Grounded Knowledge Workbench • Member & Patient Reference
Vitalis Health Australia Knowledge Base Coverage (AUD $)
All clinical tiers, Extras annual sub-limits, statutory waiting periods, and rebates below are indexed for Maya.
Inpatient Hospital Cover
Gold, Silver Plus & Bronze Plus Hospital Tiers
- • Gold Comprehensive Hospital ($295 AUD/mth Single | $590 AUD/mth Couple/Family): Covers all 38 Australian Government clinical categories including Pregnancy & Birth (Obstetrics), Assisted Reproductive Services (IVF), Joint Replacements (Hip & Knee), Weight Loss Surgery, Cataracts, Dialysis & Inpatient Psychiatric Care.
- • Silver Plus Assured Hospital ($205 AUD/mth Single | $410 AUD/mth Family): Covers 31 clinical categories including Heart & Vascular System, Oncology (Chemotherapy, Radiotherapy & Immunotherapy), Back, Neck & Spine, Dental Surgery, Plastic & Reconstructive Surgery, and Rehabilitation. Excludes Pregnancy, IVF, Weight Loss Surgery & Hip/Knee Replacements.
- • Bronze Plus Everyday Hospital ($135 AUD/mth Single | $270 AUD/mth Family): Covers 22 essential clinical categories including Bone, Joint & Muscle, Hernia & Appendix, Tonsils, Adenoids & Grommets, Gynaecology, Ear, Nose & Throat, and Digestive System.
- • Hospital Admission Excess & Child Waiver: Members choose a $250, $500, or $750 AUD excess (capped at 1x per Single or 2x per Couple/Family per calendar year). $0 Hospital Excess applies to all child dependents up to age 21 (or up to age 31 for full-time Student Dependents).
Outpatient Allied Health & Dental
Total Extras ($85/mth Single) & HICAPS
- • 100% Back Preventative & General Dental: Unlimited annual limit on routine examinations, scale & cleans, fluoride, X-rays, and simple fillings, including 2 No-Gap check-ups & cleans per member each calendar year at 4,200+ Vitalis Member First dental clinics (75% back at non-network dentists).
- • Major Dental & Orthodontics: Major Dental (crowns, bridges, root canals, wisdom teeth in-chair) up to $1,200 AUD/year. Orthodontics (braces & Invisalign) up to $1,000 AUD/year with a $2,800 AUD lifetime limit per patient.
- • Optical ($300 AUD/yr): 100% back up to $300 AUD per calendar year on prescription frames, lenses, and contact lenses at Specsavers, OPSM, Bailey Nelson & Oscar Wylee.
- • Physio, Psychology, Massage & Pharmacy: Physiotherapy, Chiro & Osteo combined $850 AUD/yr ($62 AUD initial / $50 AUD standard rebate). Clinical Psychology $600 AUD/yr ($95 AUD per consultation). Remedial Massage & Myotherapy $450 AUD/yr ($42 AUD/visit). Non-PBS Prescriptions $400 AUD/yr (up to $60 AUD per script after the $31.60 PBS threshold). Instant on-the-spot HICAPS tap-and-claim via Apple Wallet or Google Wallet.
Continuity of Cover & Emergency
Waiting Periods, Fund Switching & Ambulance
- • Continuity of Cover (Clearance Certificate): Members switching to Vitalis Health from another registered Australian fund (Medibank, Bupa, HCF, NIB, HBF, GMHBA, Teachers Health) within 30 days on an equivalent or lower tier do not re-serve any waiting periods already completed. Vitalis requests your Clearance Certificate automatically.
- • Hospital Waiting Periods & Mental Health Waiver: 0 days for accidents & emergency ambulance; 2 months for standard hospital treatments, rehabilitation, palliative care & inpatient psychiatric care; 12 months for pre-existing conditions (PEC) and Pregnancy & Birth / IVF. Members on Bronze or Silver for 2+ months can use the Australian Government Once-Off Mental Health Waiver to upgrade to Gold for immediate inpatient psychiatric admission without waiting 2 months.
- • Extras Waiting Periods: 0 days for Member First preventative dental check-ups; 2 months for general dental, physiotherapy, chiro, psychology & massage; 6 months for optical; 12 months for major dental & orthodontics.
- • 100% Nationwide Emergency Ambulance: Unlimited cover for road, air & sea emergency ambulance transport and on-the-spot paramedic treatment across all Australian states & territories, plus up to $5,000 AUD/yr non-emergency inter-hospital patient transfers.
Medical Gap & Government Incentives
Access Gap Cover, Hospitals & Tax Rebates
- • 520+ Participating Private Hospitals & Access Gap Cover: Contracted private room & theatre cover across Ramsay Health Care, Healthscope, St Vincent's Health Australia, Epworth, and Mater hospitals. Where treating surgeons and anaesthetists participate in Vitalis Access Gap Cover, Vitalis pays up to 35% above the Medicare Benefits Schedule (MBS) fee so patients experience either $0 No-Gap or a capped Known-Gap of no more than $500 AUD per specialist with prior Informed Financial Consent.
- • Australian Government Rebate & MLS Exemption: Eligible Medicare cardholders receive up to 24.608% rebate (under age 65), 28.710% (ages 65–69), or 32.812% (age 70+) as an upfront premium reduction. Any Vitalis Hospital policy with an excess ≤$750 AUD Single exempts members from the 1.0%–1.5% Medicare Levy Surcharge (MLS) (income threshold >$97,000 AUD Single / >$194,000 AUD Family).
- • LHC Loading & Youth Discount: Avoid the 2% p.a. Lifetime Health Cover (LHC) loading by holding hospital cover before 1 July following your 31st birthday (removed after 10 continuous years). Members aged 18–29 receive an automatic 2% to 10% Youth Discount locked in until age 41.