Young adult health cover

The Australian government classifies hospital cover into four tiers - Gold, Silver, Bronze and Basic. Basic hospital is the lowest level of cover, while Gold is the highest and provides cover for all hospital treatment categories. This tiered system helps you easily compare covers provided by different insurance providers, including HBF, to help you find your best cover match.

Each tier has a minimum list of hospital treatment categories that must be covered; the minimum requirements are set out by the Australian Government. Health funds can choose to offer additional coverage in the Basic, Bronze and Silver tiers. Products with additional coverage have a ‘Plus, or +” in the product name. For example, Silver Hospital Plus - this is a Silver tier product that includes more coverage than the minimum requirements for the Silver tier.

The good thing about HBF is that you can mix and match hospital and extras cover to suit your needs. This means that if you choose to get Basic Hospital Plus, you can match it with any level of extras cover.

Learn more about the hospital cover tiers.

An excess is a sum of money you pay upfront before you receive hospital treatment. Generally, the higher your excess, the lower your premium.

An excess is paid once per member, per calendar year (to a maximum of twice per couple or family policy) no matter how many times you may be hospitalised. Excess applies for day and overnight admissions.

You won’t be required to pay an excess for any dependant children on your single parent or family policy^*.

A waiting period is a period of time during which you must hold continuous membership under a particular health cover before you are entitled to receive a benefit at the level payable on that cover. You can claim benefits applicable on your level of cover for services or treatment you receive after you have served your waiting periods.

Waiting periods applicable on your level of cover are listed on the relevant product sheet.

The Medicare Levy Surcharge (MLS) is a tax applied to people who earn above a certain income and don’t have an appropriate level of hospital insurance. The tax is designed to reduce the strain on the public system by encouraging people to go to private hospitals instead.

This means you could have to pay an additional tax of between 1% - 1.5% for every day you don't have an appropriate level of hospital cover and you are:

• a single with an income for MLS purposes that is greater than $101,000; or
• a couple or family whose combined income for MLS purposes is greater than $202,000.

To reduce or avoid the MLS, you (and everyone in your family) must hold an appropriate level of hospital cover. If you or your family is only covered for extras, you will have to pay MLS if your income is over the thresholds noted above.

When you do get hospital cover, keep in mind that you’ll still pay the MLS for the part of the year you weren’t covered. You’ll only avoid the MLS completely if you’ve held hospital cover for a full financial year. Learn more about MLS.

This is a guide only. You should speak to a financial advisor or registered tax agent who will be able to take into account your income and personal situation, including any changes that occur during a tax year.

The Lifetime Health Cover (LHC) loading is an extra cost applied to the price of hospital insurance for anyone who chooses to take out hospital cover later in life. The loading was designed by the Australian Government to encourage people to take out insurance earlier in life and maintain their cover.

The loading only applies if you choose to take out hospital insurance after your 31st birthday. Basically, for every year that you don’t have hospital insurance following your 31st birthday, an additional 2% loading will apply if you take out hospital cover later down the track (capped at 70%). For example, if you choose to take out hospital cover at 36 years old, a 10% loading will be applied to your hospital insurance premiums. The loading will only be removed once you’ve held hospital insurance for 10 continuous years.

To avoid LHC, you just need to take out hospital cover on or before 1 July following your 31st birthday.

Learn more about the Lifetime Health Cover loading.

The amount you can claim back on extras services depends on your benefits (the amount you get back when you claim) and your annual limits (the maximum amount you can claim in a year).

Nearly all extras insurance policies only cover services to a limited extent, which means you'll usually pay for some of the service out of your own pocket.

What makes extras insurance worthwhile is that Medicare generally doesn't cover extras services, so without extras insurance you'd have to cover the full cost of treatment every time you receive a service.

Where your treatment is an included service on your hospital cover, your hospital costs will either be fully or partially covered depending on the type of agreement your health fund has with your specialists and hospital.

With HBF, when you’re admitted to hospital for treatment you will get 100% back for the cost of your hospital accommodation and specialists so long as you choose providers that have ‘no-gap’ (otherwise known as ‘fully covered’) agreements with HBF. Just be aware of out-of-pocket costs, which can include excess or co-payments. Please note, outpatient services are not covered under hospital insurance.

Before you book hospital treatments, contact us and we’ll help you understand what you can claim, how much you can claim, and if any excess, co-payments or waiting periods apply. To ensure we give you accurate advice, please have a written cost estimate from your provider on-hand.