Combined hospital and extras cover is the most popular form of private health insurance in Australia
You can customise your combined hospital and extras based on your needs There’s no hospital cover option without waiting periods (unless you’re switching health funds and have held hospital health insurance for a consecutive period).
LOOKING AT COMBINED HOSPITAL AND EXTRAS COVER? HERE’S WHAT YOU NEED TO KNOW TO FIND THE RIGHT HEALTH INSURANCE PLAN FOR YOU.
Thinking about getting health insurance, specifically combined hospital and extras cover? Whether you're a first-time buyer or considering a switch, we understand that navigating the world of health insurance can seem daunting. Don't worry, though – we're here to help make the process easy and straightforward for you. On this page, we'll break down everything you need to know about health insurance combined hospital and extras cover, ensuring you're equipped with the knowledge to find the perfect plan that suits your needs. So, let's dive in and discover how you can protect your health and gain peace of mind with the right health insurance cover for you!How Does Combined Hospital & Extras Cover Fit with Private Health Insurance?
In Australia, when it comes to health insurance, there are a few different types of cover to consider. The three main types are:- Hospital cover
- Extras cover (also known as general treatment/ancillary cover)
- Combined hospital and extras cover
Hospital Cover Vs Extras Cover Vs Combined Cover
- Hospital cover is designed to help with the costs of treatment as a private patient in a hospital. It can give you access to private hospitals, choice of doctor, and shorter waiting times for elective surgeries.
- Taking out hospital cover will not only give you the benefits of being treated as a private patient but high-income earners can avoid the Medicare Levy Surcharge (MLS) Medicare Levy Surcharge (MLS) . This means you’ll spend less paying the tax man and more on looking after your health.
- Extras cover helps with the cost of out-of-hospital health services that are not covered by Medicare, such as dental, physiotherapy, and optical services
- Combined cover gives you the best of booths worlds and the most comprehensive coverage with both hospital and extras cover in one policy. This can be convenient and may offer additional benefits and discounts.You can also mix and match separate policies to create a customised plan that suits your specific needs.
- PRO TIP: In addition to hospital and extras cover, it's important to consider ambulance cover as well.While some state or territory governments provide free ambulance services, others may require you to take out separate ambulance cover.
What’s Included in Private Hospital & Extras Cover?
The benefits you’ll receive from your private hospital policy will depend on the level of cover you choose. In Australia, you could be covered for more than 5,000 different medical treatments (plus avoid the long waiting lists in public hospitals) If you take out gold private hospital cover, you’ll typically be covered for the following (depending on your level of hospital cover):- Private hospital
- Ambulance services
- Shoulder and knee reconstruction
- Knee and hip replacement
- Appendicitis
- Tonsils and adenoids
- Wisdom teeth removal
- Colonoscopy
- Endoscopy
- Theatre fees
- Palliative care
- Rehabilitation
- Cataract surgery
- Open heart and bypass surgery
- Obstetrics and fertility treatment
- Plastic and reconstructive surgery
- Major eye surgery
- Renal dialysis
- Other hospital services where Medicare will pay a benefit
- General dental
- Chiropractic
- Physiotherapy
- Remedial massage
- Podiatry
- Optical
- And other services
Hospital Cover
Extras cover
Hospital cover provides financial assistance for medical conditions and emergencies that require treatment within a hospital setting. Coverage can include procedures like joint reconstructions, cataract surgery, and services related to pregnancy and childbirth, depending on the chosen level of cover.
With hospital insurance, you have the option to receive treatment as a private patient in either a public or private hospital. Opting for a private hospital can help you avoid public waiting lists, select your preferred doctor, and potentially secure a private room (subject to availability).
Hospital cover is categorized into four tiers: Basic, Bronze, Silver, and Gold, based on the range of clinical categories covered. You can find more information about each tier through the following links:
Some policies may have "Plus" or "+" in their names (e.g., Basic Plus), indicating coverage beyond the minimum clinical categories required for that tier. For example, a Silver Plus policy may provide coverage for joint replacement typically covered by Gold-tier policies.
Certain insurance providers offer age-based discounts on hospital policies, encouraging early adoption and providing potential cost savings.
Extras cover offers benefits for medical services received outside of the hospital, such as general dental, chiropractic, physiotherapy, remedial massage, optical, and podiatry, among others.
The amount you can claim for these services may be subject to either a percentage reimbursement or a set dollar amount.
Benefit limits for extras cover are usually capped annually and may include sub-limits, group limits, lifetime limits, or per person limits for family policies.
Waiting periods for extras cover are determined by the health fund and are not regulated by the government. Unlike hospital cover, waiting periods for extras cover are not influenced by pre-existing conditions.
Having extras cover alone will not exempt you from the Lifetime Health Cover loading. However, if you choose to only have extras cover without hospital cover, it will not impact your eligibility for the Australian Government Rebate.
What Are the Benefits of Combined Cover?
Combining your hospital and extras cover under one insurance policy is one way to cover all bases. Under a combined hospital policy, you’ll be insured for medical treatments you receive in and out of a hospital. Depending on your level of cover, this can protect you for almost any medical issue! Bundling your hospital and extras cover into one policy may also offer savings as you could be paying less than the normal cost of the individual policies. You’ll also be eligible for the health insurance rebate. Depending on your age and income, you could receive a 40% rebate on the cost of your insurance policy!What About Waiting Periods?
You’ve probably heard a bit about waiting periods with private health insurance. It’s actually the most common question we get asked. For example, many people planning to start a family will want to take advantage of pregnancy services under their new private health insurance policy, but they’ll need to consider waiting periods.Sadly, There’s No Hospital Cover Option Without Waiting Periods
If you’ve started a new hospital cover policy or have recently upgraded your level of cover, a waiting period will need to be served before you can utilise any of the benefits under that policy. This is to prevent people from signing up to a policy, making a big claim and then cancelling their membership once they’ve had the surgery or medical treatment. Maximum limits on private health cover waiting periods are set by the Australian Government. To help guide you, below are some of the waiting periods outlined by the private health funds:- Pre-existing conditions – 12 months
- Obstetrics services – 12 months
- Specific conditions such as rehabilitation and palliative care – 2 months
- All other hospital treatments and services – 2 months
Medicare Vs Health Insurance Hospital Cover
Australia has one of the best healthcare systems in the world, so why would you need private health insurance? Beyond the tax breaks, many people take out hospital-only health cover as it provides them with a sense of security in case something unexpected arises. After all, the last thing you want to worry about is how you’re going to finance hospital expenses when you’re ill or injured. The reality is, major medical procedures can be expensive. A hip replacement may set you back $24,000, a caesarean delivery $9,000, or coronary bypass surgery more than $47,000. The question you really need to ask yourself is whether you can afford to live without some form of private health insurance. If you’re deciding whether to get covered, a good way to see if you’ll benefit is by comparing what’s covered by Medicare versus hospital insurance.Is Ambulance Cover Part of Hospital Cover?
Some hospital cover policies will include ambulance cover. Others will include it as part of their extras cover. This will vary from fund to fund, so if ambulance cover is important to you, make sure you ask the insurer. It’s worth remembering there are two forms of ambulance cover: comprehensive and emergency only. You can read more about the different types of ambulance insurance here.Australian Government Rebates for Hospital Cover
To encourage more Australians to take out private health cover and reduce the pressure on the public healthcare system, incentives were put in place by our federal government. These include:- THE MEDICARE LEVY SURCHARGE (MLS)Taxpayers who earn a greater income than certain thresholds (over $93,000 for singles and $186,001 for couples/families) will pay an additional tax of up to 1.5% if they do not have private hospital cover. This is in addition to the standard 2% Medicare Levy.
- LIFETIME HEALTH COVER LOADING (LHC)While private health cover isn’t compulsory, if you’re over the age of 30 and haven’t organised cover by July 1st following your 31st birthday, you’ll be charged a Lifetime Health Cover (LHC) loading fee. LHC loading starts at 2% of the premium and increases by 2% every year you’re without private hospital insurance after turning 31.
What to Look for When Comparing Hospital & Extras Cover
Finding the perfect hospital and extras cover policy can be a daunting task. It's not just about the cost; you want to ensure that the policy aligns with your specific healthcare requirements. But fear not, we've got you covered! Make your sure ask you potential insurer these questions: Our online comparison tool is a handy way to compare policies or you can give our experienced team a call and they’ll do it for you! While you’re comparing, here are some key things to keep in mind:
Some policies will have an excess or co-payment applied to reduce the premium rate. The excess is what you’ll need to pay if you’re admitted to hospital for treatment. The co-payment is charged based on the days you spend in hospital.
Depending on your policy, the number of private hospitals you can receive treatment at may be limited. Typically, not all private hospitals will be covered by your insurer. This is particularly relevant for those living in regional or rural areas where private hospitals are few and far between.
Don’t assume your policy will over ambulance treatment and transport. Some funds will include ambulance in their extra packages while some may only include emergency only cover.
Medicare will cover 75% of your hospital admission and the remaining will be covered by your private health insurer. However, a GAP will be applied if your doctor or specialist charges a fee above the Medicare Benefit Scheme. In this case, you’ll be charged the gap.
Or, use our simple online comparison tool - your ultimate time-saving companion. It allows you to effortlessly compare different policies, saving you the hassle of navigating through complex information. However, if you prefer a more personal touch, our experienced team is just a phone call away. They'll gladly handle the comparison process for you, making it a breeze!
