What private health insurance covers
Private health insurance provides cover for health care not covered by Medicare such as physio and glasses. Depending on the policy you take out, it might let you have treatment in hospital as a private patient.
Depending on the policy you take out, private health insurance:
- lets you have treatment in hospital as a private patient
- can help pay medical costs that Medicare doesn’t cover
You can still choose to be a public patient in a hospital if you have private health insurance.
Types of cover
Private health insurance policies offer hospital cover and extras cover.
If you want both, you can take out combined cover or mix and match separate policies to meet your needs.
You can also take out ambulance cover if your state or territory government doesn’t cover it for you.
Hospital cover
Hospital cover helps with the costs of treatment as a private patient in hospital.
Extras and ambulance cover
Extras cover helps with the cost of out-of-hospital health services that Medicare does not cover.
Ambulance cover can help with the cost of emergency transport and medical care.
What isn’t covered
By law, private health insurance does not offer cover for out-of-hospital medical services including:
- GP visits
- consultations with specialists in their rooms
- diagnostic imaging and tests
Medicare covers these services.
If your hospital, doctor or specialist charges more than the Medical Benefits Scheme (MBS) fee for a service, this might be more than Medicare and your insurer will pay. In this case you will have to pay out of pocket costs.
Waiting periods and exemptions
You might have to serve a waiting period before you can claim some medical costs. There is a once-only exemption for some mental health services and treatments.
Find out more about waiting periods and exemptions for mental health.
Cost of cover (premiums)
Your premiums will depend on the policy you take out. Your premiums will be higher if you want:
- cover for more health services such as extras
- top or comprehensive cover
- zero excess or co-payments
Government rebates and loadings may also affect your premiums.
- Under Lifetime Health Cover, if you take out hospital cover when you’re over 30 you may pay a higher premium for the next 10 years.
- If you’re eligible for the Private Health Insurance Rebate, you can use it to lower your premiums.
Premium increases
Your insurer must let you know in advance if your premium is going to increase. This gives you time to shop around and compare health insurance policies.
Premium increases are governed by private health insurance laws.
Problems with your cover
If you’re not happy with your health insurer’s service, contact the Commonwealth Ombudsman.