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When moving to Australia on a temporary visa, whether for work, tourism, family visits, training, or bridging purposes, one of the biggest requirements is having OVHC (Overseas Visitors Health Cover). While OVHC helps you finance hospital treatment, doctor services, and emergency care, it does not cover everything.
Understanding exclusions is just as important as understanding benefits. Many visitors mistakenly believe OVHC works like travel insurance or covers every medical situation - but the rules issued by insurers like AIA, Bupa, nib, and Medibank clearly outline specific circumstances where OVHC will not pay benefits.
This blog breaks down those exclusions using the actual policy rules, helping you make informed decisions and avoid unexpected out-of-pocket expenses.
Australian health insurance legislation allows insurers to offer OVHC with different levels of hospital cover. Each insurer’s policy rules include a section titled Exclusions outlining treatments and situations where no benefits are payable. These exist because:
The exclusions are similar across all funds because all insurers are governed by the Private Health Insurance Act and must follow strict compliance standards.
The following exclusions come directly from the fund rules you shared. While the specific wording varies, the meaning is consistent across AIA, Bupa, nib, and Medibank.
1. Services Received Before Your Policy Start Date
All OVHC providers exclude any treatment or medical service provided before the policy begins, even if the claim relates to a later procedure.
This appears in all fund rules under general conditions for eligibility and benefit payment timelines.
2. Treatments During Waiting Periods (Including Pre-Existing Conditions)
Every OVHC fund applies waiting periods, and no benefits are paid for services received during those periods.
Especially important is the 12-month waiting period for pre-existing conditions, found in:
If symptoms existed in the six months before your start date, the insurer can classify the condition as pre-existing.
3. Cosmetic Surgery With No Medical Need
Cosmetic procedures that alter appearance without medical necessity are excluded across all OVHC funds.
This exclusion is explicitly referenced in:
Only medically necessary reconstructive surgery following illness or accident may be considered.
4. Treatment Not Considered Medically Necessary
If treatment is not medically necessary or is for lifestyle or convenience, OVHC will not cover it.
This includes procedures where the treating doctor cannot justify clinical necessity.
Insurers clearly state that “medically necessary” is a requirement for benefits across all hospital treatment categories.
5. Services Not Delivered by Recognised Providers
If treatment is received from a practitioner who is:
- then no benefits will be paid.
AIA, Bupa, and nib all include this under their rules for eligible providers and claim approvals.
6. Outpatient Services When Your Policy Only Covers In-Hospital Care
Many OVHC plans - especially budget or mid-tier - cover inpatient services only
Outpatient services such as:
The above mentioned services may not be covered unless your product tier includes them.
This difference- is clearly outlined in nib’s multiple tiers and Bupa’s visiting vs working covers.
7. Non-Emergency Ambulance Transport
All fund rules restrict ambulance cover to emergency ambulance transport only.
Examples:
8. Experimental, Unproven, or Non-PBS Treatments
Treatments that are:
are typically excluded across all OVHC plans.
9. Care Not Related to Illness or Injury (e.g., Immigration Tests)
Medical examinations required for:
The above services are excluded because they are not considered medically necessary.
Bupa, nib, and AIA all include this under “Non-medical purposes” exclusions.
10. Services Excluded by Specific Product Levels
Some OVHC tiers, particularly Budget, Basic, or Visitor covers - exclude entire categories of hospital treatment such as:
This is because each level of cover includes or excludes treatment types under the “Hospital Categories” table of each fund.
1. Why does OVHC have exclusions?
OVHC covers medically necessary treatment only, so exclusions exist to avoid paying for non-medical, cosmetic, or elective services. They also help insurers comply with the Private Health Insurance Act.
2. Does OVHC cover pre-existing conditions?
Yes - but only after a mandatory 12-month waiting period. Until then, any pre-existing illness, including heart disease, cancer, or chronic conditions, will not be covered.
3. Are all hospital services covered under OVHC?
No. Each product level covers specific hospital categories, and certain services like pregnancy or joint surgery may be excluded in lower-tier policies.
4. Is non-emergency ambulance transport covered?
Generally no. OVHC covers ambulance services only during emergencies, as defined in the insurer’s rules.
5. Does OVHC cover visa or employment medical checks?
No. Tests required for immigration or workplace compliance are excluded because they are not related to illness or injury.
Understanding what OVHC does not cover is just as important as knowing what it includes. Every insurer - whether AIA, Bupa, nib, or Medibank - follows strict exclusion rules set out in their fund documents. These exclusions impact claims, out-of-pocket costs, and your overall experience as a temporary visitor in Australia.
By reviewing the exclusions carefully and choosing the right policy tier, you can avoid unexpected expenses and ensure your OVHC aligns with your healthcare needs while in Australia.
You can compare OVHC plans from all major insurers directly on GetMyPolicy.online, helping you choose the right level of cover with confidence.
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