Mildura health fund review

Overview

Mildura Health Fund has been operating since 1929, originally established to serve the needs of residents of regional Australia. The fund prides itself on maintaining regional values and solely serving its members. 

As a not-for-profit fund, it’s fully owned by its 35,000 members, which allows Mildura Health Fund to offer great benefits and competitive premiums.

Hospital cover

Nobody chooses to go to hospital. But when you do, appropriate 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.

Think about what services you’re likely to need, in line with your budget. If you earn over $90,000 individually or $180,000 as a couple, taking out appropriate hospital cover may help you avoid paying the Medicare Levy Surcharge (MLS).

Mildura Health Fund keeps things simple by offering just two types of hospital cover, Basic Plus and Five Star Gold.

Basic Plus

Basic Plus is a budget-friendly option which allows you to be covered as a private patient in a public hospital, meaning you can choose your own doctor. However, there’s only one excess option with this cover, which is $750.

Key inclusions:

• Shared accommodations in public hospitals around Australia

• Ability to choose your own doctor

Five Star Gold

Mildura Health’s top tier comprehensive policy covers all Medicare recognised services and allows you to choose between an excess of $0, $250, $500 or $750.

Key inclusions:

• Treatments related to the vascular system and heart conditions 

• Cataract treatments

• Pregnancy and birth services

• Weight loss surgery

Ambulance cover 

As certain states, such as VIC, SA, WT and the NT, require residents to take out an ambulance subscription service to be fully covered, Mildura Health Fund pays these members a benefit towards their subscription each year to help offset the costs.

Members in NSW and the ACT are covered for emergency transportation within their state if they take out any Hospital cover with the Mildura Health Fund.

Extras cover 

From dental, to optical, to chiro and more, extras insurance helps cover the bills for routine treatments with rebates of up to 100%. Mildura Health’s extras reset on January 1st of every year.

While we’ve summarised the key points of Mildura Health Fund extras policies below, it’s always worth taking a closer look at any gap fees, how much you can claim back, and whether your preferred healthcare provider is recognised by the health fund.

Take the time to work out what you need and what you’re prepared to pay. If this feels a bit overwhelming, our experts are here to help.

Mildura Health Fund offers four distinct extras policies, called Dental, Base Extras and Mid Extras. These are available as standalone policies. Five Star Extras already includes dental cover and provides the most comprehensive range of services.

Dental 

Dental offers a full range of dental benefits, including a gap free for preventative dental services at selected providers.  This policy can be taken out on its own or can be combined with an extras cover and/or hospital cover

Key inclusions:

• Preventative treatment, general and major dental ($350 per person for first year of membership, $1,000 maximum benefit per year after first year is completed - sub limits apply)

• Up to 100% back on preventative dental at selected providers

• Up to 70% back on most major dental

• Orthodontics ($650 per person per calendar year)

Base Extras

Base Extras offers basic benefits and limits at an affordable price, whilst still covering a generous range of services. Base Extras can be taken out with Dental and/or hospital cover, or on its own.

Key inclusions:

• Physiotherapy and other therapies ($390 per person, $780 per family annually)

• Optical ($165 per person per year)

• Dietician ($390 per person, $780 per family annually)

Mid Extras

Mid Extras includes a higher range of benefits for things like remedial massages, physiotherapy, chiropractic, and health aids and appliances. Mid Extras can be taken on its own or in combination with Dental and/or hospital cover for greater flexibility. 

Key inclusions:

• Therapies, such as remedial massages, acupuncture and nutritionist  ($540 per person, $1080 per family annually)

• Podiatry  ($540 per person, $1080 per family annually)

• Clinical psychology ($540 per person, $1080 per family annually)

Five Star Extras

Five Star Extras is the most comprehensive extras option, offering the highest benefits and yearly limits of extras and dental covers. 

It includes dental and the Five Star Health Management Benefit, which is exclusive to the Five Star Extras cover. This covers things like fitness and prevention programs, such as swimming lessons, personal training, group training and aqua aerobics. 

Key inclusions:

• Non-PBS prescriptions

• Five Star Health Management Benefits, which includes eligible health screening tests not covered by Medicare, such as mole mapping, weight management and quit smoking.

Waiting 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 may have to wait a certain amount of time before receiving your benefit.

When you switch to Mildura Health Fund from another provider, your waiting periods may be waived unless your new policy covers something you didn’t have before.

Hospital Waiting Periods

• 12 months for pre-existing conditions, pregnancy and birth related services

• 2 months for psychiatric, rehabilitation and palliative care as well as for all other services

• None for accidents

Extras Waiting Periods

• 36 months for certain monitors and machines

• 24 months for orthodontics

• 12 months for dentures and orthotics

• 6 months for optical

• 2 months for general and major dental as well as for all other services

• None for accidents

Member benefits

Mildura Health currently offers a referral bonus of a $50 EFTPOS card² every time a family or friend joins Mildura Health. There is also a 2.5% discount for members who pay by direct debit.

How to claim

Hospital

Simply tell the hospital you hold a Mildura Health Fund policy. Your hospital account will be sent directly to them for assessment. 

It may be a good idea to call your fund before your admission date to check what benefits you’re entitled to and if there may be any out-of-pocket expenses or excess.

Extras

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

Members can also claim after receiving a treatment via the Mildura Health Fund mobile claiming app or through email, fax or mail.

Hospital agreements

Mildura Health Fund 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 Compare Club specialists are happy to help. 

Customer service

Mildura Health received zero complaints in 2020. They have a market share of <0.5%¹. 

FAQ

1. Is Mildura Health Fund a not-for-profit fund?

Yes. As a not-for-profit fund, Mildura Health is owned completely by its members.

2. Who can apply? Are there restrictions? 

Mildura Health is available for all Australians to join.

3. Is it easy to switch to Mildura Health Fund?

Mildura Health isn’t on our panel so you’ll need to contact them directly to switch. We’re confident the Compare Club team can find you a great deal from the insurers on our panel.

4. Do I need to re-serve waiting periods?

If you switch to an equivalent or lower level of cover, you generally won’t have to serve new waiting periods. However, you may need to serve new waiting periods if your new policy includes additional services or higher benefits

5. Can I change my level of cover?

Yes, you can choose a lower or higher level of cover. If you move to a higher level of cover, you will usually need to serve waiting periods on the extra services/higher benefits.

6. Do I get the government rebate?

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, read our rebate guide.

7. Do I have to pay the Lifetime Health Cover loading?

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.

8. Up to what age are children covered? 

Children are automatically covered under family cover until the day before they turn 21.

If they are full-time students, they’ll be covered until the day before they turn 25 or cease full-time study (whichever comes first) at no extra cost.

This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

1. Private Health, Mildura Health Insurer profile, accessed October 2021.

2. Mildura Health, Promotions, accessed October 2021.