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Health Insurance Cover Options

There are two types of private health insurance available:

  • hospital cover; and

  • extras (dental/ancillary) cover

While hospital cover helps with the cost of treatment by your doctor and other costs like hospital accommodation, extras (dental/ancillary) cover provides benefits for services such as physiotherapy, dental and glasses/contact lenses.

You can take out either one of these types of health insurance on their own, or combine them for a more comprehensive cover.  You can also purchase each type of cover from different health funds.

Hospital Cover

There are various types of hospital cover that you can purchase. Some policies will give you full cover for the cost of hospital and medical charges. Others, for which you will generally pay lower premiums, will require you to meet part of the costs yourself.

You can also elect to pay a lower premium in return for agreeing not to be covered for some conditions (exclusions), or to only receive limited benefits (restrictions)  for a certain condition.

You may also be able to elect to pay a set amount towards the cost of your hospital treatment (an excess) in return for lower premiums.

You could elect to pay a lower premium and take out a hospital cover policy with one or more of the following features:

An exclusion for a particular condition or conditions

If your health insurance policy features an exclusion for a particular condition, you are not covered for treatment as a private patient in a public or private hospital for that condition. For example, if you purchase a private health insurance policy that excludes maternity, hip replacements and knee replacements, and you go into hospital as a private patient for one of these conditions, your health fund will not pay any benefits towards your hospital and medical costs. If you are unsure which conditions are excluded on your health insurance policy you should call HICA on 1300 732 757 or ask your health fund.

An Excess (also known as a front-end deductible)

An excess is an amount of money you agree to pay for a hospital stay before health insurance benefits are payable. For example, if your policy has an excess of $200, you will be required to pay the first $200 of your hospital costs should you go to hospital as a private patient. An excess could apply every time that you go to hospital in a year, or it may be capped at a total amount that you will have to pay in a year. Some policies don't apply the excess to same day admissions, hospital admissions for dependant children or if you are hospitalised due to an accident.  If you are unsure how the excess on your health insurance policy works you should contact us on 1300 732 757.

A co-payment

With a co-payment, you agree to pay an agreed amount each time a service is provided. For example, a health insurance policy may have a co-payment clause that requires you to pay $50 for each night of hospital accommodation. If your policy has such a co-payment and you were in hospital for 5 nights, you would have to pay $250 ($50 x 5 nights). The total amount of co-payment you can pay in a year is sometimes limited to a set maximum amount.

Restricted benefits

If your health insurance policy has restricted benefits for some conditions you will usually be covered for treatment as a private patient in a shared ward of a public hospital for these conditions, but will face considerable out-of-pocket costs if you were to be treated in a private hospital for these conditions.

If you are unsure about whether restricted benefits apply to your health insurance policy you should call HICA on 1300 732 757..

Public Hospital Table

Some health funds offer health insurance policies that have restricted benefits for all conditions. This policy is sometimes called a public hospital table. Under this policy you will be covered for treatment as a private patient in a shared ward of a public hospital, but will face considerable out-of-pocket costs if you were to be treated in a private hospital.

Extras (Dental/Ancillary) Cover

Extras (Dental/Ancillary) Cover is available for a range of non-hospital services such as physiotherapy, optical or dental treatment. This cover is usually available separately or combined with a hospital cover.