Basic Hospital Cover Insurance

What does a basic health insurance policy cover?

There are certain treatments that all basic hospital policies need to cover. These aren’t treatments that insurers can just brush over; they’re requirements.

The only kicker? These treatments can include restrictions. When restrictions apply, you’ll only receive full coverage if you’re treated as a private patient in a public hospital. This means you could still end up on a potentially long public hospital waiting list. You’re also less likely to have a private room.

Alternatively, with restricted cover, you can still check into a private hospital as a private patient, but your health fund won’t cover all of your hospital accommodation fees. It might mean paying significantly more out of pocket, but it could also mean a shorter wait and no shared room. You’ll need to weigh up what works for you.

Some basic hospital policies come with ambulance cover, too. Different Australian states handle ambulance services in their own way. Some states automatically cover the cost of an emergency ambulance for their residents, while in other parts of the country, residents might need to help cover the cost of that 000 callout. So, depending on where you live, ambulance cover might come in handy.

What’s included, excluded, and restricted on typical basic private health insurance? 

Included (with restrictions)
Rehabilitation		Hospital psychiatric services		Palliative care
Excluded
Brain and nervous system	Eye (not cataracts)	Ear, nose, and throat	Tonsils, adenoids, and grommets	Bone, joint, and muscle	Joint reconstructions
Kidney and bladder	Male reproductive system	Digestive system	Hernia and appendix	Gastrointestinal endoscopy	Gynaecology
Miscarriage and termination of pregnancy	Chemotherapy, radiotherapy, and immunotherapy for cancer	Pain management	Skin	Breast surgery (medically necessary)	Diabetes management (excluding insulin pumps)
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 surgeon)	Implantation of hearing devices	Cataracts	Joint replacements	Dialysis for chronic kidney failure	Pregnancy and birth
Assisted reproductive services	Weight loss surgery	Insulin pumps	Pain management with device	Sleep studies

Included (with restrictions)
Rehabilitation	Hospital psychiatric services	Palliative care
Excluded
Brain and nervous system	Eye (not cataracts)	Ear, nose, and throat
Kidney and bladder	Male reproductive system	Digestive system
Miscarriage and termination of pregnancy	Chemotherapy, radiotherapy, and immunotherapy for cancer	Pain management
Heart and vascular system	Lung and chest	Blood
Podiatric surgery (provided by a registered podiatric surgeon)	Implantation of hearing devices	Cataracts
Assisted reproductive services	Weight loss surgery	Insulin pumps
Tonsils, adenoids, and grommets	Bone, joint, and muscle	Joint reconstructions
Hernia and appendix	Gastrointestinal endoscopy	Gynaecology
Skin	Breast surgery (medically necessary)	Diabetes management (excluding insulin pumps)
Back, neck, and spine	Plastic and reconstructive surgery (medically necessary)	Dental surgery
Joint replacements	Dialysis for chronic kidney failure	Pregnancy and birth
Pain management with device	Sleep studies

How much does basic hospital cover cost?

Health insurance premiums vary between policies. But here’s an exciting tidbit: private health insurance also works on a ‘community rated’ basis. That means everyone, regardless of age or health history, pays the same price for the same policy. This includes your eligibility for taking out cover – you can’t be knocked back just because you’re more likely to need to use your private hospital cover. Talk about keeping things fair and square!

On that note, though, premiums tend to change a bit between states and territories. It’s down to different hospital and medical costs in each place. As if Australian cities didn’t have enough to argue about when it comes to where the best place to live is!

Something else to keep in mind is that something called an excess also affects your premium. Essentially, an excess is an-out-of-pocket expense. Before you’re properly admitted to hospital, you’ll need to pay your excess if you want your insurance to swoop in and save the day. The good news is that the higher your excess, the lower your monthly or annual premiums will usually be. It’s all a matter of striking the right balance between your needs and your budget.

Average monthly basic health insurance premium for singles, September 2025

Source: PrivateHealth.gov.au – September 2025

Note: All monthly averages are based on singles basic hospital cover policies. Policies selected had an appropriate excess to be exempt from the Medicare Levy Surcharge, and were available to buy in September 2025. Rebates are not included.