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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.
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
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.
Hospital insurance can be broken down into four tiers: Gold, Silver, Bronze and Basic. Each tier has a minimum list
of Government mandated categories of hospital treatments and services that they must include (e.g. for a policy to
be called “Gold”, it must cover all 38 categories of treatments and services). Health funds can also choose to go
above and beyond the list by including more categories in their products than the bare minimum required. If so,
there is the option to add a “plus” or “+” after the name of the cover, i.e. “Bronze Hospital Plus”, to show that
the product includes more than the minimum.
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.
When you go to a private hospital for a medical procedure (e.g. surgery), hospital insurance helps cover the cost of:
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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