Private health insurance can be broken up into two parts: hospital cover and extras cover.
There’s hospital cover
Hospital cover helps with the cost of some (or all) medical treatments and services when you go to hospital such as:
- Operating theatre fees
- Doctors services
- Pathology and Radiology services
- Specialists services
- Intensive care services
- Surgically implanted prostheses
Your level of hospital cover will determine the types of services you are covered for. A higher level of cover will include more services.
Hospital cover gives you more freedom
Hospital cover usually allows you the freedom to:
- Choose a hospital
- Choose a doctor
- Choose when to be treated
- Chose a private room
- Be treated as a private patient in a public hospital
- Be treated as a private patient in a private hospital
You also have the freedom to choose to be treated under Medicare in a public hospital — you don’t have to use your private health insurance.
Then there’s Extras cover
Extras cover helps with the cost of services that are not covered by Medicare and that occur both in and out of hospital. It provides peace of mind on a day-to-day level, helping with the cost of visits to the:
It also covers a wide range of other services such as ambulance, home nursing and occupational, speech and eye therapy.
Some services are not covered
Private health insurance does not cover you for visits to your General Practitioner (GP) and consultations with specialists. X-rays and blood tests are also not covered unless they’re taken once you’re admitted to hospital.
There may be out of pocket expenses
Private health insurance may not cover the total cost of hospital and medical bills. This means you may have to pay an amount out of your own pocket. The out of pocket expense is referred to as the gap. The amount you will have to pay depends on whether your health fund, doctor(s) and hospital have a gap agreement.
All heath funds have waiting periods
When you take out private health insurance for the first time or you upgrade your existing cover, you have to serve waiting periods before you can claim for services. Find out more about waiting periods.