'll take care of the rest.
Your cover starts as soon as we receive your first payment and you can begin claiming as soon as any applicable waiting periods are over.
You can amend your details at any time by logging in to the member's portal and editing your myOwn profile. Alternatively, you can give us a call on 1300 300 338. This goes for changing your address details, payment details or if you change your name when you get married.
Who can make changes to my cover?
Only the member - the person whose name the policy is under - and anyone the members authorises can make changes to your cover.
What happens if I need to go to hospital?
We recommend you contact us prior to your admission to find out if the hospital you are to be admitted to is on our participating hospital list and to confirm that you have the right level of cover for the treatment you are seeking. If the hospital you are admitted to isn’t one of our participating hospitals, you may not be covered in full for your accommodation or theatre costs. Contacting us first means you will know what types of benefits you will receive and what your out out-of of-pocket costs will be.
When you are admitted to hospital, the hospital will ask if you have private health insurance and will check your eligibility with us. All myOwn hospital covers includes an excess cost to help lower your premium and it is when you are admitted to hospital that you will be asked to pay this excess.
You can choose to pay via direct credit with a credit card or direct debit via your bank. Each method and its benefits are detailed in our member guide. Payment cycles are weekly, monthly or annually. Please call us on 1300 300 338 if you want to change how you pay your premium.
What happens if we're planning to have a baby?
If you’re planning to start or grow your family and your hospital cover doesn’t include pregnancy, you’ll have to upgrade your cover at least 12 months before giving birth to ensure all waiting periods have been served. Newborn babies aren’t admitted as patients in hospitals unless there are complications or your baby requires medical attention. In these instances your baby will be covered provided they are added to the policy. Adding a newborn is easy; you can do this yourself through the membership portal or give us a call and we will add the baby for you.
How can I get a new member card?
If your card is lost or stolen you should contact us as soon as possible to avoid fraudulent claims and we'll send you a brand new one. Remember, whenever you get a new card from us, your old one automatically becomes invalid so throw it away to avoid any confusion.
All of our hospital covers have a $500 excess option, and we also offer a $750 excess on all hospital covers except for Basic Hospital. A higher excess will reduce your premium. A lower excess means you’ll pay less on admission to hospital, but your premium will be higher.
How do I get a 100% refund on my hospital excess?
Where your policy includes an Excess Refund, it means that if you hold this policy or another eligible policy for at least 6 months and hold Silver AIA Vitality status or higher, myOwn will refund 100% of your hospital excess.
You will need to pay your excess when you’re admitted to hospital and then you can claim this amount back. See your Member Guide for more details.
Can I claim on orthotic and orthopaedic appliances?
To qualify for benefit payments, these must be custom-made by practitioner podiatrist or orthotist. For an orthosis to be custom made, a plaster cast or mould must be taken. Please note that customising, heat moulding, trimming or adjusting an existing ‘off the shelf’ appliance does not constitute a custom-made appliance. Orthopaedic appliances attract benefits where the application of which has resulted from, and is required immediately following, the injury or surgery, and a doctor's letter of recommendation is required prior to claiming.
Am I covered for health appliances?
What are benefit replacement periods?
A benefit replacement rule applies to some items/services covered by myOwn’s extras cover. This means that after you claim for an item, you must wait a specified period before you can lodge another claim for the same type of item. Call our Member Service Team on 1300 300 338 to find out which treatments have benefit replacement periods.
Can I claim for weight loss programs?
You can claim for weight loss programs under our Dietetics Extras cover but only when it has been recommended, in writing, by a doctor for preventing or improving a specific health condition. Also, the weight loss provider must be a member of the Weight Management Council of Australia and agree to abide by the Weight Management Code of Practice.
Please note that we only cover weight loss program fees and will not provide any benefits for meals, groceries or exercise components.
Where can I find recognised Extras providers?
You can only claim extras benefits where treatment is received in person from a recognized health practitioner, received in Australia. To find out if your practitioner is recognised you can ask your practitioner before you make your appointment or call us on 1300 300 338 (we’re open from 8am to 6pm AEDT). You cannot claim for treatments you provide to yourself or to members of our family or business partners and members of their family.
Can I claim for Extras purchased over the internet?
Yes - but only when purchased online from Australian optical and pharmaceutical providers when a script is provided. For a company to be considered an Australian provider, an ABN needs to be visible on the company’s website. Benefits for services, treatments and other costs received overseas are excluded and will not receive any benefit.
I have adult children who are still studying - are they covered by my family policy?
Family cover provides cover for the member, their partner and their children including dependant students up to the age of 25. Cover for child dependants ceases once they turn 21, unless they qualify to remain on the policy as a student dependant. When a child dependant turns 21, they have two months to get their own cover and not have to serve any waiting periods if moving to equivalent or lower cover. Student dependants also have two months from either turning 25 or ceasing to be a student to get their own cover. For mid-year school, apprenticeship and traineeship leavers who transfer from their parent’s myOwn policy within two months of leaving school or finishing an eligible apprenticeship or traineeship through a registered training group will not have to serve waiting periods if they transfer to an equivalent or lower level of cover. A letter from their school or registered training group confirming the date of completion is required.For end of year school, apprenticeship and traineeship leavers, they are covered until 31 March of the following year and will not have to serve waiting periods if they transfer to an equivalent or lower level of cover.
Are there some Extras I can't claim for?
Services or treatment rendered by a practitioner not in private practice and/ or not recognised by bodies approved by myOwn Health Insurance.
Pharmacy items, where they are available over the counter and purchased with or without prescription.
Mass immunization, services rendered in the course of the carrying out of a mass immunization.
myOwn specified and approved orthopaedic appliances purchased for support purposes only.
Pressure garments purchased for reasons other than the treatment of burns, varicose veins, lymphedema or post-operative surgery up to 60 days from hospital discharge only.
For more information please see our member guide.
When you join us you'll receive a full welcome pack with all you need to make the most of your cover. If you can't see what you're looking for above, take a look at our member guide or call us on 1300 300 338.
There are lots of ways to make a claim. You'll just need to make sure you've served all your waiting periods before you start the claims process. Then, if you have Extras cover, you can simply use your membership card. Alternatively, you can use our member's portal, or even claim by post. We've detailed the ins and outs in the member guide (plus some extra process info that may come in handy).
Where can I see the claims I've made?
You can see them all online. Simply register to use our member's portal and head to the claims section to look at your history.
Why wasn't my claim paid?
To find out more, we recommend checking out your cover’s detailed terms and conditions published in our Fund Rules. These are available by calling us on 1300 300 338.
Tell me more about AIA Vitality?
We thought you'd never ask. AIA Vitality is what makes us different. For all the details on how the program can boost your wellbeing and make sure you maintain a level of good health, head to the AIA Vitality site.
Phone us on 1300 300 338, Monday to Friday between 8am and 6pm AEST.
You can also use any of the methods above to request a copy of our full Complaints Handling policy.
If one of our Member Service Consultants can’t resolve your problem, then it will be escalated to our Member Service Manager (or someone with equivalent decision-making authority) and finally to our Chief Health Insurance Officer. If the problem is still unresolved the matter can be taken to the Private Health Insurance Industry Ombudsman.
What are the Private Health Insurance health reforms?
The Australian Government has introduced a range of changes to how private health insurance operates to make it simpler and more affordable. The main changes are: the introduction of Gold, Silver, Bronze and Basic levels of cover; standard clinical definitions of what is included in your cover; higher excess options to make your premium lower; the exclusion of some natural therapies from cover and the option to offer a discount of up to 10% for people who are aged 18-29. These changes will make it easier to compare cover across different health funds and in some cases make cover more affordable.
Why has the name of my product changed (new product tiers)?
One of the recent reforms that Australian Government made to health insurance is for all covers to be grouped into tiers: Gold, Silver, Bronze and Basic. The tier the cover is in must be included in its name, which is why our product names are changing. This means that is now easier for you to compare covers across different health funds as all Gold covers (for example) must meet a minimum set of requirements.
Why has the name of services changed (clinical definitions)?
One of the recent reforms that Australian Government made to health insurance is standardise the clinical definitions used to describe the services that are included or excluded from a cover. Because this will be uniform across all health funds, it'll be easier for you to know what is and isn't included in your cover and compare this across different health funds.
Where your policy includes a Dental Gap Refund, it means that if you have served your general dental waiting periods and hold AIA Vitality Silver status or above, myOwn will refund 100% of your dental gap payment on eligible preventative dental treatments. You will need to pay your provider at the time of service. After validating your eligibility, myOwn will reimburse any gap payment made on the eligible claim. To be eligible for this you must hold AIA Vitality Silver status or above at the time of service. There is nothing more for you to do. myOwn will make a direct deposit into the nominated bank account on your membership.
If you are making a manual (non-HICAPS) dental claim, you will still need to make the claim, but you won’t need to do anything different to how you claim today to receive the refund. We will process all refunds within five business days of receiving the claim.
What does ‘preventative dental treatment’ mean?
Preventative dental treatments refer to the following dental treatments: comprehensive oral examinations, periodic oral examinations, removal of plaque or stains, removal of calculus (first and subsequent visit) and the provision of a mouthguard.
Which preventative dental treatments are eligible?
151 (Provision of a mouthguard).
Dental Gap Refund cannot be used where the service limit for preventative dental has already been reached.
Are my children covered for the Dental Gap Refund?
Yes – provided you are on an eligible policy and at least one of the adult members on the policy have attained AIA Vitality Silver status or above.
We will process Dental Gap Refunds within five business days of receiving your claim – whether that is lodged through HICAPS at your dentist or through you lodging an eligible claim with us. The refund will be paid as a Direct Debit to your nominated bank account.
I have Silver AIA Vitality status, but my partner doesn’t – are they eligible for Dental Gap Refund?
No. To be eligible for Dental Gap Refund the person the claim is for must have AIA Vitality Silver status or above. (Dependents on a family policy will have access to Dental Gap Refund when at least one policy holder or partner/ spouse achieves AIA Vitality Silver status or above.).
What does Travel and Accommodation cover me for?
Where your policy includes a travel and accommodation benefit this can be used to claim towards the travel and accommodation costs of either yourself or a carer (if applicable) while you’re in hospital.
Benefits are only eligible where the round trip is at least 200km within Australia. Benefits are capped at $50 per day for accommodation and 15 cents/km for travel for you and your carer.