Hospital Cover in Australia: Learn more about what's covered

What is hospital cover?

Hospital only cover is offered by private health funds. It covers a large share of your in-hospital bills such as your accommodation, theatre fees, medicine, and doctors’ fees. You can be admitted to both private and public hospitals as a private patient with hospital cover.

Another type of health insurance is extras cover. Extras cover includes general treatment such as dental, optical, physiotherapy, and chiropractic. Health funds typically offer a mix of extras and hospital cover under a combination policy.

Why should you get hospital cover?

One of the major benefits of hospital cover is peace of mind. As much as we like to think we have the stamina of youth, our health care needs change.

In Australia, we’re lucky to have a strong public healthcare system. But Medicare has its limitations. Private health care can help you and your family choose a preferred doctor or avoid elective surgery waiting lists.

What isn’t included under hospital cover?

The procedures that aren’t included with hospital only cover depend on your level of cover and your health fund. You can choose to include or exclude many services depending on your current life stage - for example, pregnancy and assisted reproductive services can be removed once you have children.

If you’re after general treatment such as dental, optical, chiropractic or physiotherapy cover, these are only available under an extras policy rather than hospital cover.

What are the waiting periods for hospital cover?

Every health policy includes waiting periods that you need to serve before you can claim benefits. The waiting periods for hospital cover are enforced by the Australian Government.

If you have a pre-existing condition that has shown signs or symptoms during the past six months - such as heart disease, high blood pressure or diabetes - you’ll be able to make a claim under hospital cover once you serve the 12 month waiting period.

Pregnancy similarly requires you to wait a period of 12 months. Psychiatric care, rehabilitation, palliative care (even for a pre-existing condition) and hospital admission only require a two month waiting period.

What are the different levels of hospital cover?

Hospital cover has different levels ranging from basic hospital insurance to medium and top cover. Basic cover will usually cover you for the basics (such as accidents, and appendix and tonsil removal) while a higher level of cover will cover you for more complex procedures (such as back surgery, cancer, and heart procedures).

Can you avoid the Medicare Levy Surcharge (MLS) if you get hospital cover?

Many people get hospital cover to avoid tax otherwise known as the Medicare Levy Surcharge (MLS). If you earn more than $90,000 as a single or $180,000 as a family, you could be paying up to 1.5% extra in tax if you don’t have hospital cover. By getting Government approved hospital cover, you won’t be liable for the Medicare Levy Surcharge.

How can you save on hospital cover?

A great way to save money on your hospital cover is to compare health insurance in Australia. If you look at like-for-like policies, you can find the right policy for your budget and ensure you and your family get peace of mind.

See if you can save on your insurance with iSelect.