A guide to hospital insurance and what it covers

By Jasmine Leete
Thursday, 27 February, 2020

While Australia’s public health system is one of the best public health systems on the planet, it doesn’t offer its patients much choice, if any. It also forces people with non-life-threatening conditions to join triage-based waiting lists that can leave you waiting for treatments anywhere from a few months to years! This is the primary reason that many people turn to private hospital insurance.

Private hospital cover gives you much more flexibility and choice to determine your own healthcare needs, such as who you’re treated by, when the treatment occurs and what hospital it occurs in. You won’t have to endure months of pain, discomfort or worry on a public waiting list — private hospitals do sometimes have waiting lists, but these are much shorter than public hospitals.

Types of Private Health Insurance

There are three types of general cover with private health insurance in Australia. These are:

  • Hospital Cover — which covers the cost of hospital expenses such as your room, treatment costs and the cost of the medical professionals who will treat you.
  • Extras or Ancillary Cover (also known as General Treatment Cover) — which covers out-of-hospital medical care such as dental, optometry, physiotherapy and similar.
  • Ambulance Cover — which covers any ambulance transport costs if you call an ambulance or need to be transported while under hospital care.

We have also seen a number of Dental Cover options over the last decade; however, these are quite limited and generally do not offer as much as the dental benefits you’ll receive in an Extras Cover package.

Taking out hospital cover also helps to cover the costs associated with your treatment and accommodation when you spend time in a public hospital as a private patient.

Types of Hospital Cover

There are four main hospital cover policies that determine what benefits you’ll receive. These are:

Private Patient in a Public Hospital

As mentioned above, if you use the public hospital system and do not pay for private cover, you’ll receive minimum benefits and only be treated in a public hospital setting. As a private patient in a public hospital though, you’ll be able to select your own doctor. Unfortunately, you’ll still need to endure public waiting list times for treatment, so it’s worth booking into a private hospital if you don’t want to wait.

Low Private Hospital Cover

You’ll have access to private hospital treatment and can choose your own doctor. You will not have to endure the public waiting lists, but your excess might be slightly higher than the next two options.

Medium Private Hospital Cover

Medium cover gives you the same features as basic cover, but you’ll also receive extra benefits such as heart surgery, back, neck and spine treatments, hearing device implants, palliative care and rehabilitation.

High Private Hospital Cover

This is the highest cover option and will give you private hospital cover with a broader choice of excess payments. You’ll also be covered for all medical services that Medicare issues a benefit for.

Treatments that Hospital Insurance Covers

There are around 5,000 different medical treatments that you could be covered for in Australia; however, the treatments you’re covered for will depend on the provider and level of cover you choose. With a high private hospital cover, you’ll usually be covered for:

Private or Public hospital accommodation Gynaecology
Shared or single room Heart and vascular system
Back, neck and spine Hernia and appendix
Blood Hospital psychiatric services
Bone, joint and muscle Implantation of hearing devices
Brain and nervous system Insulin pumps
Breast Surgery (when medically necessary) Joint reconstructions
Cataracts Joint replacements
Chemotherapy, radiotherapy and immunotherapy for cancer Kidney and bladder
Dental surgery Lung & Chest
Diabetes Management Male reproductive system
Dialysis for chronic kidney failure Miscarriage and termination of pregnancy
Digestive system Pain Management
Ear, nose and throat Pain Management with Device
Eye Palliative care
Gastrointestinal endoscopy Plastic and reconstructive surgery (when medically necessary)
Pregnancy and birth Podiatric surgery
Rehabilitation Tonsils, adenoids and grommets
Skin Weight loss surgery
Sleep studies Other hospital services where Medicare will pay a benefit.

Extras cover provides you with many more out-of-hospital services. You may not need any or all of these hospital or extras services for most of the time while you’re on a private health insurance plan, but if and when you do, you’ll be extremely grateful you have it! Some people rely heavily on hospital insurance to maintain their long-term wellbeing, due to chronic disease or injuries, so for them, hospital insurance is a necessity.

Whether you think you’ll need to use your hospital insurance often or just for emergencies, the best way to ensure you get the most out of a hospital insurance provider is to choose an established provider who is a not-for-profit organisation. This will ensure they put their efforts into making their customers happy, rather than trying to make a profit. For example, GMHBA Health Insurance is a not-for-profit organisation who have been helping Aussies stay healthy for almost a century!

Many of their value-based cover options include AIA Vitality membership, which rewards you for staying healthy with things like retail gift vouchers and amazing savings. GMHBA also supports local communities with community programs, events and sponsorships, but it’s primarily their affordable, benefit-packed cover options that set them apart from the rest. Whoever you choose as your provider, you can breathe easy knowing you’ll be receiving great medical care and can avoid those dreaded waiting lists!

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