Updated: 20 April 2021
Answering these 3 simple questions will help you figure out if the hospital cover you’re considering will
come through for you when it matters most.
Right now, you might just be buying hospital cover to avoid
Lifetime Health Cover loading and the Medicare levy surcharge.
Even if that’s the case, it’s still worth making sure your cover will be there for you if anything were
to happen, so you’re not left with large out-of-pockets for your hospital treatment.
But finding hospital cover that you can rely on is easier said than done.
That’s why we’re here to help. When you’re shopping around, keeping these three questions in mind
will help you understand whether the hospital cover you’re considering is right for your needs.
1. Are you covered for all the services you need?
Everyone’s health needs are unique. That’s why, when choosing hospital cover, it’s important to
think about things like your age, lifestyle and any health issues you may have before you buy.
When you’ve figured out the services you’d like covered, you can start looking at which tier of hospital
cover will suit your needs.
There are four tiers of hospital cover to choose from: Gold, Silver, Bronze or Basic. Gold is the most comprehensive,
while Basic is—you guessed it—the most basic.
Each tier includes cover for a minimum number of specific treatment categories (a treatment category being something
like dental surgery or joint reconstructions). On every tier, you’ll get cover for whatever is in the tier below
it, and more.
The tier a hospital cover option falls into depends on minimum coverage
standards as set by the Australian Government. For example, to qualify for the Bronze tier, a hospital cover
option must include 21 treatment categories.
If a hospital cover option includes more than the minimum required treatment categories, but doesn’t quite make
it into the tier above, health funds have the option to include a “plus” or “+” in the name of
that hospital cover option, e.g. Bronze Hospital
Plus. The idea behind this naming convention is to help you understand that the product you’re on includes
more than the minimum required coverage.
TIP: Before you commit to a product, check the product sheet (a summary of what’s covered) to
make sure you know exactly what’s covered and what’s not. This is especially important if you’re
comparing health funds because there can be variation between what’s covered within the same tier.
2. What will you get back when you claim?
What you get back when you claim is a really important thing to understand before you buy hospital cover. What you
get back depends on a bunch of things, but one of the big ones is whether a service is covered, restricted, or
Excluded services are not covered at all. If you try to claim on an excluded service, your health fund won’t
pay your claim.
Then there’s your covered services, which is where things get tricky. For services covered on your hospital
cover, they will either be included or restricted.
With HBF, if a service is included, you’ll get 100% back when you’re admitted to hospital for treatment
so long as you choose a fully covered specialist and attend a Member Plus hospital. Normal out-of-pockets for things
like any excess, co-payment or outpatient treatments will still apply.
Then there’s restricted services—these are services where you will only receive the minimum default
benefit (i.e. not very much back) when you make a claim. Basically, if a service on your policy is restricted,
you’ll may have a large out-of-pocket if you claim on that service.
TIP: When searching for hospital cover, check the product sheet for any excluded or restricted
services. That way, you can be confident in what you’ll get back when you claim.
3. Are there any waiting periods?
If you’ve never had hospital insurance before, or if you’re adding cover for something you’ve not
had before, you’ll probably need to serve a waiting period.
What are they?
Basically, a waiting period is a set amount of time where you’re paying premiums but can’t make a claim.
They’re important because without them, people could join a health fund, claim and then leave—this
behaviour can drive up premiums for everyone else with that health fund.
Waiting periods for hospital services should be the same across every tier of cover and are generally the same
across health funds. Here’s a breakdown of the maximum amount of time you’ll have to wait before making a
- Pre-existing conditions: 12 months
- Pregnancy and birth-related services: 12 months
- Psychiatric care, rehabilitation or palliative care, even for a pre-existing condition: 2 months
- All other circumstances: 2 months
TIP: While some health funds waive two and six month waiting period for extras cover, it’s
unlikely you’ll find a health fund that waives them for hospital cover. When searching for hospital cover, check
the product sheet for details about any waiting periods. That way, you’ll know exactly when you can start
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