What’s Included In Basic Cover?

We get it—choosing health insurance isn't exactly straightforward. You've got a ton of options to choose from and way too much jargon to decipher. Fortunately, that's where we can help. We'll outline exactly how Basic cover can help you and make picking your policy a little bit easier. Sounds good? Great! Let's get into it.

What is Basic Cover?

Basic cover is the lowest level of hospital cover that you can buy and is sometimes referred to as Accident Only Cover. It’s like dipping your toes into the insurance pool instead of doing a deep dive. True, you only get cover for a small number of hospital treatments, but the price usually reflects this. 

Insurers might also put their own twist on what gets included, whether it's the bare minimum or something extra. For this reason, it's important to make sure you fully understand what basic policies cover (and more importantly, don’t cover!) before you commit to anything.  

Don't rush into anything just because Basic cover might come cheaper than Bronze, Silver or Gold policies, either! These other policies tend to cover more treatments. With Basic cover, you might end up with more out-of-pocket expenses if you need one of these treatments down the track. 

What does Basic insurance cover?

There are certain treatments that all basic hospital cover policies need to cover¹. These aren't treatments that insurers can just brush over, they're requirements. 
 
The only kicker? These basic policies can also include restrictions. When these restrictions apply, you'll only receive full cover if you're treated as a private patient in a public hospital². This means you could still end up in a shared room or put on the notorious public hospital waiting list.  

Still, you’ll end up with some kind of cover for the following: 

• Rehabilitation: Physical rehabilitation for anyone who’s recovering from an illness or surgery.
• Palliative care: Treatment to provide pain management and quality of life for people with a terminal illness.
• Hospital psychiatric services: Treatment and care for people with psychiatric, mental, addiction or behavioural disorders. 

Ah, but a dash of patience, please! A waiting period of up to two months can also apply before you’re able to claim on these treatments³. So you might need to grab a cup of tea, and let your policy simmer, before you get to savour its benefits. 

Speaking of benefits, some basic hospital policies will also cover the costs of emergency ambulance services. However, isn’t compulsory, so it depends on the terms of your policy⁴. 

Furthermore, basic hospital cover won’t usually give you the same level of protection as those other fancy product tiers—the Bronze, Silver and Gold policies. However, if your insurer is feeling generous, they might offer basic policies that cover additional treatments. These policies are sometimes known as basic plus [+] policies⁵. 

What is not included in Basic Cover?

Okay, so you're probably still weighing up whether Basic cover is right for you. That’s smart thinking! But it also means you should understand exactly what kind of cover you're not going to get. Here are the treatments that could be excluded or only covered at a restricted level (private patient in a Public Hospital) if you take out a basic Hospital policy⁶: 

• Brain and nervous system 
• Eye 
• 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 an accredited 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

What cover do other hospital policies provide?

We've already touched on the other three 'product tiers' of Hospital cover, but we haven't really explored how they work. Yes, they all cover a broader range of hospital treatments—or 'clinical categories'—but it's time to look at what they actually give you: 

• Bronze: Must cover a minimum of 21 clinical categories, including the digestive system, joint reconstructions and medically necessary breast surgery.
• Silver: Must cover a minimum of 29 clinical categories, including blood-related conditions, hearing implants and treatments for the back, neck and spine.
• Gold: Must cover all 38 clinical categories, including joint replacements, cataracts and insulin pumps.

All things being equal, higher levels of cover will usually cost more than the lower levels. This is why it might be a good idea to compare different policies and weigh up the coverage provided against the price. Savvy consumers take note! 

^{Source: PrivateHealth.gov.au - Product Tiers}  

Who is Basic Cover suitable for?

Basic cover might be a good fit if you're somebody who's young, fit and in good shape. Y’know, the type of person who probably won't need hospital treatment in the near future. For older people, or people with families and specific health needs, this can be a different story: they might prefer a higher level of cover that lets them access a wider range of hospital services.  

Many insurers will also let you increase your level of cover, or change your policy, if you decide that you need more coverage in the future. So it’s unlikely that you will ever be ‘stuck’ with basic cover when your needs change.  

Even better, it might just help you if you're looking to avoid the Lifetime Health Cover (LHC) loading. This is an extra amount you’ll need to pay if you take out a health insurance policy sometime after you turn 31—usually the 1st of July following your 31st birthday⁷. 

However, if you sign up for hospital cover before this time, and you maintain your cover, you won’t need to pay a LHC loading on your policy after you turn 31. Nice! 

How much does Basic Cover cost?

Again, this will depend on the specific policy you end up choosing, so the cost can vary. 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 policy⁸. Fair and square, folks! 

That’s not all, though. The cost of your policy also depends on something called an excess. Essentially, it’s an-out-of-pocket expense. When you make a claim, you’ll need to pay the excess before your insurance swoops in to 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. 

Can Basic Cover help me with tax expenses?

Yes, but like most things in life, it depends on your circumstances.  

From 1 July 2023, if you’re a single earner soaring above $93,000 as an individual, or a power couple raking in more than $186,000 as a couple or family, you might be required to pay a tax called the Medicare Levy Surcharge (MLS).  

(FYI, the changes which came in 1 July 2023 is the first time that the MLS income rates have been amended since 2014, so it’s likely that these rates will remain stable for the next few years or so.)  

However, you can avoid this sneaky surcharge if you hold the right level of hospital cover.    

Basic Cover can provide a cost-effective way to avoid this surcharge, too. Just make sure it covers you, your spouse and any of your dependent children. Plus, it will need to meet the following requirements⁹:  

• The excess for singles cannot be less than $750  
• The excess for couples or families cannot be less than $1,500 

How can I compare Basic Cover policies?

Finding the right health insurance can take a bit of time and effort. Like homework, it's not exactly a lot of fun. But that's why we're here to make it a little more bearable. 

See, by comparing policies, you can quickly weigh up all the different benefits, price tags and coverage levels on offer. This is an easy way to find cover that's a good fit for your needs. And at iSelect, we've got our own way of making this a quick and painless process. 

So use our online comparison tool to compare policies from a wide range of providers*, or give us a bell on 1800 784 772 and speak to one of our health advisors. You might just find what you’re looking for in a matter of minutes!

^{Sources:
1 Australian Government - Private Health Insurance Reforms (Page 2)
2 Australian Government | Department of Health and Aged Care - Hospital cover and product tiers 
3 Commonwealth Ombudsman | Private Health Insurance Ombudsman - Waiting periods for private health insurance (Page 2) 
4 Privatehealth.gov.au – Ambulance
5 As above.
6 Australian Government - Private Health Insurance Reforms (Page 2)
7 PrivateHealth.gov.au - Lifetime Health Cover 
8 The Parliament of The Commonwealth of Australia | Senate - Private Health Insurance Legislation Amendment (Age of Dependents) Bill 2021: Replacement Explanatory Memorandum (Page 2) 
9 Australian Government | Australian Tax Office - Appropriate level of private patient hospital cover}