For a transport to be covered under your membership it must be assessed as ‘Clinically Necessary’ by a qualified medical professional.
The term ‘Clinically Necessary’ means that there is a genuine clinical need;
• To move the patient (i.e. the current hospital cannot treat the patient)
• For the patient to use an ambulance
• For clinical monitoring during transport
Patients cannot book their own transport and it must be booked by your doctor via the Emergency Services Telecommunications Authority (ESTA) on 1300 366 313.
There are exclusions that you should be aware of, such as;
- membership doesn’t cover ambulance services if you are within your waiting period
- cases where the transport is for social or convenience reasons (such as choosing your own location of treatment)
- when a third party is responsible for payment (such as the sending hospital in the public system)
- Click here for a full list of exclusions
We cannot guarantee that a particular transport will be covered under membership however, if your clinician has booked the transport in line with the Department of Health and Human Services (DHHS) Ambulance Payment Guidelines and the Membership Scheme Business Rules then it will likely be covered. Note that if the booking is found to not be in line with the guidelines, membership will not cover it.
We encourage you to view more information and some examples on the "Membership Cover and Non-Emergency Transport" page. You can also find links to the Ambulance Payment Guidelines & the Membership Scheme Business Rules.