What is OSHC And What Does it Cover and What's not?
What is OSHC?
With the right health cover, you’re ready for anything
Overseas Student Health Cover (OSHC) does more than just meet Australian Government visa requirements. It helps you pay for medical and hospital care and protects your health Australia-wide.
Accidents and illnesses can happen and medical costs in Australia can be very high. Getting OSHC gives you peace of mind and ensures you are not paying more than you need to for healthcare.
Why do I need OSHC?
OSHC is compulsory for all international students in Australia (except if you are a Norwegian, Swedish or Belgian national). This includes the student and their family members such as, spouses and children under 18 years old. It’s also important to remember that If you renew your visa, you must renew your health cover.
What does OSHC provide?
OSHC will help you meet the costs of medical and hospital care that you may need during your stay. It will also pay benefits for pharmaceuticals and ambulance services.
OSHC in Australia is designed to meet the minimum standards set by the government. This is so overseas students are covered to at least the same level as Australian residents who are eligible for Medicare (the public healthcare system).
OSHC covers you for:
100% of the Medicare Benefits Schedule (MBS) fee for medical services including your doctor, specialist, surgeon, anaesthetist, X-rays and blood tests provided in hospital.
- Shared ward accommodation, same day services, accident and emergency and outpatient medical and post-operative services in public hospitals.
- 100% of the charges for all costs for overnight or same-day hospital stays in private hospitals which have an agreement with your OSHC provider.
- Surgically implanted prostheses (such as an artificial joint for a hip replacement) up to the approved amount listed on the Federal Government’s Prostheses List such as pace maker, eye lenses, hip and knee replacements, human tissues and more.
Hospital costs can be expensive, so it’s always best to contact your OSHC provider before seeking hospital treatment.
- You’re coved for unlimited emergency ambulance transportation to hospital for admission and on-the-spot emergency treatment by recognised providers anywhere in Australia. A medical emergency is an acute injury or illness that poses an immediate risk to your life or your long-term health. For non-medical emergency treatments, you can visit a medical centre or clinic.
Doctors and specialists
You will usually see a doctor or specialist in a medical centre.
Your OSHC covers you for:
- 100% of the MBS fee for medical services provided by a doctor or General Practitioner (GP).
Example: if your GP charges more than the recommended MBS, you’ll need to pay for the difference. This is called an out-of-pocket cost.
- 85% of the MBS fee for medical services provided by a specialist eg x-rays, blood tests and other pathology services.
Example: a medical service is listed under Medicare as $200 and your specialist charges $250. Your OSHC provider will pay $170 (85% of $200) and your out-of-pocket is $80.
Prescription medicines are medicines that your doctor must authorise before you can buy them from a pharmacist.
- If you are prescribed medicine by a doctor or specialist, and the medicine appears Pharmaceutical Benefit Schedule (PBS) approved listing of medications, then you are eligible to claim up to $50 per approved prescription medicine, up to a total of $300 for single and $600 per family membership per calendar year (1 January to 31 December)
- However, You will have to pay a minimum amount first before the above benefits are payable. This minimum amount is known as the Pharmaceutical Benefit Schedule (PBS) co-payment fee and Australian residents must pay it too. This amount does vary each year
Example One: If a prescribed medicine costs $75, you will need to pay the minimum PBS amount ($38.80 2018 PBS Rate), and then your OSHC provider will pay a benefit of the remaining $36.20.
Example Two: If a prescribed medicine cost $200, your OSHC provider pays the full $50 benefit as per your OSHC, and your out-of-pocket is $150.00 which is a combination of the PBS ($38.80 + the remaining $111.20).
What is a pre-existing condition?
A pre-existing condition is when a medical practitioner (GP and or Specialist) that you have seen in Australia or from your home country declares to your OSHC provider that there were signs or symptoms of an illness during the 6 months before you arrived in Australia, or the 6 months before your visa was granted (whichever was later). There is a 12 month waiting period for pre-existing conditions.
What is a waiting period?
A waiting period is the time you need to wait before receiving a benefit from your OSHC. Some costs, such as medical expenses relating to a pre-existing condition, are not covered during your waiting period.
- There is usually a 2-month waiting period for psychiatric-related medical conditions.
- There is usually a 12-month waiting period for all pregnancy and birth related services and other pre-existing conditions.
What’s not covered?
- Treatments that are not approved by the Medical Services Advisory Committee and/or recognised by Medicare.
- Cosmetic surgery that is not clinically necessary and where benefits are not payable by Medicare.
- Non-emergency ambulance transportation
- IVF and assisted reproductive services
- Experimental treatment
- Any treatments obtained outside of Australia.
- Extras services such as dental check-up, physiotherapy, chiro and podiatry consultations.
What are exclusions?
These are things you can’t claim for because they’re not included in your cover. If your OSHC has exclusions for certain conditions, you won’t be covered if you are treated for those conditions.
For example, if your OSHC excludes cosmetic surgery that is deemed as not clinically necessary, your OSHC provider will not pay any benefits towards your hospital and medical costs.
If you are unsure whether you are covered for a treatment or service, check with your OSHC provider first.
What is Extras cover?
Extras cover can help you pay for some of the common health services that are not covered by your OSHC policy. This type of cover gives you money back for non-hospital services including dental treatment, physiotherapy, optical services and more. The amount of money you can claim back depends on the level of cover you have. If you have a higher level of cover, you usually get a higher percentage of costs back. Your annual limit is usually higher as well. We recommend that you speak to your OSHC provider about the options available to you.
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