We’re making hospital visits smoother so you can focus on the most important thing: getting back to health.
When you need to go to hospital, your first priority should be to get better, so we’ve broken down everything you might need
to know and do before your hospital stay. At any time, please feel free to contact us – from hospital costs to claims
and recovery, we’re always here to help.
Avoid surprise bills by understanding what you’ll be covered for before you head to hospital. Depending on your hospital
policy, you might have a number of excluded treatments (things you won’t be covered for), so check that the procedure
you’re going to have is included in your policy before you’re admitted by logging into myHBF and checking your product sheet.
It’s also good to be aware of what your health fund covers vs. what Medicare covers. Your hospital insurance will only cover
inpatient services, which are any services or procedures that happen once you’re formally admitted to hospital (when
you officially ‘check-in’ as an in-patient). Sometimes you can go to hospital for an appointment or treatment (things
like blood tests or scans), but not be admitted; this is considered an outpatient service, which your health fund will
not cover. Don’t worry - Medicare generally helps cover these costs so you shouldn’t have to pay all outpatient expenses.
Most hospital treatments begin with a trip to your GP, who’ll discuss your treatment with you and refer you to a specialist
if necessary. We can’t choose your specialist for you, but we can make the process easier and less daunting. When you’re
selecting a healthcare provider;
In general, if you choose to be treated as a private patient in a private hospital, Medicare pays 75% of the Medicare Benefits
Schedule (MBS) fee, and HBF pays the remaining 25%. Some specialists (doctors, surgeons, anaesthetists) can choose to
charge more than the MBS fee. If this happens, there may be a ‘gap’, which is the difference between the MBS and the
To help manage your out-of-pocket costs for inpatient hospital services, it’s important to understand that your specialist’s
fee will fall into one of three categories:
Medicare Benefits Schedule (MBS) fee
Total medical cost
No agreement / Opt out
HBF has a large network of Member Plus hospitals across Australia, which help keep your out-of-pocket costs to a minimum.
In Member Plus hospitals you’ll be fully covered for shared room accommodation and theatre fees for all agreed services
on your policy, less any co-payment or policy excess.
Most hospital-stay services are covered in Member Plus hospitals, but there may be some that are not, called ‘non-agreed’
services. Before you arrange a hospital stay call us on 133 423 to confirm you are being admitted to a Member Plus hospital
and what you are covered for. Remember that all benefits are subject to any restrictions or inclusions on your cover.
Member Plus hospitals also cover:
Find a provider
You can still choose to be treated here, but you may incur significant out-of-pocket costs, so check with us before you
HBF will pay a benefit towards your treatment if you choose to be admitted as a private patient in a public hospital,
but there may also be out-of-pocket expenses if you have an excess, stay in a private room or your doctor charges
more than the MBS fee.. You may not avoid public hospital waiting lists, get a private room or have continuity of
care with the same doctor.
If you choose to be a public patient in a public hospital, you’ll be fully covered by Medicare for your hospital stay,
including free accommodation, doctors’ services, diagnostic tests and medications (but excluding personal expenses
such as television hire or telephone calls).
As a public patient you won’t be able to choose your doctor or room type, and you may be put on a long waiting list for
non-emergency surgery. Doctors will be appointed by the hospital to treat you and private rooms will only be allocated
according to clinical need.
At your specialist consultation, he or she will assess your condition and if necessary discuss your hospital treatment
options. Remember to;
The amount you’ll pay out of your own pocket for your hospital procedure will depend on your level of cover, the specialists
you’re seeing and the hospital you’re attending.
We’ll check all details including any waiting periods, restrictions, minimum benefits, whether excess co-payments apply
and how to minimise any out-of-pocket expenses.
So we can give you accurate advice, please call us with your written cost estimate. We’ll ask you questions about your:
Specialists name and provider number
Day or overnight patient
Anaesthetists name and provider number
MBS item numbers for your treatment
Specialist fee for your treatment
Hospital admission date
Any other fees estimated
You’re legally entitled to know what your costs might be before going into hospital. If your hospital stay involves any
out-of-pocket hospital charges, for example assistant surgeon or pathologist fees, the hospital (whether public or
private) and your specialist must disclose the cost and obtain your agreement in writing before admission - this
is called informed financial consent. The only time informed financial consent is not required is in an emergency
where you are unconscious or otherwise unable to give consent. In these circumstances consent is deemed to have been
Every hospital works a little differently, but there will often be some expenses you will incur that you should prepare
If you receive treatment as an outpatient (i.e. you are not admitted), in most instances you will not be covered by private
health insurance. If eligible, these services may be claimed from Medicare.
There are some hospital procedures, such as cosmetic surgery, that are not eligible for a Medicare rebate or covered
by private health insurance.
Be aware of any waiting periods on your policy as you will not be covered for treatment you have before this time has
elapsed. HBF can advise you on your personal waiting periods, but in general, a waiting period of 12 months applies
to pre-existing conditions, maternity and IVF, and a 2 month waiting period exists for general hospital treatments/palliative
care, psychiatric and rehabilitation services.
If you receive treatment that is specifically restricted or excluded on your policy as a private patient, you will incur
significant out-of-pocket expenses.
We can only process claims and provide benefits to you if your treatment happened less than two years ago.
You may be hit with significant out-of-pocket medical and hospital costs if you are not eligible for full Medicare benefits
and don’t have eligible Overseas health cover either.
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