Hospital cover is divided into tiered categories – Basic, Bronze, Silver and Gold – with each category including a broader range of services than the one beneath it.
Gold offers the most comprehensive cover of the lot, while Basic hospital cover provides the lowest level of cover, meaning there are more exclusions (services not covered) than the other tiers. Regardless of what tier you choose health funds can offer services and treatments that are beyond what’s mandated in the policies. If they do, the policy is given a ‘plus’ or ‘+’ to denote it offers additional cover.
For example, if a Silver policy offers cover for having a baby as a private patient, the policy will be classified as Silver Plus not Silver.
There are plenty of benefits to hospital cover, such as the choice of the doctor and the hospital for your treatment (depending on the availability of both). You can also recuperate in your own private room (subject to availability), and – most importantly – hospital cover helps you avoid public waiting lists for procedures in the public health system.
Also known as general treatment or ancillary cover, extras cover looks after medical treatment costs or health services that are not undertaken in a hospital; for items that Medicare doesn’t pay a benefit towards.
Different policies will offer different levels of cover. While extras policies aren’t categorised in the way that hospital insurance is, extra’s cover is broken down into ‘basic’ and ‘comprehensive’ policies. The ‘basic’ policies offer cover for less expensive procedures (e.g. scale and cleans for your teeth) while, the more ‘comprehensive’ policies cover larger sets of procedures (e.g. wisdom teeth extraction, crowns and bridges), however the larger covers may cost more as a result.
Besides the fact that that each product covers different treatments and services (detailed above), hospital and extras cover differ in several other ways:
For the best of both worlds, you can get a combined policy that packages both hospital and extras under one health fund. You also have the option to mix and match – getting an extras policy from one fund and hospital from another, depending on what best suits your needs and circumstances.
Medicare is Australia’s public health system that covers the cost of a range of medical, hospital and pharmaceutical treatments. Inside the hospital as an inpatient, Medicare must deem the procedure medically necessary for your private health insurance to be able to pay a benefit.
Private health insurance also allows you to choose your own doctor, stay in a private room in a private hospital (provided one is available) and avoid the public system waiting lists for treatment.
Any person with a Medicare card is entitled to public treatment, whereas only those who have health insurance will receive a benefit towards their private treatment from their fund. If you were to seek private treatment without insurance, you would have to pay the entire cost of this treatment out of your own pocket.
Outside of the hospital, your private health insurance policy may provide cover towards treatments that Medicare doesn’t cover. These treatments can include things like dentistry, physiotherapy and podiatry.
Yes, there is a difference; extras policies only cover treatment provided in a non-hospital setting and while hospital policies will cover your treatment in hospital, it won’t cover your journey there in the first place. This is what ambulance cover is for.
Unless you live in Queensland or Tasmania, the cost of treatment and transport in an emergency ambulance is not covered by the state and territory governments. Meaning you’ll have to pay for these costs yourself – unless you have ambulance cover.
Ambulance cover can be purchased through a registered health fund or ambulance authority, although some funds may include it in their hospital or extras health insurance policies.
Yes, however you’ll need to hold a policy and serve applicable waiting periods before you can make a claim (For example, 12 months). Mandatory waiting periods stop people from immediately taking out hospital or extras cover when they fall ill and flooding the private system.
That’s completely up to you. Some people take out hospital cover only because they want choice if they need surgery. While other people just want extras cover for out-of-hospital treatments like dental, optical and physio. It’s all up to you if you would like to get hospital cover, extras cover or even both.