Compare hospital and extras cover

Hospital cover pays towards medical conditions that require inpatient hospital treatment. This can include elective surgeries like joint reconstructions and cataract surgery, depending on the level of cover you choose. To claim a benefit from your health fund, you must be admitted to hospital as an inpatient, the treatment must be medically necessary, listed on the Medicare Benefits Schedule and included on your policy, and all relevant waiting periods must be completed.

Hospital insurance will pay a benefit towards your treatment as a private patient admitted to a private or public hospital. If you’re treated in a private hospital, you’ll be able to avoid public waiting lists, choose your available doctor and have a private room (depending on availability).

Hospital cover is divided into four tiers depending on the clinical categories included; these tiers are Basic, Bronze, Silver and Gold. Some polices may have a ‘Plus’ or ‘+’ in the name (e.g. Basic Plus), meaning they cover more than the minimum required clinical categories without meeting the requirements for the next tier up. For example, a Silver Plus policy may provide cover for joint replacements which is ordinarily only required to be included by Gold tier policies.

Extras cover (also called ancillary or general treatment cover) covers outpatient treatments and services not covered by Medicare.

Extras cover can provide benefits for a range of out-of-hospital extras services like dental check-ups, chiropractic, physiotherapy, remedial massage, and podiatry, among others. It can also pay towards products like hearing aids, prescription glasses, contact lenses and orthotics, depending on the inclusions in your policy.

The amount you can claim will be either a percentage or a dollar amount. These benefits are typically capped to an annual limit and can include sub limits, group limits and lifetime limits, as well as per-person limits and policy limits.

Waiting periods are decided by the health fund and aren’t regulated by the government. Unlike with hospital cover, pre-existing conditions won’t affect your waiting periods.

Standalone extras cover won’t help you avoid Lifetime Health Cover loading or the Medicare Levy Surcharge or benefit from an aged-based discount. However, if you choose standalone extras cover, you’re still eligible for the Australian Government rebate.

Policies may vary between health funds, so make sure you check the relevant policy brochure for a full list of inclusions, exclusions, limits, benefits and restrictions.

Yes, you can take out a hospital insurance policy with one health fund and extras cover with another. The potential advantages of this split cover option may include:

• better value for money (depending on the policies you’re comparing)
• having a broader range of policies to choose from, allowing you to select 2 individual policies that best suit your needs.

Like any insurance option, there are potential disadvantages to split health cover, including:

• If you opt for split cover, it can take more effort and research to find 2 different coverage options that suit your needs.
• You won’t have a single premium like you would for a combined policy. This could make it harder to keep track of your finances.

Many health insurance providers are flexible with their options when it comes to level of cover, so it’s unlikely you will need to resort to split health cover to get what you need. Your own health needs, medical history and preferences will be the biggest influence on whether a combined policy or split health cover is the best option for you.

Yes, extras cover does have different levels of cover; however, unlike hospital cover, these tiers aren’t set by the government. Instead, health funds decide what levels of cover, limits and services they will include. This makes it even more important to check policy documents and compare your options to get the best cover for your needs.

The level of extras cover will play a role in determining which specific treatments are included in your policy, which will be outlined in the brochure. Make sure you understand not only what inclusions are part of a policy, but what these inclusions cover. For example, there are usually 4 different inclusions that cover different dental services. If you want coverage for wisdom tooth removal, you’ll most likely need the major dental inclusion to make a claim.

Combined hospital and extras policies do have waiting periods, just as standalone policies (e.g. hospital-only cover) do. Once you take out or upgrade your cover, you’ll need to serve these waiting periods before you can claim on a specific service or treatment.

When switching or upgrading to a higher level of cover, you’ll only need to serve a waiting period for any upgrades or improvements to the policy. You won’t be required to re-serve any waiting periods that you’ve already completed when switching or upgrading from an active policy. If you’re yet to complete any waiting periods, you’ll be required to serve the remaining time before claiming.

Hospital cover

The Australian Government sets the maximum waiting periods for hospital insurance, which differ depending on the treatment. For pregnancy and birth-related services and treatment for pre-existing conditions, your waiting period will be 12 months. For all other services (including in-hospital treatment for mental health services, palliative care and rehabilitation regardless of whether the condition is pre-existing), you can make a claim after just 2 months.

Extras cover

Waiting periods for extras are set by the health fund and can range from several months to several years, depending on the procedure or treatment. For example, general dental usually only has a waiting period of 2 months, while orthodontics may have a waiting period of 12 months and some services like hearing aids may have a waiting period that is even longer.

Some health funds will waive waiting periods for certain services if you’re a new customer taking out an eligible policy, so keep an eye out for these deals. Health funds are more likely to waive 2–6 month waiting periods than longer waiting periods. There are even some policies available which have no waiting period at all on select services. For example, there are policies that offer dental with no waiting periods. Typically, this will only be offered for dental services with shorter waiting periods, such as general dental.

No, LHC loading applies to the base premium of your hospital cover if you take out health insurance after 1 July following your 31st birthday. LHC loading adds 2% to your premiums for every year over 30 you are when you first purchase hospital cover after turning 31. However, this only applies to your hospital cover, meaning you don’t have to pay LHC loading on your extras premiums.

To avoid LHC loading, you’ll need to take out hospital cover before your base date (typically the 1 July following your 31st birthday). This hospital cover can be a standalone policy or form part of combined cover. When you take out a combined health insurance policy before 1 July following your 31st birthday, maintaining the hospital insurance component will help you avoid the LHC loading.

Emergency ambulance cover is included in some hospital cover and some extras policies, depending on the insurer and policy, while other insurers offer ambulance cover as a standalone policy. Even if your hospital or extras policy includes ambulance cover, it’s important to understand what’s included, as inclusions vary.

However, some Australians will have ambulance trips covered by their state or federal government. This includes:

• Queenslanders anywhere in Australia
• Tasmanians while they’re in Tasmania
• some pensioners, veterans and concession cardholders.

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