Understand your hospital cover

A simple guide to hospital cover and how it works.

What is hospital cover?

Also known as hospital insurance, hospital cover helps cover costs when you’re admitted to hospital. In this article, we’ll explain what you need to know about HBF hospital cover and how it could benefit you.

How hospital cover works

Hospital insurance helps cover costs when you’re admitted to hospital. It covers things like your doctors’ fees, accommodation and theatre fees.

With HBF private hospital cover, you can go to a private hospital for treatment and we will help cover some of your costs. You’ll also be able to choose your specialist and avoid the public hospital waiting list.

You can also go to a public hospital as a private patient. In this case, you may be able to choose your doctor and specialist, but this will depend on availability. If you have cover for a private room, you will only get access to one if there’s one available and there’s no one who needs it more than you.

If you don’t have hospital insurance you can still choose to be treated in a private hospital; however, without hospital insurance you will have to pay most costs out of your own pocket.

HBF hospital cover

HBF offers six levels of hospital cover: Basic Hospital Plus, Basic Hospital Plus Elevate, Bronze Hospital Plus, Silver Hospital, Silver Hospital Plus and Gold Hospital. 

Each level of cover fits into the Australian Government’s 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 can offer more coverage than the minimum required in each tier.

As a wide range of services are included in each tier, it’s best to carefully compare each cover before choosing the right level of insurance to suit your needs.

Once you’ve chosen the level of hospital insurance you need, you can purchase a policy. You will be required to pay HBF a premium (usually fortnightly, monthly, half-yearly or annually) and once you’ve served your waiting periods, you’ll be able to claim benefits for covered services, treatments or goods.

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Helpful terms to know

Waiting periods

A waiting period is a set amount of time during which you must continuously hold your level of cover before you can claim a benefit. Waiting periods exist to stop people from signing up when they need treatment, claiming and leaving without contributing premiums to the fund which drives premiums up for all other members of the health fund. Waiting periods may apply when you:

  • Purchase health insurance for the first time
  • Change your level of cover and end up with new services that were not on your previous cover. You’ll have to serve the relevant waiting periods for the new services before you can claim any benefits
  • Change your level of cover and end up with higher benefits and/or limits. You’ll have to serve the relevant waiting periods before you can claim the increased benefits and/or limits. During this waiting period, you may be able to claim as per your previous cover
  • Decrease your hospital excess. You’ll have to serve the relevant waiting periods before you can pay the lower excess. During this waiting period, you may be able to claim and the excess on your previous cover will apply
  • Re-join a fund after a break from cover

Where you have continuous hospital cover and switch to HBF, we’ll honour any waiting periods you served on your previous health cover, so you won’t have to re-serve them. If you are part-way through a waiting period, you’ll just have to serve the remainder before you can claim.

Hospital excess

A hospital excess is the amount of money you agree to pay upfront when you’re admitted to hospital for treatment.

With HBF, you’ll only pay the excess once per person, per calendar year, no matter how many times you are admitted to hospital.

Exclusion

An exclusion is a service, treatment or good which is not included on your cover. No benefits are payable towards excluded treatments, services or goods. If you choose to get treatment for an excluded service, you may incur significant out of pocket costs.

For example, if your hospital insurance policy excludes Assisted reproductive services and you choose to get IVF, we won’t pay anything towards the cost of those services.

Restriction

A restriction is a treatment or service for which your health fund will only pay the minimum default benefit (this 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, leaving you with an out-of-pocket cost to pay.

For example, if you need Hospital psychiatric services but it’s listed as a restricted service on your policy, we 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. You can learn more about minimum default benefits on the Australian Government’s Private Health website.

When you review your cover options, consider your current and future health needs to ensure you get the right level of cover. If a policy has restricted services, think about whether you’ll need that treatment in future. If the answer is yes, you may want to consider a higher level of cover.

Hospital out-of-pocket

An out-of-pocket is the portion of a hospital bill that you pay from your own pocket for which you won’t be reimbursed – by either us or Medicare.

Ciara's story

Cheerleader Ciara was devastated after a fall left her with multiple injuries and needing reconstructive surgery. Thankfully, having hospital insurance meant she could choose her own doctor, avoid lengthy wait times and get back on stage sooner.

Frequently asked questions

We’ve answered our members’ common questions about hospital insurance.

Do I need hospital cover?

It’s entirely up to you. Many Australians initially get hospital cover to avoid government penalties like the Medicare levy surcharge, but the real value of private hospital insurance is in the freedom and control it gives you over your healthcare.

With hospital cover, you can go to a private hospital for treatment and your health fund will help cover some of your costs. You’ll be able to choose your specialist and avoid the public hospital waiting list.

If you don’t have hospital cover but choose to be treated in a private hospital, you will have to fund your own treatment. If you don’t have hospital cover and go to a public hospital for treatment, you won’t have a choice of specialist and will have to wait on the public hospital waiting list— this could mean months, or even years before you receive treatment.

Learn more about the benefits of hospital cover.

When can I start using my hospital insurance?

When you buy hospital insurance for the first time or after not having it for a long time, or you upgrade to include a new service, there will generally be a waiting period you need to serve before you can claim.

At HBF, waiting periods for hospital insurance are as follows:   

  • 12 months for pre-existing conditions* and Pregnancy and birth
  • Two months for other in-hospital  treatments
  • Seven days for Urgent ambulance (by road)
  • One day for Accident cover

*Pre-existing waiting periods do not apply for Psychiatric care, Rehabilitation or Palliative care.

What isn’t covered by hospital insurance?

Your hospital insurance doesn’t cover ‘outpatient’ services—these are treatments you receive when you haven’t been formally admitted to hospital, for example, tests and examinations (e.g. x-rays and blood tests). In most cases, Medicare will help cover these services.

Depending on your level of cover, you may also have exclusions and/or restrictions. If a service is excluded, it’s not covered at all. If you have a restricted service, you will receive the minimum default benefit, which generally means you pay a large out-of-pocket.

Hospital insurance does not cover everyday services like physio, chiro, optical – these are covered under extras insurance instead.

What does health insurance cover?

Hospital insurance helps cover the cost of ‘inpatient’ services—these are treatments you receive when you’re admitted to hospital for care (e.g. for surgery). Hospital insurance helps cover your medical specialists’ fees, as well as accommodation, approved prostheses and theatre fees. 

The specific hospital treatments and services you’re covered for (e.g. chemotherapy, a colonoscopy, tonsil removal, knee reconstructions etc.) depend on the level of hospital cover you choose. 

Learn more about hospital insurance here.

How much will I get back when I make a hospital insurance claim?

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 Information for Health 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.  Also take note that any outpatient services are not included in your hospital cover.

How is the cost of my hospital cover calculated?

Hospital insurance is governed by what’s known as ‘community rating’. Community rating dictates that health insurance must be equally accessible and cost the same for everyone regardless of their health status, claims history or personal traits like gender or age. 

While the base price of a hospital insurance product (like HBF Bronze Hospital Plus) will be the same for everyone living in your state, the final cost of your hospital insurance may be different to what your neighbour pays because of several different factors:

1. Excess
An excess is a sum of money you agree to pay upfront when you’re admitted into hospital for treatment. Generally the higher your excess, the lower your premium.

2. Lifetime Health Cover (LHC) loading
The LHC loading is an additional cost applied directly to a premium. It only affects people aged 31 or older who do not currently have hospital insurance who decide to buy it after turning 31. It’s an Australian Government incentive designed to encourage people to take out hospital insurance earlier in life and maintain it.

Learn more about Lifetime Health Cover Loading.

3. 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 and comes in the form of a refund; the rebate can either be applied directly to your premium to reduce its cost or be claimed when you submit your tax return.

Learn more about the Australian Government Rebate on Private Health Insurance

4. Scale
The price of hospital insurance will vary depending on whether you get cover for one or two adult members on your policy. 

5. Discounts
Depending on how often you pay your premiums, you may receive a discount on eligible policies. This discount applies whether you pay each time you receive a statement from us 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


HBF direct debit discounts: You can also receive a 4% discount on your premium if you choose to pay by direct debit for your hospital insurance policy (excludes HBF Urgent Ambulance only policies). 

At HBF, we’re here for our members when they need us most

Experience you can trust

We've got over 80 years experience helping our members navigate health insurance and the healthcare system.

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We’re one of the largest not-for-profit health funds in Australia and with no shareholders to pay, we focus on giving more back to our members.

We’re flexible

Mix and match our hospital and extras products to create cover that’s right for you.