We all know private health insurance can help alleviate some of the costs associated with medical treatment in a private hospital, but what exactly does this cover and how can you make the best use of having private health insurance?
Of course, having private health insurance offers you peace-of-mind and financial security when going to hospital, but there are other benefits too. Private health insurance also provides you with:
It is also helpful to remember that even if you have private health insurance, you can choose to be treated as a public patient if you go to a public hospital. The decision is yours each time you need to go to hospital.
Private health insurance uses Medicare as the basis for what type of healthcare is covered. In addition it also covers other health care like dental care (which is not necessarily covered by Medicare). It is separated into two main areas – hospital and extras cover. Some people choose to have just one type of cover or both.
Private health insurers offer a range of choices regarding policies so you can select the level of cover, premiums, and excess that suits your needs. As your level of cover and included benefits increase, generally your premiums increase as well. You can choose to have either hospital or extras cover, or have them combined as a package.
Hospital cover helps pay for costs when you are admitted to hospital as a private patient for either day surgery or overnight procedures for services like:
Extras cover helps with the cost of out-of-hospital health services that Medicare does not cover. The included benefits will vary depending on the level of extras cover you have chosen, and typically include services such as dental check-ups and major dental, the cost of prescription optical eyewear, as well as physio and pharmacy.
How much is covered will depend on the level of extras cover you hold or choose to take out.
By law, private health insurance cannot cover out-of-hospital medical services including:
These are services covered or subsidised by Medicare. There may be a gap between the fee that is charged for these services and the amount which Medicare covers, and will also depend on whether you are being treated as an in-patient or out-patient.
Imagine you are heading to your GP because you have a sore knee. During your consultation, your GP might choose to send you to get some imaging done on the area, or they might refer you to a specialist. These appointments – the GP, specialist and imaging – by law cannot be covered by your private health insurance. Depending on the circumstances they may be covered by Medicare. To save money on these appointments, ask for bulk billing where possible.
Your specialist may recommend surgery. If you choose to have this procedure performed at a private hospital and you are admitted as an “in-patient”, then your stay will be covered by your private health insurance (if it includes a benefit for this surgery).
Your insurance will also subsidise your doctor’s fees however you may have a gap here if the doctor charges a fee higher than the Medicare scheduled fee, does not bulk bill or use our Access Gap scheme. It also covers theatre, accommodation fees for the procedure and the cost of any tests that need to be performed while admitted as an in-patient. Find out more about out of pocket costs>
You may also have an Excess or Co-payment amount which will need to be paid directly to the hospital. Check your cover details for more information on what procedures are covered under your level of hospital cover.
If you require pharmaceuticals while you are in hospital, related to your admission (e.g. pain relief) these will also be covered. This does not include any medications you were already taking before surgery.
Once you are discharged out of hospital, you are considered an “out-patient” so any post-surgery appointments you may have will be subsidised or covered by Medicare, not private health insurance.
If there’s one thing we’re sure of, it’s that our members are satisfied with their health insurance. We've been awarded Australia’s Most Satisfied Health Insurance Customers by Canstar, five years in a row.
Canstar 2019-2023. Compares Health Partners customer responses with average of other brands researched.
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