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Private hospital cover helps pay for your treatment as a private patient in an Australian hospital. With private hospital cover, you can have your choice of doctor and stay in a private room (both depending on availability), as well as avoid long public waiting lists.

Depending on the treatment you require, you may need to sit through policy waiting periods before you can begin claiming unless you’ve sat through them before and held continuous cover. Waiting periods differ depending on the treatment you need; for example, in-hospital psychiatry services have a waiting period of two months, while pregnancy and birth-related services are 12 months.

Changes to hospital cover

As of 1 April 2019, the Federal Government introduced reforms in a bid to help simplify private health insurance. The reforms split hospital cover into four categories: Basic, Bronze, Silver and Gold. Providers had until 1 April 2020 to implement these reforms.

Each category has a set number of benefits and treatments regardless of which health fund you’re with. That said, providers have the choice of adding ‘plus’ or ‘+’ to Basic, Bronze and Silver policies which include extra coverage that isn’t mandated by the reforms.

What does hospital cover include?

What’s covered by your hospital insurance will depend on what tier policy you have, as higher-level cover will offer more benefits. For example, Basic only includes cover for three of the 38 clinical categories, while Gold covers all of them.

Here’s a glimpse of what each hospital insurance tier covers:

TreatmentsTier
BasicBronzeSilverGold
RehabilitationR
Hospital psychiatric servicesR
Palliative careR
Brain and nervous system 
Ear, nose and throat 
Joint reconstructions 
Heart and vascular system  
Back, neck and spine  
Dental surgery  
Joint replacements   
Pregnancy and birth   
Weight loss surgery   
R – indicates that the category is a minimum requirement of the tier

You can find out the full list of treatments covered by the health insurance tiers on our health insurance categories page.

What does hospital cover exclude?

It’s simple really: your hospital cover generally doesn’t include treatment that occurs outside a hospital, including but not limited to:

  • dental checkups
  • physiotherapy sessions
  • chiropractic work
  • optometry (such as prescription glasses).

The above treatments are subsidised by extras policies, which are sometimes called ancillary policies.

The treatments from your cover will also depend on your level of insurance; for example, with a Silver policy some examples of exclusions include cover for weight loss surgery and pregnancy and birth.

Frequently asked questions

What is the top hospital cover?

The highest level of hospital cover is Gold, which includes coverage for all 38 clinical treatments available under private hospital insurance.

What is basic hospital cover?

Basic hospital cover is the lowest level of private hospital insurance and is a great option for those seeking a policy for the purpose of avoiding tax implications like the Medicare Levy Surcharge (MLS). It includes restricted coverage for hospital psychiatric services, rehabilitation for patients recovering from surgery or illness and palliative care. If you’re choosing to be treated as a private patient in a public hospital, you may be subject to public waiting lists for these services.¹

Some providers may also offer Basic ‘plus’ policies that come with additional benefits.

Is ambulance covered by private health insurance?

Depending on which state or territory you live in, ambulance services may be covered by your private health insurance. Residents in all states and territories except for Queensland (QLD) and Tasmania (TAS) (where ambulance services are free), can take out ambulance cover through their private health insurer or their state’s ambulance authority.

People who hold a Department of Veterans’ Affairs Gold Card are entitled to free ambulance services across Australia, while residents of QLD and TAS have their ambulance costs covered by their state governments.

NSWThe NSW state government subsidises 49% of the cost of ambulance services for people who don’t have ambulance cover. However, this can still be costly, which is why ambulance cover is widely available through registered Australian health funds in NSW.
People with a Health Care Card, Pensioner Concession Card, Commonwealth Seniors Health Care Card and who otherwise meet NSW’s exemption criteria can access ambulance services at no cost.²
VICResidents of VIC can take out ambulance cover through a registered Australian health fund.
People who hold a Pensioner Concession Card or Healthcare Card are entitled to free ambulance cover.
QLDThe QLD state government covers ambulance services for their residents in both Queensland and around Australia.
If you receive a bill for ambulance services in another state or territory, you can forward it, along with proof of QLD residency, to the Queensland Ambulance Service.
WAResidents of WA can take out ambulance cover through a registered Australian health fund.
SAResidents of SA can take out ambulance cover through a registered Australian health fund
TASAmbulance services in TAS are free to residents, except for motor vehicle or workplace accidents which are covered by insurance. Unlike QLD, Tasmanians can only receive to free ambulance cover in their state.
ACTResidents of ACT can take out ambulance cover through a registered Australian health fund.
People who meet the ACT Ambulance Service’s exemption criteria are entitled to free ambulance services.
NTResidents of NT can take out ambulance cover through a registered Australian health fund.
What is hospital cover excess?

Hospital cover excess is the lump sum you pay when you get admitted to hospital. Sometimes you can choose a higher excess in exchange for a lower premium, and vice versa. Some providers might apply the excess only once per year, and others might charge it for each admission.

What are hospital cover co-payments?

Similar to excess, co-payments are an amount you pay when you’re admitted to hospital. However, they are paid for each day you’re in the hospital. For example, you may choose a co-payment of $100 per day in hospital, which would result in a $500 payment if you’re admitted for five days.

Co-payments can also be capped per admission, per year of membership or both.

Why should I get hospital cover?

You could be eligible for a rebate
Depending on your age and income, you could receive a rebate from the Federal Government on the cost of your hospital cover. You can choose to receive this with your tax return or as a discounted premium.

Avoid extra tax
The MLS is a tax levied on higher-income earners ($90,001+ for singles and $180,001 for families) who don’t have hospital cover. If you want to avoid it, get covered – simple as that!

Lock in a low rate with Lifetime Health Cover
By taking out hospital cover before 1 July following your 31st birthday, you will not be subject to the Lifetime Health Cover (LHC) loading for as long as you hold the cover, even if you switch between health funds. Conversely, purchasing private insurance after this age may subject you to a two per cent loading on your premiums for every year you don’t have cover as part of the Government’s Lifetime Health Cover regulations. LHC loading caps out at 70% and is removed once you’ve held continuous cover for ten years.

Peace of mind
Above all, hospital cover gives you the confidence of knowing that when a medical event arises, you and your family are covered with high-quality private care. The most important thing in life is your health. Regardless of what stage of life you’re in, everyone can benefit from private hospital cover.

How can I get hospital cover?

A great way to find a good deal on hospital cover is by shopping around and comparing your options – which we can help you do right now with our health insurance comparison service.

Our service is quick, simple and completely free to use, so you can search and compare policies all day long if you want to. Simply enter in some details about you and the sort of coverage you’re after to get the ball rolling.

So, what are you waiting for?

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