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What are out-of-pocket expenses?

Out-of-pocket expenses are the additional costs you'll pay for a treatment or service, once all of the Medicare and private health insurance benefits have been expended. Usually, out-of-pocket expenses apply when you’re not fully covered for a particular treatment or service, or when a set benefit limit applies. For example, say you picked a pair of $700 Prada glasses, and your policy covers $210 per Membership Year, your out-of-pocket expenses will be $490 for that pair of glasses.

For extras services, we publish many of the benefits payable for the services covered by your policy here on our website, but you can also contact us to find out how much we'll cover.

To find out how much is payable on dental services, we recommend getting a quote from your dentist first and the item number that applies to each service so we can accurately let you know how much will be covered.

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What is Extras cover?

Extras cover pays benefits on a number of private health services, like dental, optical, podiatry, physio etc that aren't covered by Medicare.

We offer four levels of Extras cover. Premium and Essential Extras pay benefits on the biggest range of treatments and therapies, while Select Extras and Young Extras are more tailored to services you might use most frequently.

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What is ancillary cover?

Ancillary cover is another term for Extras cover.

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What is a waiting period?

Waiting periods are exactly what their name suggests; the length of time a policy holder needs to wait before being able to make claims on services.

They apply when you join any health fund for the very first time, or when you upgrade to a higher level of cover.

Waiting periods are designed to keep health cover fair for everyone, by protecting the fund and Members against people who join intentionally to make big claims, and then cancel their membership.

If you're transferring from another fund and take out an equivalent level of cover, or if you've previously been covered by your parents' membership, we recognise that you've already served the waiting periods, so you can claim straight away. If you upgrade to a higher level of cover when you switch, you'll only need to serve the waiting period on the increased benefits.

Our table below outlines the waiting periods that apply to hospital and extras:


2 month waiting period appliesHospital

  • For all hospital treatments or services where there are no pre-existing conditions (excluding accidental injury ^)
  • Approved psychiatric services
  • Approved rehabilitation treatment e.g. inpatient, rehabilitation, stroke recovery, cardiac rehabilitation
  • Palliative care


  • Dental
    • Diagnostic – includes examinations & consultations
    • Preventative – includes cleaning and scaling, fluoride treatment etc.
    • Simple extraction
    • Restorative – composite and amalgam fillings
    • General services – includes mouth guards and occlusal splints
  • Optical
  • Acupuncture
  • Audiology
  • Chiropractor
  • Remedial massage therapy and myotherapy
  • Osteopathy
  • Dietitian
  • Chinese Medicine
  • Occupational therapy
  • Orthoptic therapy
  • Physiotherapy
  • Exercise physiology
  • Podiatry
  • Psychology
  • Speech therapy
  • Healthy Living benefits
  • Foot orthoses and orthopaedic shoes
  • Pharmaceuticals
  • School accidents

12 month waiting period appliesHospital

  • Pre-existing conditions
  • Pregnancy and birth
  • Mechanical Aids and Appliances
  • Surgery for assisted fertility programs such as IVF or GIFT, sterilisation or vasectomy
  • Mammograms and bone density tests
  • Hearing aids


  • Major dental services
    • Periodontics – specialised gum treatment
    • Surgical extraction – includes wisdom tooth extraction
    • Endodontic services – includes root canal therapy
    • Crowns and bridges
    • Prosthodontics – dentures
    • Orthodontics – braces etc.
  • Child birth education

^ Two month waiting periods apply for most other items or services. Cover for an accident is immediate provided it is not recoverable from another source such as Workers Compensation, third party or other liability provision. Sporting accidents sustained by sportspeople in activities relating to their fulltime employment as a sporting professional, including training and competition have a two month waiting period.

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What benefits do you pay for hearing aids?

Hearing aids are covered on our Better Hospital (Silver+) product. A benefit amount is provided to use over a period of three (3) Membership years based on the date on which the purchase of a hearing aid/s is made. The benefit limit is applied based on your length of membership with Queensland Country Health Fund.

  • Up to 10 years - $1,000
  • 10-15 years - $1,500
  • 15 years + - $2,000

Benefits for the cost of hearing aids are per person up to the approriate benefit level.

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What happened to Singles and Couples, Top Hospital, Comprehensive Hospital, Intermediate Hospital, Value Hospital and Public Hospital over?

Singles and Couples (also previously known as Smart Start) (Basic+), Top Hospital (Gold), Comprehensive Hospital (Gold), Intermediate Hospital (Basic+), Value Hospital (Basic+) and Public Hospital (Basic+) Covers are no longer sold as a new product. If you've already got one of these policies there's no change, and we'll still honour all of the conditions, inclusions and benefits you enjoy on the policy.

However, if you're on a different level of cover and wanted to change to this one, or already hold it and wanted to recommend it to a friend, this policy type is no longer available.

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Can I upgrade my cover?

If you're on one of our lower or medium levels of cover, you can choose to upgrade at any time by contacting us on 1800 813 415.

Upgrading could include:

  • Increasing the level of cover - for example, going from Vital Hospital (Bronze+) to Better Hospital (Silver+)
  • Adding a new cover - for example, adding extras cover
  • Reducing your excess - that is, going from $500 excess to $250

If you're upgrading, you may need to serve waiting periods on the upgraded portion of your cover. While you're waiting, we'll still honour the benefits of your previous cover. Conditions also apply to hospitalisation if you're changing your excess.

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Can I downgrade my cover?

If things are a bit tight financially, or if you want to change to a level of cover that's more practical, you can choose to downgrade your cover.

Downgrading may include:

  • Reducing the level of cover - for example, going from Better Hospital (Silver+) to Vital Hospital (Bronze+) Cover
  • Removing a current cover - for example, dropping extras cover
  • Increasing your excess - going from a $250 to $500 excess

If you choose to downgrade, you won't need to serve additional waiting periods, and your new excess applies to inpatient hospital services immediately.