Onemedifund Review
Overview
Onemedifund was established in 2007 as the private health insurance brand of the National Health Benefits Australia Pty Ltd.
Onemedifund Key Facts
Founded: 2007
For-Profit or Not-For-Profit?: Not-For-Profit
Private Hospital Agreements Nationwide: 285
Day Hospital Agreements Nationwide: 274
Headquarters: Wollongong, NSW
Health Deal Represented?: No
Onemedifund Hospital Cover
National Health Benefits has 1 hospital policy that covers all the services under the MBS clinical category. This policy is called:
- Gold Hospital
Onemedifund Extras Cover
Extras cover takes care of the everyday medical services that are not generally covered under Medicare. These are services like seeing a chiropractor for a sore back or getting a new pair of prescription glasses. National Health has 2 extras covers and these can only be purchased together with their hospital cover. These are the extras cover currently available:
- Extras
- Economy Extras
Onemedifund Wait Periods
Onemedifund 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:
Onemedifund Hospital Wait Periods
- 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 to Claim Extras with Onemedifund?
NHBA have 5 quick and easy claiming options. These are:
On the spot: Swipe your membership card at a health provider that uses the HICAPS system to have your claim processed immediately.
Online: You can register yourself on their website and lodge your claim by providing the details on your receipt.
Fax: claim by faxing a completed claim form and your scanned receipts to 1300 673 406
By Mail: You can lodge your claim by posting relevant accounts and receipts to: Locked bag 25, Wollongong NSW, 2500
Onemedifund Gap Cover
National Health’s gap cover is called the 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 specific gap scheme.
Onemedifund: Gap Cover Ratings By State
You can gauge how efficient a gap scheme is by comparing health funds in the same state or territory and determining which of the fund offers a greater proportion of medical services covered at no gap. While it is more likely that a medical service covered under your fund can be utilised at no personal cost to the customer, it is entirely the choice of the physician whether or not to participate in the gap 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.
Onemedifund Medical Services with No Gap: 56.5%
Industry Average 79.1%
Onemedifund Medical Services with No or Known Gap: 100%
Industry Average: 90.5%
Onemedifund Medical Services with No Gap: 89.6%
Industry Average: 89.5%
Onemedifund Medical Services with No or Known Gaps: 96.3%
Industry Average: 95.7%
Onemedifund medical services with No Gap: 92.7%
Industry Average: 86.7%
Onemedifund medical services with No or Known Gap: 99.0%
Industry Average: 95.1%
Onemedifund medical services with No Gap: 94.5%
Industry Average: 89.2%
Onemedifund medical services with No or No or Known Gap: 98.4%
Industry Average: 94.5%
Onemedifund medical services with No Gap: 90.7%
Industry Average: 89.5%
Onemedifund medical services with No or Known Gap: 99.5%
Industry Average: 96.6%
Onemedifund medical services with No Gap: 82.7%
Industry Average: 84.4%
Onemedifund medical services with No or Known Gap: 94.2%
Industry Average: 96.2%
Onemedifund Medical Services with No Gap: 92.3%
Industry Average: 90.2%
Onemedifund Medical services with No or Known Gap: 99.0%
Industry Average: 96.7%
Onemedifund Medical Services with No Gap: -%
Industry Average: 84.2%
Onemedifund Medical Services with No or Known gap: -%
Industry Average: 93.8%
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