Private health insurance in Queensland

When it comes to private hospital cover, policies will fall into one of four tiers: Basic, Bronze, Silver and Gold. These are in order of both level of cover and price, so Basic policies have the lowest level of cover and tend to be the most affordable. In contrast, Gold policies have the most comprehensive cover but are typically also the most expensive.

The prices above are based on monthly premiums for Single-only policies that exempt you from the Medicare Levy Surcharge and have a $750 excess. Doesn’t include any rebates, discounts or loadings. Plus policies are included in the base tier (Silver-plus policy prices have been factored in the Silver category).

Like hospital cover, the cost of extras cover can vary greatly depending on the health services included, annual limits and other factors. The average cost for an extras cover policy in Queensland is $86.60.¹ This is slightly above the national average of $84.73. ¹

In Queensland, the state government covers all ambulance costs for QLD residents, which means you don’t need ambulance coverage. This doesn’t just cover ambulance costs within the Sunshine State but also Australia-wide.⁴

If you’re a Queensland resident visiting another state who needs ambulance transport, you will probably receive an invoice for your trip in the ambulance. You can forward this invoice to the Queensland Ambulance Service who will cover the cost, provided you can provide evidence of your Queensland residency to confirm your eligibility.⁴

Extras cover (sometimes referred to as ancillary cover) provides cover for services outside the hospital that Medicare doesn’t cover. This includes out-of-hospital services such as:

• Dental, including dental check-ups
• Physiotherapy
• Optical services and products
• Occupational therapy
• Podiatry
• Chiropractic services
• Natural remedies.

Remember, different policies may offer different cover. There may also be limits applied to how much you can claim and gap payments you’ll need to make. Be sure you understand exactly what your policy includes and excludes to avoid unpleasant surprises in the future.

Hospital cover helps with the healthcare costs of private patients who are admitted to the hospital, including hospital costs, accommodation, consultations, anaesthetist fees and more. Private hospital cover provides various benefits, including your choice of available healthcare provider, a private room (subject to availability) and being able to avoid long public waiting lists for elective surgeries. Since 2019, hospital cover has been categorised under four tiers, which are:

Basic: The minimum level of cover, offering a restricted level of cover for three out of 38 clinical categories.

Bronze: This offers hospital insurance for 3 restricted clinical categories and 18 unrestricted clinical categories.

Silver: This type of policy offers restricted cover for 3 clinical categories and unrestricted hospital cover for 26 clinical categories.

Gold: Unrestricted cover for all 38 clinical categories is available with this type of policy.

Restricted cover refers to being only covered as a private patient in a public hospital. When in a private hospital, your health fund will only pay some costs, like a small amount of your accommodation fee. This means more out-of-pocket fees for you.

Unrestricted cover means you’re covered for all fees as a private patient in a private hospital or private day hospital, the exception being any agreed excess or co-payments. This includes accommodation and theatre fees.

Without knowing your specific details, it’s difficult to estimate how much health insurance will cost you. Several factors will affect the cost of health insurance premiums, including:

• Your excess
• Your level of cover (including your tier of hospital cover and any extras cover)
• Your family status
• Aged-based discounts
• Lifetime Health Cover (LHC) loading
• Whether you receive the private health insurance rebate.