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Hospital Only Health Insurance

Key Points
  • Faster Access to Elective Surgery: With hospital cover, you can enjoy quicker access to elective surgeries, avoiding long public system waiting lists.
  • Choice of Doctor and Hospital: Private health insurance offers the flexibility to choose your preferred doctor and hospital, giving you more control over your care.
  • Private Room Options: Depending on availability, hospital cover provides access to private rooms, ensuring greater comfort and privacy during your stay.
  • Hospital Cover Levels: Hospital cover is available in various levels, including Basic, Bronze, Silver, and Gold. Choose the one that aligns with your health needs.
  • Comprehensive Gold Cover: Gold-level hospital cover includes a broad range of services, including joint replacements and maternity care, offering extensive coverage.
  • Shorter Waiting Times: With private hospital cover, enjoy shorter waiting times compared to the public healthcare system, enabling faster treatment.
  • Hospital Cover Benefits: Enjoy coverage for essential medical services like surgeon fees, prosthetics, pharmaceuticals, and more, ensuring comprehensive protection.
  • Consider Your Budget and Health Needs: When selecting hospital cover, it’s important to consider your budget, specific health needs, and any policy exclusions.
  • Avoid the Medicare Levy Surcharge: Having private hospital cover can help you avoid the Medicare Levy Surcharge, which can apply if you don’t have adequate coverage.
  • Compare Policies with Compare Your Health: Use Compare Your Health’s comparison tool to explore different policies and find the one that suits your needs and budget.

Australia’s Healthcare System and the Benefits of Private Health Insurance

Australia offers both public and private healthcare systems, each with varying levels of care and coverage. By choosing private health insurance, you can access a range of benefits, including:

  • Faster Access to Elective Surgery: Get quicker treatment for elective surgeries compared to the public healthcare system, reducing wait times.
  • Choice of Surgeon: With private health insurance, you have the freedom to choose the surgeon that suits you best.
  • Choice of Hospital: You can select your preferred hospital, whether it’s public or private, allowing you greater control over your healthcare experience.

Additionally, private hospital cover provides the added benefit of private rooms (subject to availability), offering more comfort and privacy during your hospital stay.

Types of Private Health Insurance in Australia

Australian private health insurance plans fall into three main categories:

  • Hospital-Only Cover: This cover is for in-hospital treatment and helps with expenses like surgeries and hospital stays.
  • Extras-Only Cover: This provides coverage for out-of-hospital services such as dental care, optical, physiotherapy, and more.
  • Combined Cover: A combination of both hospital and extras cover, offering comprehensive protection for all your healthcare needs.

With over 50 health funds in Australia, each provider offers unique policies tailored to different healthcare needs. Finding the right one can feel overwhelming, but Compare Your Health’s insurance comparison tool makes it easy to discover the best health fund that suits both your healthcare requirements and budget.

In this post, we’ll take a closer look at hospital-only cover, its benefits, and tips for choosing the right policy. Let’s dive in and explore how this type of cover can be a valuable choice for your healthcare needs.

What is Hospital Cover?

Private hospital cover is a type of insurance that helps cover the cost of hospital stays, especially for elective surgery and other treatments not available in the public system. The benefits of private hospital cover are:

  1. Choice of Doctor: You can choose your doctor or specialist for treatment.
  2. Choice of Hospital: You can choose from a range of private participating and public hospitals.
  3. Shorter Waiting Times: Avoid the long waiting times in the public system, especially for non-emergency elective procedures.

Hospital coverage is available on several levels, each with varying degrees of coverage and benefits. The main levels of hospital cover are:

  • Basic Hospital: This covers the minimum required for essential treatment, but many services are restricted or excluded.
  • Basic Plus Hospital: Adds a few more services to the Basic level but still has many limitations.
  • Bronze Hospital: Covers more services, including basic treatments like joint reconstructions and hernia repairs.
  • Bronze Plus Hospital: Adds more services beyond the standard Bronze level, depending on the provider.
  • Silver Hospital: Includes all Bronze services plus more complex treatments like heart and lung procedures.
  • Silver Plus Hospital: Adds to Silver level with some Gold level services.
  • Gold Hospital: Gold Hospital is the most comprehensive hospital coverage, covering all clinical categories, including joint replacements, pregnancy, and cataract surgery.

Each level is designed to suit different healthcare needs, so you need to choose the right level of cover for your personal health and budget. Knowing what’s covered in each level will help you decide which hospital cover is best for you.

Extras Included in Hospital Cover

Private hospital cover is more than just for elective surgery. Depending on the level of cover you choose – Basic, Bronze, Silver or Gold – there are other treatments and services included. These services go beyond surgery and are important to your overall healthcare experience. Here are some common inclusions in many hospital cover policies:

  1. Selected Medical Admissions: Covers non-surgical medical treatments that are directly related to services covered under your policy (e.g. treatments related to chronic conditions or acute medical needs).
  2. Day Surgery: Procedures are done on a day-patient basis so you can go home the same day after treatment.
  3. Overnight Accommodation: Private room accommodation when available or shared room in a private hospital.
  4. Special Care Unit Accommodation: Covers the cost of intensive care or other specialist care units when required.
  5. Operating Theatre Fees: Use of the operating theatre for surgery or invasive treatments.
  6. Doctor’s Surgical Fees and In-Hospital Consultations: Surgeon or other specialist fees during your hospital stay.
  7. Government-Approved Prosthetic Devices: Prosthetics like joint replacements, pacemakers or other government-approved devices.
  8. Allied Health Services: In-hospital services like physiotherapy, occupational therapy and other rehabilitative treatments.
  9. Pharmaceuticals: Medicines approved by the Pharmaceutical Benefits Scheme (PBS) are required during your hospital stay related to specific treatments.
  10. Ward Drugs and Sundry Medical Supplies: These include medical supplies needed during your stay, such as bandages, painkillers, and other routine medications.
  11. Nursing Care: During your hospital admission, professional nursing services for monitoring or treatment.
  12. Patient Meals: Meals during your stay in the hospital are covered by most hospital insurance policies.
  13. Common Treatments and Supportive Care: Routine treatments like wound care and support for associated conditions during hospitalisation.
  14. Associated Treatment for Complications: Treatments that arise from complications during surgery or medical procedures and any associated unplanned treatments.

By including these extras, hospital-only cover covers everything that goes beyond surgery. So, all your hospital-related needs, from specialist treatments to recovery, are taken care of with minimal out-of-pocket expenses.

Levels of Hospital Cover

Private hospitals cover in Australia have 38 clinical categories that cover a wide range of medical procedures, from simple ones like hernia repairs to complex ones like joint replacements or cataract surgeries.

Basic Hospital

The Basic Hospital level is the most limited level of cover and covers:

  • Rehabilitation (restricted)
  • Hospital Psychiatric Services (restricted)
  • Palliative Care (restricted)

Restricted means the cover for these services is minimal and you will only receive reduced benefits if you’re admitted to a hospital. For example, it doesn’t cover the full cost of private accommodation in public or private hospitals, so you may face significant out-of-pocket expenses for theatre fees, accommodation or other related costs if treated in a private hospital. If you’re treated as a public patient under Medicare, public hospital waiting lists will apply, so you should consult your doctor to determine the best option.

Basic Plus Hospital

The Basic Plus level includes the same restricted services as Basic but with at least one or more of the benefits from higher levels (Bronze, Silver, or Gold). Not all Basic Plus policies are the same, so read the fine print. For example, nib’s Basic Essential Hospital Plus covers 7 clinical categories in private hospitals, and Medibank’s Basic Plus Healthy Start covers 3.

Bronze Hospital

By law, Bronze hospital cover must include a broader range of clinical categories so you’ll have access to treatments like:

  • Brain and Nervous System
  • Eye (not Cataracts)
  • Ear, Nose and Throat
  • Tonsils, adenoids and grommets
  • Joint Reconstructions
  •  Kidney and Bladder
  •  Male Reproductive System
  •  Digestive System
  •  Hernia and Appendix
  •  Gynaecology
  •  Miscarriage and Termination Of Pregnancy
  •  Chemotherapy, Radiotherapy and Immunotherapy for Cancer
  •  Pain Management
  •  Skin
  •  Breast Surgery (medically necessary)
  •  Diabetes Management (Excluding Insulin Pumps)

This level has more protection. Many common surgeries and treatments are covered, but some significant services, like heart procedures and major surgeries, may still be excluded.

Silver Hospital

Silver hospital cover adds to Bronze by covering more advanced treatments like:

  • Heart and vascular system
  •  Lung and chest
  • Blood
  • Back, neck and spine
  • Plastic and reconstructive surgery (medically necessary)
  • Dental surgery
  •  Podiatric Surgery (provided by a registered podiatric surgery)
  • Implantation of hearing devices

Silver is for those who want a more comprehensive policy without paying for all the services covered under Gold.

Gold Hospital

Gold hospital cover is the most comprehensive and must cover all clinical categories, so it is best for those with complex medical needs. In addition to the services covered by Bronze and Silver, Gold also covers:

  • Cataract surgery
  • Joint replacements
  • Dialysis for chronic kidney failure
  • Pregnancy and Birth
  • Assisted reproductive services (e.g. IVF)
  • Weight loss surgery
  • Insulin pumps
  • Pain management devices
  • Sleep studies

Gold is for families planning to have children, those with chronic health conditions or those who require frequent specialist treatments.

Understanding the differences between these levels of hospital cover is key to choosing the right policy for you. Each level is designed to cater to different healthcare needs, from basic to full coverage of high-end treatments.

Use Compare Your Health  comparison tool to navigate these options and find the right hospital cover for you.

 

Hospital Cover Benefits

Hospital cover offers many advantages to those who have private health insurance beyond what’s available in the public system. Some of the benefits include:

Shorter Waiting Times

One of the biggest benefits of hospital cover is that you can have elective surgery much sooner than the public system. In 2022-23, public hospitals across Australia had extended waiting times for elective surgery due to the backlog caused by COVID-19 disruptions. On average, patients waited 49 days for their surgery in 2022-23, up from 40 days the previous year. For some surgeries, like hip and knee replacements, waiting times were over 365 days.

In contrast, private hospital cover allows for faster scheduling of elective procedures, often within weeks, depending on the doctor and hospital. This is especially important for non-emergency treatments that affect your quality of life, like cataract surgery or joint replacements, so you can have peace of mind and relief from pain or discomfort sooner.

Private health coverage gives you more choices and reduces the stress of long waits so you can take control of your health. For reference, 9.6% of patients in public hospitals waited over a year in 2022-23, which is over 70,000 people.

Choice of Doctor

One of the big benefits of private hospital cover is the ability to choose your doctor or specialist. This means you can pick a healthcare provider based on their expertise, reputation or familiarity with your medical history. This level of choice can make a big difference in the outcome of your treatment, as you’ll feel more comfortable and confident with a doctor you know.

Private Room Options (Where Available)

Private health insurance gives you more comfortable accommodation during hospital stays. In public hospitals, patients are put in shared rooms with other patients, separated only by curtains. With private hospital cover, you may have access to a private room (if available), which can be more private, comfortable and peaceful during your recovery. Private rooms are subject to availability, but having the option can make the hospital experience better, especially for longer stays.

Tax Benefits

Private hospital cover can also help you avoid the Medicare Levy Surcharge (MLS) which is a tax on individuals who earn over a certain income and don’t have private hospital insurance. For singles earning over $97,000 or families over $194,000, the MLS can be 1% to 1.5% of their income. By having eligible private hospital cover, you can avoid this extra tax and potentially get the Australian Government Rebate, which reduces your premium based on your income and age.

How to Choose the Right Hospital Cover

  • Choosing the right hospital cover is important so you have the right support when you need medical attention and potentially avoid big out-of-pocket costs. To make the best choice you need to consider the following:

    Assess Your Health and Lifestyle

    Firstly, you need to assess your current health and lifestyle. Ask yourself:

    • Do you have any pre-existing conditions that may need hospital treatment in the next 12 months?
    • Are you planning for major life events like pregnancy that may require hospital services?
    • What’s your family health history, and could it impact your future healthcare needs?

    You may opt for basic cover if you’re generally healthy. But if you foresee needing specialist treatments or surgeries, a more comprehensive cover might be worth considering.

    Budget

    Your budget is a big factor when choosing hospital cover. You can pay premiums fortnightly, monthly, quarterly or annually. Keep these in mind:

    • Understand your level of cover: More comprehensive cover with fewer exclusions will generally cost more.
    • Look at excess and co-payment options: These can reduce your premium, but be prepared for higher out-of-pocket costs when you claim.
    • Compare health funds: Use comparison tools like Compare Your Health  platform to ensure you’re getting the best value for your money for your specific needs.

    How Much Cover Do You Need

    Private hospital cover in Australia is split into four levels: Basic, Bronze, Silver and Gold. Each level covers different types of treatments:

    • Basic: Covers essential services but often at a limited level. You may have limited benefits or higher out-of-pocket costs for many treatments.
    • Bronze, Silver and Gold: These levels cover increasing levels of hospital services. Gold is the most comprehensive, covering everything from pregnancy and joint replacements to assisted reproductive services and cataracts.

    Please read the policy details to determine what is covered and what is not for each level.

Waiting Periods and Exclusions

When you take out an Australian private health insurance policy, you’ll need to be aware of waiting periods. These are time frames that begin from the day you purchase your policy. During this waiting period, you won’t be able to claim or access any benefits covered by your policy. If you need medical services during this time, you’ll be responsible for covering the full cost yourself. The length of waiting periods varies depending on the type of treatment or service.

Here are the standard waiting periods for common health insurance benefits:

  • New Conditions: 2 months
  • Pre-existing Conditions: 12 months
  • Rehabilitation, Psychiatric Care, and Palliative Care: 2 months
  • Pregnancy and Birth-related Services: 12 months
  • IVF and Assisted Reproductive Services: 12 months
  • Weight Loss Surgery: 12 months

If you’re switching to a new policy and have already served the waiting period with your previous insurer, you won’t need to serve it again. This can help you transition smoothly to your new coverage without additional waiting times.

Compare Health Insurance Policies to Find the Right Fit

When choosing the best hospital cover for your needs, it’s important to compare policies from different insurers. Policies can vary significantly in key areas like hospital networks, gap cover, and additional benefits. Here’s what to keep in mind when comparing:

  • Hospital Network: Each insurer has its own network of hospitals. Before committing to a policy, make sure the insurer’s network includes your preferred hospitals and specialists. A larger network offers greater flexibility in where you can receive treatment, especially for elective surgeries.
  • Gap Cover: Sometimes, the cost of medical services may exceed what Medicare and your insurer will pay, resulting in a “gap” or out-of-pocket expenses. Some insurers have better gap cover arrangements with specific hospitals and doctors, which can reduce or eliminate these costs. Be sure to compare the gap cover offered by each insurer, as well as their agreements with hospitals or specialists you might want to use.
  • Clinical Category Coverage: Hospital policies come in various tiers—Basic, Bronze, Silver, and Gold. Each level covers different clinical categories, so it’s important to compare what is fully covered under each policy and what services may be restricted or excluded (e.g., joint replacements, cataract surgery, heart procedures).
  • Additional Out-of-Hospital Benefits: Some insurers offer extra services outside of hospital care as part of their hospital cover. For example, some provide home-based healthcare, such as rehabilitation, mental health support, or post-surgery recovery services. These benefits can be invaluable, allowing you to recover in the comfort of your own home.

By considering these factors and using Compare Your Health’s comparison tool, you can easily compare policies from different insurers and find the plan that best suits your healthcare needs and budget.

 

Hospital Cover vs. Medicare: Understanding the Differences

Medicare, Australia’s public healthcare system, provides free or low-cost medical services for in-hospital treatments. For many procedures, such as joint replacements, you won’t need to pay for the surgery if you’re treated as a public patient in a public hospital. Medicare is considered one of the best public healthcare systems globally, ensuring essential health services are available to all Australians.

However, relying solely on Medicare has its limitations. While it covers in-hospital treatments, there are challenges, especially for elective surgeries. One of the biggest drawbacks is the long waiting times in the public system. Non-urgent procedures can often have significant delays, with some waiting for months, or even over a year, for treatment. For example, 9.6% of elective surgeries in the public system in 2022-23 were delayed by more than a year.

Additionally, when you are admitted as a public patient under Medicare, you don’t have a say in which surgeon performs your procedure or which hospital you’re treated at. After surgery, you’ll likely recover in a shared room with other patients, which can limit your privacy and comfort compared to what you’d experience with private healthcare.

Hospital cover through private health insurance helps address these limitations by offering more control over your healthcare experience. With private hospital cover, you can:

  • Choose your surgeon and hospital
  • Access quicker treatment for elective surgeries, reducing waiting times
  • Recover in a private room (where available), enhancing your comfort and privacy

Private health insurance provides more flexibility and comfort, making it a valuable option for those who want greater control over their healthcare.

Government Incentives and Rebates for Private Health Insurance

The Australian Government offers several incentives and rebates to make private health insurance more affordable, particularly for individuals and families who may otherwise face higher premiums. Understanding these incentives can help you reduce your costs:

  • Private Health Insurance Rebate (AGR – Australian Government Rebate)
    The Private Health Insurance Rebate is one of the most well-known incentives designed to make health insurance more affordable. The rebate is income-tested and based on your age and taxable income. Generally, the rebate decreases as your income increases. Seniors receive a higher rebate due to their increased healthcare needs, while younger individuals with higher incomes may receive a lower rebate or none at all. The rebate can be applied to your premiums or claimed as a refundable offset at tax time.
  • Medicare Levy Surcharge (MLS)
    The Medicare Levy Surcharge is a tax penalty imposed on higher-income earners who do not have eligible private hospital cover. It ranges from 1% to 1.5% of your income, depending on how much you earn. The surcharge encourages Australians to take out private hospital insurance by forcing individuals to either pay for health insurance or incur a higher tax. Having private hospital cover helps you avoid the surcharge and provides additional benefits like faster treatment.
  • Lifetime Health Cover (LHC)
    The Lifetime Health Cover Loading is a government initiative aimed at encouraging individuals to take out hospital cover earlier in life. If you don’t take out private hospital insurance by July 1st following your 31st birthday, you will incur a 2% loading on your premium for every year you delay, up to a maximum of 70%. This loading remains in effect for 10 years once you take out cover. Taking out insurance early can help you avoid this additional fee.
  • Young Persons Discount (YPD)
    The Young Persons Discount is available for individuals aged 18-29 who take out private hospital cover. It offers a reduction of up to 10% on premiums, which decreases by 2% each year until the age of 40. This incentive encourages younger Australians to invest in private health coverage, stay insured long-term, and benefit from lower costs earlier in life.

Get the Most Out of Incentives

By using government incentives, you can save a lot on private health insurance. Make sure you assess your needs and qualify for these rebates and benefits. That way, you’ll get the most savings and cover for you and your family.

For personalised advice on how to get the most out of your private health insurance and access these government incentives, contact Compare Your Health at enquiries@healthdeal.com.au or call 1300 369 399

Changing Your Hospital Cover Made Easy

Changing your hospital cover is simple with Compare Your Health. We handle the entire process for you, so you don’t have to worry about a thing. When you sign up for a hospital cover policy through Compare Your Health, we’ll ask for your Medicare card number, previous health fund member number, and payment details. Once you submit your application, here’s what happens:

  • Secure Transfer of Your Information: We’ll send all your details securely to your new health fund.
  • Welcome Email: You’ll receive a welcome email with your new health fund details.
  • Transfer Certificate Request: Your new health fund will request a transfer certificate from your previous fund, which outlines any waiting periods you’ve already served.
  • Cancellation of Direct Debits: Your old health fund will cancel your ongoing direct debit and refund you any pre-paid money on a pro-rata basis (this typically takes about 10 working days).
  • New Health Fund Card and Onboarding Call: Your new health fund will mail you a card and contact you for an onboarding welcome call from their customer service team.
  • Automatic Payment Setup: All payments will be set up during the sign-up process, so you can relax and enjoy your new health cover.


Here’s the revised content for Compare Your Health:

Hospital Cover for Different Life Stages

As you move through various life stages, your health insurance needs will change. It’s important to align your hospital cover with these changes to ensure you’re getting the right coverage without paying for services you don’t need. Below is a guide to help you choose the right hospital cover for each life stage:

  • Young Adults (Under 30s)
    If you’re healthy and don’t need extensive medical care, Basic or Basic Plus hospital cover is typically sufficient. These plans cover essential services like psychiatric care, rehabilitation, and palliative care, but may offer limited coverage for other procedures. Additionally, young adults can qualify for the Young Persons Discount (YPD), which can reduce premiums by up to 10% if you take out cover before age 30, making hospital cover more affordable.
  • Starting a Family (20s-40s)
    If you’re planning to start or grow your family, upgrading to Gold hospital cover is recommended. Gold policies cover all essential services, including pregnancy, birth-related services, and assisted reproductive technologies like IVF. Since birth-related services are only covered by top-tier policies, it’s important to plan ahead and serve the waiting periods (usually 12 months) before you need these services.
  • Middle-Aged Adults (40s-50s)
    As you enter your 40s, you may need more comprehensive cover to address age-related conditions such as cardiac care and joint reconstructions. Bronze or Silver hospital cover offers a good balance of affordability and a broad range of services. If you haven’t yet taken out hospital cover by age 31, be mindful of the Lifetime Health Cover (LHC) loading, which adds a 2% surcharge for each year you delay purchasing hospital cover after your 30th birthday.
  • Finished Having Kids (40s-50s)
    After finishing your family, it’s important to review your hospital cover to ensure you’re not paying for services you no longer need, such as pregnancy and birth-related services. Silver Plus hospital cover may be a good option at this stage as it covers common health conditions but excludes obstetrics, ensuring you’re not overpaying while still having access to necessary treatments.
  • Empty Nesters (50s-60s)
    As your children become independent, your health priorities may shift toward managing chronic conditions or preventive care. Silver Plus or Gold cover is ideal for this stage, as these plans provide coverage for age-related procedures like cataract surgeries, joint replacements, and weight loss surgery. Depending on your health history, you may also want to consider policies that cover podiatry, cardiac services, and joint reconstructions.
  • Seniors (60+)
    As you enter your senior years, you’ll likely need more medical attention. Consider Silver Plus cover to protect yourself against complex procedures like joint replacements, dialysis, cataract surgeries, and chronic illness management. At this stage, eliminate unnecessary services (such as pregnancy or assisted reproductive services) to manage costs while prioritising essential healthcare services.

How to Make a Claim for Your Elective Procedure

When undergoing an elective procedure in Australia, managing the claims process is essential to avoid unexpected costs. Here’s how you can handle it step-by-step:

  • Before the Procedure:
    Confirm your coverage with your health fund, including details about your hospital and doctor’s agreements with your insurer. Check if you will face any out-of-pocket costs, often referred to as “gaps.”
  • At the Hospital:
    Depending on your policy, you may be required to pay an excess or co-payment upfront. Make sure you’re aware of these costs before your procedure.
  • Post-Procedure Bills:
    If you receive a bill from your doctor, lodge the claim through your health fund’s website, app, or by phone. Keep all receipts, invoices, and treatment details for reference.
  • Direct Claims by the Doctor:
    Often, the hospital and doctor will submit the claim directly to your health fund. In this case, the process will be handled between the health fund and the hospital, and you will only need to pay any gap fees that may arise.
  • Post-Claim:
    Even after your claim is processed, check for any remaining gap payments. Keep all bills and claims for future reference, as you may need them for verification or future claims.

FAQs

What is Gap Cover?

Gap cover helps reduce out-of-pocket costs when a doctor or hospital charges more than the Medicare Benefits Schedule (MBS) fee. There are two types:

  • No Gap: – This where there will be no gap for you to pay following the procedure
  • Known Gap: – This is where you will be charged a maximum gap of $500 per specialist, per admission to hospital or a maximum of $800 for obstetrics services

I’ve Been Told I Have a Gap From My Doctor; What Can I Do?
You can ask your doctor if they participate in another health fund’s gap cover arrangement. Switching health funds might help reduce or eliminate your gap fees. Plus, you won’t have to re-serve waiting periods, even for pre-existing conditions, as long as you’ve already served the initial waiting period.

Can I Change My Doctor If I Have a Gap?
Yes, you can change doctors before surgery if you’re not satisfied with the gap fee. Contact your health fund or use their online tools to find doctors who participate in their gap cover arrangements.

What’s Covered in Hospital-Only Cover?
Hospital-only cover includes treatments that require in-patient care, meaning you are formally admitted to the hospital. This usually covers day surgeries, overnight stays, and certain procedures that require a hospital setting. However, it doesn’t cover outpatient services, such as consultations or follow-up visits where you’re not admitted. Coverage varies depending on your policy tier (Basic, Bronze, Silver, or Gold). Be sure to check your health fund’s clinical category coverage to see what’s fully covered.

Compare Now

Hospital coverage can offer significant benefits, and the best way to choose the right hospital-only insurance provider is by using the Compare Your Health Insurance Comparison tool. With this tool, you can easily compare health insurance plans, costs, and providers to find the best option for you.

Need Expert Advice?

if you need expert guidance,feel free to reach out to us:

Contact: Compare Your Health
Email: info@compareyourhealth.com.au
Phone: 1300 631 373

Get in touch with our experts for tailored advice and support in making informed health insurance decisions for you and your loved ones.

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Frequently Asked Questions

Depending on the policy, private health insurance can help cover the cost of your medical treatments in or out-of-hospital that Medicare sometimes won’t cover. Out of hospital treatment can include services such as Dental, optical, physiotherapy or even remedial massage

Private health insurance can help cover medical treatment received when hospitalised. Therefore, it is important to select the right level of cover for the clinical categories that are necessary to you.

Your private health insurance should change as often as needed to ensure you are covered at all the different stages of your life.

Also, private health insurance gives you the ability to choose your own doctor and avoid any public waiting lists for categories covered by your policy.

There are many top competing health funds, however you want to find one that is best suited to your individual health requirements and not just a health fund that is the best in the market.

This can sometimes be a difficult task for individuals, therefore companies like Health.Compare can offer comparisons of different health insurance policies to help you choose a policy that is catered to your health circumstances and budget.

Excess is the amount you pay upfront to cover some of the hospitalisation expenses if you ever get hospitalised. The higher the excess, the lower your private health insurance premiums will be. This usually applies to people with relatively lower health concerns who do not see themselves being in hospital anytime soon and in the event that they are hospitalised, they can agree to pay a higher excess, ultimately reducing their regular premiums.

Please be aware that excess amounts do vary depending on the health insurance provider, so it may be beneficial for you to consider your individual health and financial circumstances at the time of buying the insurance policy before agreeing to the Excess amount.

In Australia, health insurance is not tax deductible however you can receive rebates for your private health insurance. When taking out Private Health Insurance you choose whether or not to claim a rebate from the government. The government rebate is dependent on a number of factors including age and taxable income.

This can be applied to Hospital, Extras or combined products.

According to a recent report by APRA, 55.2% of Australians have extra cover, and 45.2% have hospital cover. These are the verified figures as of June 2022.

While the average cost of private health insurance adds up to $160 per month per person, your premiums may go up or down depending on the type of cover you choose or the excess amount you agree upon.

The starting point for many, is to look at your individual needs, preferences and financial circumstances.

We will help guide you through this conversation by first understanding and then matching your needs to a tailored level of cover. Ultimately, what’s best for you and your situation will be completely different to many others who are eligible for Private Health Insurance.

Yes you can have a private hospital insurance policy with one health fund and extras cover with another. This can be helpful as some funds might have a hospital policy you like, but not the extras cover you require for the specific out-of-hospital treatments.

Private health insurance provides many benefits to its members giving them access to a wide choice of health providers, faster access to medical services and the ability to avoid long wait times experienced in the public hospital system. In this FAQ we will answer some of the common questions about private health insurance.

What are the benefits of having private health insurance?

  • Access to private hospitals and faster treatment times
  • A wider range of treatment options
  • Ability to choose your own doctor and hospital
  • Reduced out-of-pocket expenses
  • Access to many health services and treatments not covered by the public system

Can I choose my own doctor and hospital if I have private health insurance?

Yes, with private health insurance you have the ability to choose your own doctor and hospital, giving you greater control over your health care to achieve a better overall health outcome.

How can I choose the right private health policy for me?

When choosing private health insurance, there are a few factors to consider:

type of cover required (hospital or extras)

  • your budget
  • your age and pre-existing medical conditions
  • the level of cover required
  • the range of health services you need to be covered for

Why should I get extras cover?

extras cover will give you further coverage on a range of treatments such as dental, optical, chiropractic, massage and physiotherapy.
some extras health policies also include further natural therapies such as acupuncture and Chinese medicine

How much does private health insurance cost?

The cost of a health policy in Australia varies depending on what type of cover you choose, your age, if you have any dependents and any pre-existing conditions. On average, the cost of private health insurance is around $2,000 per year for an individual and $4,000 per year for a family.#

In Australia, private health insurance is available to provide financial protection and contribution to medical expenses, but not all medical expenses are covered by your private health policy. In this FAQ we will explain the questions you have around what is typically covered and what’s not covered with private health insurance.

What is not covered by standard private health insurance?

The most common exclusions from private health insurance policies in Australia include:

  • Elective cosmetic operations, such as cosmetic surgery and cosmetic dentistry
  • Weight loss surgery, unless it is deemed medically necessary
  • Infertility treatments, such as IVF
  • Alternative therapies, such as homeopathy, aromatherapy, kinesiology, reflexology and iridology
  • Mental health services, such as counseling and psychotherapy, unless they are part of a hospital treatment plan
  • Non-medical services, such as transportation and accommodation for medical treatment
  • International travel for medical treatment
  • Experimental treatments or procedures that are not yet widely accepted or covered by Medicare

Does private health insurance cover dental services?

No, private health insurance does not generally cover routine dental services, such as check-ups, cleanings, and fillings. However, some private health insurance policies may offer coverage for more extensive dental procedures, such as orthodontics and oral surgery, that are performed in a hospital setting.

Does private health insurance cover optometry services?

Similar to dental, optometry services are not covered by private health insurance such as eye examinations although prescription glasses and contact lenses are covered by private health extras policies.

Am I covered for ambulance services?

Not all private health policies cover individuals for ambulance services. However, some states in Australia automatically cover policy holders through their state or territory.

Will my private health policy cover prescription drugs?

No, private health insurance policies in Australia do not cover prescription drugs. Prescription drugs are covered by the Pharmaceutical Benefits Scheme (PBS), which is a government-funded program.

In conclusion, it’s important to understand what is not covered under your policy to avoid any surprises when you need to make a claim. While most health insurance policies provide coverage for a wide range of medical expenses, there are still some things that are not covered, and it is important to understand these exclusions.

So, you have private health insurance and want to know how much you might have to pay for medical treatments out of your own pocket? We’ve got you covered with our easy guide FAQ.

What does ‘no gap’ mean when it comes to private health insurance?

Basically, it means that you won’t have to pay anything out of your own pocket for certain medical services, these are covered by your private health insurance. It’s the difference between what your doctor or hospital charges and what Medicare and your private health fund will pay and it’s known as the ‘gap’. With a ‘no gap’ arrangement, your insurance will cover the full cost of the service.

So, I won’t have to pay anything extra?

That’s right! With the ‘no gap’ arrangement, you won’t be left with any unexpected bills to pay. Your private health insurance will cover the full cost of the medical service, so you can focus on your health and recovery.

How does it work?

To be eligible for a ‘no gap’ service, you’ll need to use a provider who is part of your private health insurance provider’s ‘preferred provider’ network. This means that the provider agrees to charge you a set fee for a particular medical service, and your private health insurance will cover this fee in full. This way, you can be sure that you won’t have to pay anything out of your own pocket.

Can I get ‘no gap’ for any medical procedure?

Unfortunately, ‘no gap’ is only available for some medical services, and only if you use a provider who is part of your private health insurance provider’s ‘preferred provider’ network.

Is ‘no gap’ the same as ‘bulk billing’?

No, they’re not the same thing. ‘Bulk billing’ is when medical providers bill Medicare directly for their services, so you don’t have to pay anything out of your own pocket. ‘No gap’ is a service that’s offered by private health insurance providers, and it covers the full cost of certain medical services.

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