The government introduced a new tiered system for naming and categorising hospital insurance products: The Gold,
Silver, Bronze and Basic system. Each tier has a minimum list of hospital treatment categories that they must
include—these are requirements set by the Australian Government.
On a sliding scale of Basic to Gold, Basic covers the least and Gold covers the most. Each tier includes cover for
everything in the tier below it, plus more (sometimes, a lot more). Health funds don’t need to stick to the
minimum—they can offer more coverage than is required in each tier.
Explore our hospital products
Who is covered?
Health funds generally offer four categories of membership. These provide cover for individuals and family groups.
| Number of people covered |
Usually listed as |
| 1 adult |
Single |
| 2 adults |
Couple |
| 1 adult and any number of dependants |
Parent Plus |
| 2 adults and any number of dependants |
Family |
What is a dependent?
A child on a family or single parent policy who is under 25 years of age and not married or in a de-facto relationship. If this person is 21 years of age or over, they must either be studying full time or earn less than $24,500 per year.
What are waiting periods?
A waiting period is a set amount of time during which you can’t claim benefits. If you’ve never had health
insurance or you’re upgrading your level of cover, you may need to serve a waiting period before you can
claim. All health funds have waiting periods. They exist to stop people from signing up when they need
hospital treatment, claiming and leaving without contributing premiums to the fund.
How much will it cost?
The factors that contribute to the cost of a hospital insurance policy vary from person-to-person. The
base price of hospital insurance is the same for everyone thanks to community rating, but the final cost
of your hospital insurance may be different to what your neighbour pays.
Here are six key factors that contribute towards the cost of your hospital insurance:
-
Level of cover
The base price of your premium depends on whether you choose to buy basic, medium or top
level of cover. The price can change again depending on the specific policy you choose.
-
Excess
An excess is a sum of money you agree to pay upfront when you go to hospital. The higher
your excess, the lower your premium.
-
Lifetime Health Cover (LHC) loading
The LHC loading is an additional cost applied directly to a premium. It only affects
people 31 or older who have never had hospital insurance and decide to buy it after the
deadline. It’s an Australian Government incentive designed to encourage people to take
out hospital insurance earlier in life, and maintain it.
-
Australian Government Rebate on Private Health Insurance
The rebate is an Australian Government incentive designed to make health insurance more
affordable. It’s calculated based on your age and income. It comes in the form of a
refund, which can be applied directly to your premium to reduce its cost, or be claimed
at tax time.
-
Scale
The price of hospital insurance changes depending on the number of people you’d like
covered on a policy. Generally, as you add more people to a policy, the premium will
increase.
HBF shows prices based on a policy for a single person, but not all health
funds display their pricing this way. That’s why it’s important to take note of how
many people the listed policy price includes.
-
Discounts
Depending on your health fund and your health insurance policy, you may get a discount on
your premium depending on when you pay.
HBF frequency discounts
Depending on how often you pay
your premiums, you may receive a discount on eligible policies. This discount
applies whether you pay by statement or by direct debit.
| Payment frequency |
Discount (%) |
Discount (weekly equivalent) |
| Quarterly |
0.48% |
1/4 week per year |
| Half yearly |
1.92% |
1 week per year |
| Yearly |
3.83% |
2 weeks per year |
Exclusions & Restrictions Explained
Depending on your health fund and the type of health insurance policy you buy, you may have
exclusions and restrictions on certain procedures or services. They indicate procedures or
services for which you’ll get a small benefit, or no benefit at all.
Exclusions and restrictions vary between health funds, levels of cover and between policies,
so it’s important to understand what’s covered, not covered or covered to a limited extent
before you decide on the level of cover or type of policy you need.
What is an exclusion?
An exclusion is a procedure or service for which you can’t claim a benefit. If a
procedure or service is listed as an exclusion on your policy, your health fund
won’t help cover the cost for that procedure or service in a private or public
hospital.
For example, if your hospital insurance policy excludes assisted reproductive
services like IVF, your health fund won’t pay anything towards the cost of that
service.
What is a restriction?
A restriction is a procedure or service for which you’ll only receive the
minimum default benefit, which is set by the government. If a procedure
or service is listed as restricted on your policy, you’ll be covered for
it, but only to a very limited extent, which will leave you with an
out-of-pocket cost.
For example, if you need psychiatric care but it’s listed as a
restricted service on your policy, your health fund will only pay
the minimum default benefit for that service. That would leave you
to pay the rest of the bill out of your own pocket.
When you see a procedure or service that’s listed as restricted
on a policy, think about whether you’ll need that treatment in
future. If the answer is yes, it’s a good idea to consider a
higher level of cover that will pay better benefits.