Emergency Services Health Review
Overview
Emergency Services Health is a restricted, not-for-profit health fund for employees and volunteers in the emergency services, such as ambulance workers, fire-fighters, state emergency personnel, and medical and water response and recovery staff and their families.
The fund was established by Police Health for Australia’s first responders after many requests to extend their membership to emergency services personnel.
Emergency Services Health is the only insurance provider in Australia to offer a rollover on most of their unclaimed Extras.
Emergency Services Health Key Facts
Founded: 2017
For-Profit or Not-For-Profit? Not-For-Profit
Private Hospital Agreements Nationwide: 282
Day Hospital Agreements Nationwide: 267
Health Deal Represented? No
Headquarters: Adelaide, SA
Emergency Services Health Hospital Cover
Emergency Services Health offers one specialized Hospital Cover. This policy has no benefit limitation periods or exclusions and covers treatments where Medicare pays a benefit.
- Gold Hospital
Emergency Services Health Extras Cover
Extras Cover takes care of the everyday healthcare service expenses that are not generally covered under Medicare such as dental services, prescription glasses, and physiotherapy.
Emergency Services Health offers a Rollover Benefit; this means members can carry over unused annual maximum benefits not claimed in the previous year to the next.
Here is the current extras cover available:
- Rolling Extras
Emergency Services Health Combined Cover
Emergency Services currently offer one combined cover and this is:
- Gold Combined
Emergency Services Health Waiting Periods
ESH recognises the waiting periods you have already served with a previous health fund if you switch, this is called “portability”. For first-timers taking out a hospital cover, members who may have lapsed in hospital coverage and those upgrading their level of cover, the waiting periods below will have to be served before members can claim on services:
Hospital Waiting Periods
- Ambulance services: 1 Day
- Accidental Injury: None
- New Conditions: 2 Months
- Pregnancy and birth-related services: 12 months
- Pre-existing conditions: 12 months
- Rehabilitation & Palliative care: 2 months
- Weight Loss Surgery: 12 months
How Do You Claim Extras With Emergency Services Health?
Claiming extras with ESH is a quick and easy process. Here are the 5 ways to claim:
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Via a mobile app: You can lodge a claim by uploading a photo of your receipt using the Emergency Services Health Mobile Claiming
Online: You can log into their website and lodge your claim by providing the details on your receipt.
Fax: Lodge your claim by attaching a completed Emergency Services Health claim form and attaching the relevant receipts to and fax to 1300 151 152
Mail: Post a completed form along with the relevant receipts to
Emergency Services Health,
Reply Paid 84966,
Halifax St SA 5000
Emergency Services Health Gap Cover
ESH gap cover is called Access Gap Cover. If your doctor charges you more than the standard MBS fee, this is known as the ‘gap’ and can leave you with an out-of-pocket expense. Access Gap can help to minimise or eliminate personal expense but it is the choice of the physician to participate in any given gap scheme.
Gap Cover Ratings By State
To determine how beneficial a gap scheme will be, we suggest comparing health funds in the same state or territory to show which of the funds offer a greater proportion of medical services covered with no gap. While it is more likely that a medical service covered under your health fund can be utilized at no personal cost to you, it is entirely the choice of the physician whether or not to participate in the gap cover scheme.
Medical Services with No Gaps — the percentage of claims that were fully refunded.
Medical Services with No or Known Gaps — the percentage of claims that were fully refunded, or where the policy holder knew the cost before the surgery was performed.
The information below outlines the percentages of services covered under no-gap and known-gap.
Emergency Services medical services with No Gap: 100%
Industry Average: 79.1%
Emergency Services medical services with No or Known Gap: 100%
Industry Average: 90.5%
Emergency Services medical services with No Gap: 88.8%
Industry Average: 89.5%
Emergency Services medical services with No or Known Gap: 96%
Industry Average: 95.7%
Emergency Services medical services with No Gap: 93%
Industry Average: 86.7%
Emergency Services medical services with No or Known Gap: 98.1%
Industry Average: 95.1%
Emergency Services medical services with No Gap: 91.5%
Industry Average: 89.2%
Emergency Services medical services with No or Known Gap: 96.2%
Industry Average: 94.5%
Emergency Services medical services with No Gap: 89.4%
Industry Average: 89.5%
Emergency Services medical services with No or Known Gap: 100%
Industry Average: 96.6%
Emergency Services medical services with No Gap: 81.5%
Industry Average: 84.4%
Emergency Services medical services with No or Known Gap: 100%
Industry Average: 96.2%
Emergency Services medical services with No Gap: 66.7%
Industry Average: 90.2%
Emergency Services medical services with No or Known Gap: 100%
Industry Average: 96.7%
Emergency Services medical services with No Gap: 54.2%
Industry Average: 84.2%
Emergency Services medical services with No or Known Gap: 79.2%
Industry Average: 93.8%
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