Emergency Services Health Fund overview

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fund-iconOverview

Emergency Services Health Fund (ES Health) is Australia’s only private health fund exclusively for emergency workers and their families.

They are backed by Police Health, which covers over 60,000 members of Australia’s police community and boasts an 85 year history.

The fund offers high benefits around psychology and counselling, as a reflection of the nature of their members’ jobs. They also allow you to roll over most of your extras benefits.

fund-iconKey features

  • Most unused benefits roll over with you, as well as 80% back on most claims.
  • Only offers a top-tier Gold hospital plan, with no excess to pay and freedom to choose your own providers.
  • Comprehensive ambulance cover included in all policies regardless of home state, including emergency and non-emergency transport.

fund-iconHospital cover

Nobody chooses to go to hospital. But when you do, hospital cover will help you get the treatment you need, where and when you want it. It also helps to pay the bills, as fees for hospital rooms and specialists can add up.

ES Health only offers top tier premium hospital cover, both as a standalone policy or combined with extras. The fund states that anything else would be doing a disservice to their members, who regularly risk their lives in their everyday occupations.

Gold Hospital

ES Health’s only hospital cover is completely comprehensive with no exclusions, excess or co-payments. It’s an expensive policy, but comes with peace of mind that every service recognised by Medicare is covered. Over 25,000 doctors across Australia participate in their Access Gap scheme, designed to minimise out-of-pocket costs.

Key inclusions:

  • Assisted reproductive services
  • Pregnancy and birth
  • Weight-loss surgery
  • Cataracts
Gold Combined

Gold Combined cover combines Gold Hospital and Rolling Extras at a reduced premium.

There are no exclusions, no benefit limit periods, no excess to pay and no co-payments on hospital cover. Extras cover pays up to 80% for most services and allows you to roll some unused extras limits over.

fund-iconAmbulance cover

All Emergency Services Health Fund policies include 100% ambulance cover for emergency transport, clinically required non-emergency transport and treatment not requiring transport.

Ambulance cover is guaranteed for all ES Health members, regardless of whether they are in their home state or visiting another part of Australia.

fund-iconExtras cover

Extras cover is there to help you with the cost of services generally not covered by Medicare, such as dental, optical, physiotherapy and a range of other services.

ES Health offers just one type of extras cover – Rolling Extras. Unlike other funds where all your annual benefit limits reset (usually on 1 January), most of your unused benefits with ES Health will roll with you from one calendar year to the next.

You’ll need to serve a 12 months waiting period after joining (or 2 years for major dental) before ES Health will let your benefit limits roll over.

Rolling Extras

Rolling Extras provides comprehensive cover for the average person to enjoy, with a benefit of up to 80% on most services.

  • Unlimited General Dental
  • $1,500 limit on Major Dental
  • 100% back on lenses and frames at OPSM and Laubman & Pank (annual limit applies)
  • $850 combined annual limit on psychology and counselling

fund-iconWaiting periods

Waiting periods are there to stop people from signing up, claiming and then cancelling their cover. It means once you take out a new plan, you’ll have to wait a specific amount of time before you can claim on your cover.

When you switch to ES Health from another provider, you won’t have to re-serve your waiting periods, unless your new policy covers something you didn’t have before.

Hospital Waiting Periods
  • 12 months – Obstetrics, pre-existing conditions (excluding psychiatric care, rehabilitation or palliative care), CPAP machines, non-surgically implanted prosthesis and appliances
  • 2 months – All other benefits, excluding accidents
Extras Waiting Periods
  • 3 years – rehabilitation, psychiatric and palliative care (even for a pre-existing condition)
  • 12 months – Major Dental, orthodontics, hearing aids, nebulisers, blood glucose, blood pressure monitors, blood coagulation monitor and pre-existing conditions
  • 12 months, or 2 years for Major Dental – Rollover Benefit
  • 2 months – All other benefits, excluding accidents

fund-iconMember benefits

As a not-for-profit fund, all profits are diverted back into ES Health to create greater benefits for members.

ES Health is backed by Police Health, which boasts a member satisfaction rating of 98% (Member Satisfaction Research, Members Health Fund Alliance, 2019).

All well as the rolling extras benefits, ES Health Fund members can also get access to the Nourish Baby program

fund-iconHow to claim

Claim on the spot through the HICAPS payment system at your provider, or through the Queensland Country Health Fund Mobile app or online. You can also claim by email or post your claim form.

Hospital

Simply tell the hospital you are a member of an ES Health policy. Your hospital account will be sent directly to ES Health for them to assess on your behalf.

Extras

You can swipe your membership card to claim directly on the spot with your provider’s HICAPS terminal.

You can also claim via the ES Health claiming app, or fill out the claim form and send it via email or mail.

fund-iconHospital agreements

ES Health has agreements with a large number of hospital and day surgery providers across Australia.

When comparing policies, it’s worth checking if your preferred local hospitals and clinics are covered. Our specialists at Health Insurance Comparison can do this for you.

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state-graphic

Source: Private Health Ombudsman

fund-iconCustomer service

From 1 January to 31 March 2020, the Private Health Ombudsman received 1 complaint from an ES Health member.

ES Health is backed by Police Health, which boasts a member satisfaction rating of 98% (Member Satisfaction Research, Members Health Fund Alliance, 2019).
Source: Private Health Ombudsman

fund-iconFAQs

Yes – all profits are diverted back into the fund, for increased benefits to members.

The Emergency Services Health Fund is restricted. You can only join ES Health if you or a close relation works or volunteers for an Australian emergency service, either now or in the past.

Eligible sectors include fire, ambulance, water or state emergency response and recovery sectors.

Alternatively, if you or a family member currently or have in the past worked for an Australian police fund, you may be eligible to join ES Health’s parent fund, Police Health.

Eligible family members for ES Health include children and their partners of emergency service workers, as well as grandchildren, siblings and their partners, and nieces and nephews.

Health Insurance Comparison does not compare for ES Health, so you’ll need to contact them directly to switch.

If you’re not eligible for ES Health, it’s free to compare a range of funds with Health Insurance Comparison.

You can switch to an equivalent or lower level of cover without re-serving waiting periods. You will only be required to serve waiting periods if you have upgraded to a higher level of cover and/or higher benefits.
Emergency Services Health Fund only has one level of hospital cover and one extras policy, although you can combine them. You’ll need to speak to the fund directly to do this.
For every dollar of private health insurance premiums, the Australian Government provides eligible Australians with a rebate of up to 33.4% (depending on your age and income). To learn what you’re entitled to, use our rebate calculator.
If you’re 31 or over, you usually need to pay 2% loading for each year you’ve gone without hospital cover since the 1st July following your 31st birthday. You can find out more here.
Children can remain on your ES Health policy until the age of 21, or the age of 25 if they are studying full-time.
Phone: 1300 703 703
Post: Emergency Services Health, Reply Paid 6111 Halifax St, Adelaide SA 5000
Email: enquiries@eshealth.com.au
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