Explore Health Insurance

Health insurance is broken down into two main types: hospital cover and extras cover. You have the option of combining these together under a combined health insurance policy.

How does combined hospital and extras cover work?

Combined hospital and extras covers two types of insurance under one policy. You’ll be insured for a range of medical treatment inside and outside of hospitals. These policies are typically pre-packaged by health funds to suit different lifestyles and budgets.

Hospital coverExtras cover
Hospital cover protects you for medical events and emergencies that require in-hospital treatment.

With hospital insurance, you’ll have your choice of agreement private hospital, doctor and accommodation, theatre costs and medical treatment (when each is available).

Extras cover provides benefits for out-of-hospital medical care like dental treatment, optical appliances, physiotherapy and remedial massage, among others.

The amount you can claim will generally be limited to a specific amount per treatment with an overall limit set per year.

If a health fund doesn’t offer a combined package to meet your needs, you can choose a separate standalone hospital cover and extras cover and combine them yourself to create something that suits you better.

If a health fund doesn’t offer a combined package to meet your needs, you can choose a separate standalone hospital cover and extras cover and combine them yourself to create something that suits you better.

The benefits of taking out combined health insurance

Combining hospital with extras policies is one way to ensure you drive your dollar further with a broader range of cover inclusions and the flexibility to combine different levels of cover for hospital and extras (e.g. gold hospital combined with lower level extras). While this type of cover, allows you to

  1. get a better fit for your needs, and
  2. claim on out-of-hospital services you’ll actually use (e.g. physiotherapy, remedial massage, dental).

If you choose to combine your hospital and extras through the same fund, you’ll also have the convenience of only paying one premium and having one contact point.

Should you take out hospital insurance by your 31st birthday, you can avoid the Lifetime Health Cover (LHC) loading when you get insured later in life. Purchasing hospital insurance can also help you avoid paying the Medicare Levy Surcharge (MLS) – if you’re a higher-income earner. While it doesn’t affect everyone, it’s worth trying to avoid these costs.

female patient with a female medical professional in a private hospital


Frequently asked questions

Can I take out separate hospital and extras cover from different funds?

Yes, you can take out a hospital insurance policy with one health fund, and extras cover with another. This can be handy as some funds might have a hospital policy you like, but not cover the specific out-of-hospital treatment you’re looking for under an extras policy.

However, having one policy means you only need to worry about one premium payment, so it might be a little easier than having hospital and extras cover with different funds.

What levels of hospital cover are available?

Hospital cover is broken up into four tiers. The four tiers of hospital cover, basic, bronze, silver and gold, all have the same minimum number of treatment types (known as clinical categories) across health funds.

Some funds may opt to add additional categories to provide further coverage. The health fund will add ‘+’ or ‘plus’ to the name, making it easier to know if you’re getting anything extra in your hospital insurance. For example, obstetrics is available in all gold hospital policies, but not silver, bronze or basic cover – unless the insurer decides to list it on a plus policy.

What levels of ancillary cover are available?

When it comes to extras cover, things work a bit differently. The services you can claim on and the amount of money you can claim are decided by the health fund. There are no set categories like there is for hospital policies. As such, it becomes much more important to shop around to ensure your healthcare needs are met.

The level of extras cover will be specified under the policy, with the specific treatments listed on your product disclosure statement.

Can I mix and match my hospital and extras cover?

Some funds offer set packages, others offer the flexibility to mix and match the level of hospital cover and which extras policy you want, depending on what the insurer has to offer. This means it is entirely possible to have a basic or bronze hospital policy with higher levels of extras cover, and vice versa.

Do waiting periods apply to combined health insurance policies?

Combined hospital and extras do have waiting periods, just as standalone policies will too. Once you take out cover, you’ll need to sit these waiting periods before you can claim on a specific service or treatment.

The Australian Government sets hospital insurance waiting periods, which differ depending on the type of treatment listed on the policy. For example, for pregnancy cover, you have to wait 12 months to make a claim. For mental health services though, you can make a claim in just two months.

Typical hospital cover waiting periods
2 months12 months
·         Psychiatric care

·         Rehabilitation

·         Palliative care

·         Pre-existing conditions

·         Pregnancy and birth-related services (including IVF)

Source: Waiting periods for private health insurance. Private Health Insurance Ombudsman, Australian Government. 2018.

Waiting periods on extras are instead set by the health fund and can range from several months to several years, depending on the procedure or treatment. For example, orthodontics may have a waiting period of 12 months or longer.

Some health funds will waive waiting periods for certain services if you’re a new customer taking out a policy so keep an eye out for these deals!

Do I pay LHC on the full premium of combined extras and health insurance policy?

No, Lifetime Health Cover (LHC) loading applies on the base premium of your hospital cover, if you take out health insurance after July 1st following your 31st birthday.

You do not have to pay LHC on your extras premiums.

Which kind of health insurance covers ambulance trips?

Ambulance cover is covered by hospital cover and some extras policies, depending on the insurer.

However, bear in mind, some Australians will have ambulance journeys covered by a state government or the Federal government. This includes:

  • Queenslanders anywhere in Australia
  • Tasmanians while they are in Tasmania
  • Some pensioners, veterans and concession cardholders

If health insurance covers emergency transportation, limits may apply to the number of trips that can be claimed on within a 12 month period. You can learn more about the rules for each state and territory in our guide to ambulance cover.

Compare hospital and extras cover

With all the coverage of hospital cover and extras cover together in one policy, there’s plenty to compare when it comes to combined health insurance. We make comparing health insurance a breeze.

You can compare combined hospital and extras cover for free with our health insurance comparison tool. In minutes, you’ll be able to review policies side-by-side, using our easy tool to help you find the coverage you want. If you see a policy you like, you can get coverage straight from our comparison tool.

All of this in one place. Simples!

So, what are you waiting for?

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