Top Hospital cover
Our highest level of hospital cover
If you’re worried about public hospital waiting times, and want to ensure you and your family can see the doctor of your choice, then Top Hospital cover is for you.
With our Top Hospital cover, you’ll get comprehensive insurance that covers you for things like accommodation in a private or public hospital, theatre fees, intensive care and many surgical events, plus you can choose the excess level that suits you and your family that you pay towards any in-patient treatment.
What you're covered for
Your choice of doctor/hospital
With private hospital cover, you'll avoid potentially long public hospital waiting times and can choose to be treated by your preferred doctor.
Private hospital accommodation
Accommodation in a private hospital for surgeries and procedures.
Fees that a hospital charge for the usage of the operating room and equipment.
Surgically implanted prostheses
Benefits for surgically implanted artificial hips and knees etc.
For time required to be spent in intensive care.
Tonsils and adenoids removal
Surgery to remove the adenoids and tonsils.
Removal of the appendix
Cover for colonoscopies
Grommets in ears
For treatment of conditions affecting the middle ear.
Cover for gynaecological treatments in hospital.
Treatment for hernias provided in hospital.
Reconstructive surgeries for shoulders, knees, etc.
Including herniated discs and vertebral fusion surgeries.
Including biopsies and craniotomy.
Plastic and reconstructive surgery
Surgical specialty involving the restoration, reconstruction, or alteration of the human body (excludes cosmetic surgery).
In-hospital rehabilitation services
Rehabilitation of patients with neurological, muscular skeletal, orthopaedic and other medical conditions following stabilisation of their acute medical issues.
Access Gap Cover
The Access Gap Cover scheme is designed to reduce your out-of-pocket expenses when you receive a service in a hospital as an inpatient. If your surgeon or doctor participates it can mean reduced out-of-pocket expenses for you.
Nursing home type patients
We pay a benefit towards a nursing home patient. This amount is determined by the Federal Government. Certification is required.
Public hospital accommodation as a private patient
If you need treatment in a public hospital and you wish to choose to be treated by your own doctor you can elect to be treated as a private patient. If you don’t get choice of your own doctor you may simply elect to be treated as a public patient.
Pregnancy and birth-related services
Obstetric related services
Assisted reproductive services
Includes services such as IVF.
Cardiac and cardiac related services
Major eye surgery
Includes cataract surgery and surgery for other major eye conditions. Does not include laser surgery to restore vision.
Treatment for kidney failure, e.g. chronic renal failure.
Gastric banding and obesity surgery
Gastric banding, sleeving/diversions or bypass (weight loss surgery)* including replacements, repairs and adjustments.
Hip and knee joint replacement surgery
A benefit limitation period (BLP) of two years (24 months) applies to hip or knee joint replacements.
Hospital benefits payable on these hospital services during the designated BLP will be the minimum benefit declared by the Minister for Health and Ageing, except when a waiting period hasn't been fully served, in which case no benefit applies.
BLPs don't apply to new Members transferring from another private insurer, or for existing Members changing your level of hospital cover, as long as you transfer within 63 days of ceasing your previous cover. If you hadn't fully served your waiting periods under your previous cover, you'll be required to finish serving these waiting periods before you'll be entitled to benefits in a private or public hospital.
Mechanical aids and appliances
Benefit up to 85% of the cost or hire of approved mechanical appliances and artificial aids.
Covered products include: blood pressure monitors, glucometers, tens machines, crutches, walking frames and wigs. A benefit limit of 85% of the cost up to $2,000 per person per Membership Year applies. Benefit replacement periods apply on certain mechanical aids. Sub-limits may apply to benefits for some aids or appliances.
Please note: A letter of referral from your doctor or practitioner may be needed to accompany a claim. Please contact us before purchasing an aid or appliance to check these requirements and what benefits may be payable.
Mammograms and bone density test
Benefit up to $75, limited to 2 services for each of these tests. Claims are subject to there being no Medicare benefit payable. The Membership Year limit is $300 per person covered.
Also includes benefits for digital mammography and breast tomosynthesis.
The hearing aid/s benefit limit is provided to use over three Membership Years, based on the date your purchase of a hearing aid/s is made. The limit amount applied is based on your length of membership with Territory Health Fund.
- Up to 10 years - $1,000
- 10-15 years membership - $1,500
- 15+ years - $2,000.
Benefits per person are calculated at 85% of purchase cost up to the appropriate benefit limit.
Australian Hearing Services
Benefit of $25 per Membership Year per eligible person for the cost of a Hearing Services Card.
- Special – Benefit of up to $150 per day limited to $750 per person covered.
- Home – Benefit up to $15 per visit or $60 per day limited to $600 covered.
- Bush – Benefit up to $15 towards the cost of treatment with an annual limit of $300 per person.
Benefits up to $35 per day to a maximum of four days per person listed on the membership.
Most pharmaceuticals relating to your admission
Most pharmaceuticals (prescribed medications) relating to your surgery, procedure or hospital admission.