What private health insurance covers

Private health insurance may provide:

If you have hospital cover, you are covered against some or all of the costs of being a private patient in either a public or private hospital. Alternatively, you can still choose to be treated as a public patient in a public hospital at no charge (under Medicare).

There are many hospital cover policies to choose from. These policies cover some or all of the cost of your hospital care and allow you to choose your own doctor or specialist.

As a privately insured patient you may insure against some or all of the costs of health services not covered by Medicare, such as:

Hospital Cover

Extras (Dental/Ancillary) Cover

You can purchase extras (dental/ancillary)cover on its own or together with hospital cover. You can even purchase hospital with one health fund and extras with a different health fund.

Nursing Home Type Patients

If you are in hospital for more than 35 days in succession you will be regarded as a Nursing Home Type Patient (NHTP) unless your doctor specifies otherwise. Generally, all NHTP's have to pay part of the cost of hospital accommodation. Federal Government legislation does not permit health funds to insure you for this part of the cost.

Ambulance Cover

Medicare does not cover the cost of ambulance services. If you want cover for such a service, you must arrange it yourself. You can usually arrange ambulance cover from the ambulance authority in your State.

Health funds may pay or reimburse you for all or part of your annual subscription to your voluntary State ambulance authority or the costs associated with transportation. If you take out a hospital insurance policy in New South Wales or the ACT, you will find your health fund premium may include this cover.

Queensland Residents

Community Ambulance Cover (CAC) replaced the Queensland Ambulance Subscription Scheme and ambulance transport charges on the 1st of July 2003. Quite simply CAC means every all Queensland residents are automatically covered for the cost of ambulance transportation anywhere, anytime, across Australia.

Community Ambulance Cover gives certainty of funding to the Queensland Ambulance Service by spreading the cost across the community. A charge will apply to each electricity sale arrangement unless an exemption has been obtained.

For more information, please refer to the list of Rates levied since the commencement of the scheme. This rate is adjusted annually in line with movements in the Australian Bureau of Statistics Capital Cities Consumer Price Index for Brisbane, for the year to 31 March (CPI).

Community Ambulance Cover is not a ‘user-pays’ system for ambulance services. No Matter who pays for the electricity supplied to your business or household, every Queenslander is automatically covered for the cost of ambulance services nationwide.

Tasmanian Residents

The Tasmanian Ambulance Service provides a free service to Tasmanian residents. The only chargeable cases are those related to motor vehicle or workplace accidents where insurance arrangements cover costs. In addition the Department of Veterans Affairs meet the cost of ambulance transport for veterans.

Arrangements To Cover Medical Gap

Health funds are able to negotiate agreements with hospitals and doctors so that you can know beforehand what costs (if any) you have to pay. Some agreements may give you full cover against the costs of hospital and medical charges. Others may require you to meet part of the costs.

Hospitals, which have agreements with health funds, generally submit a single account for hospital services provided direct to the fund. Doctors who have agreements with health funds also usually forward all accounts to the fund.

If you have a policy that requires you to pay part of the hospital or medical costs, the hospital or doctor may bill you directly. Hospitals and doctors with agreements with your health fund must, whenever possible, inform you of any amount you will have to pay before providing a medical service in hospital.

Your health fund can advise you which hospitals and doctors are covered under its gap arrangements.

Read more about the Medical Gap.