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Member Onboarding

What is Hospital Insurance

A simple guide to hospital insurance and how it works.

Hospital insurance helps cover costs when you’re admitted to hospital for treatment. It helps pay for the fees of medical specialists like doctors and anaesthetists, as well as covering accommodation, prostheses and theatre fees.

To help reduce the strain on the public hospital system, the Australian Government introduced the Medicare Levy Surcharge to encourage high income earners to get hospital insurance and seek treatment at a private hospital. With an appropriate level of hospital insurance, you won’t have to pay the Medicare Levy Surcharge.


Why hospital insurance?

Hospital insurance gives you more control and flexibility when you need to go to hospital. If you choose to go to a private hospital for treatment, your health fund will help cover your costs. You also have more choice: you can choose the doctor that treats you, when you receive treatment and gain access to a private room.

In contrast, without hospital insurance you’ll probably go through the public hospital system. While your procedure and associated services are free, as a public patient you can’t choose your doctor or your room type. You may also need to wait a long time before receiving elective surgery (surgery that is not considered life threatening). For example, if your child needs their tonsils removed you could wait months before they’re admitted to hospital for surgery.

If you don’t have hospital insurance you can still choose to be treated in a private hospital; however, without hospital insurance to help cover costs this can be very expensive.


How does it work?

Hospital insurance can be broken down into three levels of cover: basic, medium and top. Each level of cover includes a different number of procedures and services. Generally, as the level of cover increases, so do the number of procedures and services covered.

If you’re buying hospital insurance for the first time or you’re upgrading your policy, you may need to serve a waiting period. A waiting period is a set amount of time during which you can’t claim benefits. All health funds have waiting periods, which exist to stop people from joining, claiming and leaving without contributing premiums to the health fund.


What is covered?

When you go to a private hospital for a medical procedure (e.g. surgery), hospital insurance helps cover the cost of:

  • Medical practitioner fees e.g. doctors and anaesthetists
  • Accommodation in a private or shared room
  • Theatre fees
  • Intensive care
  • Drugs, dressings and other consumables
  • Prostheses
  • Diagnostic tests
  • Pharmaceuticals

These items are listed separately on your hospital bill. Depending on your health fund, level of cover, your doctor and the hospital you choose to go to, some of these items may be fully covered, while other items like doctors’ fees may require you to pay some out-of-pocket.


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