Additional qualifying periods apply when transferring to tables E2 or E3 from a Smart table for crowns, bridges, etc. Compensation from other sources. Australian Unity benefits are not payable where a member has a right to claim damages, compensation or benefits from any other source. Please contact the Claims Analysis section for advice concerning compensation claims. Extent of Benefits.
Benefits are limited to the insured rate or actual amount charged, whichever is less.
Conditions and benefits apply as at the date of service. Payment of benefits for hospitalisation in excess of 35 days will require medical evidence certifying the need for on-going acute care in hospital to be provided to Australian Unity. Surgical procedures listed on the Government Exclusion List may require medical certification before benefits are payable. Hospitalisation in an Australian Unity agreement hospital is available at the insured rate for 365 days per year subject to medical certification as to the need for on-going acute care or in the case of drug and alcohol or rehabilitation hospital programs, medical certification that progressive gains are being made by the patient as a result of that program. Benefits for purely cosmetic procedures are payable at a reduced level by Australian Unity and may not attract any rebate from Medicare.