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How to find the ideal Australian Hospital Cover?

Private hospital cover could help you avoid public waiting lists for surgery in your choice of doctor, private hospital, and private room if available. It can help avoid LHC Loading and the Medicare Levy Surcharge. Trust Fair Health Care Alliance to provide you with expert guidance and a range of informed options to choose from.

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How to find the ideal Australian Hospital Cover?

Private hospital cover could help you avoid public waiting lists for surgery in your choice of doctor, private hospital, and private room if available. It can help avoid LHC Loading and the Medicare Levy Surcharge. Trust Fair Health Care Alliance to provide you with expert guidance and a range of informed options to choose from.

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Comparing Health Insurance Hospital Cover

What Is Private Hospital Cover?

With this type of cover, you can have peace of mind knowing that you’ll have access to the medical treatment you need as a private patient in a hospital. Private hospital cover offers the flexibility to choose your preferred doctor and opt for the comfort of a private room (depending on availability). This means you can avoid the long waiting lists of public hospitals and focus on getting the care you need. When it comes to your health, having multiple options can make all the difference. Let us help you find a policy that works for you!

How Many Levels of Hospital Cover Can I Choose From?

When you opt for private hospital cover, you can be assured that you will receive benefits towards your hospital treatment as a private patient in a private or public hospital, for the categories included in your policy. This includes hospital costs like your accommodation, theatre fees, and approved prostheses.

When it comes to selecting hospital cover in Australia, there are typically multiple levels of cover to choose from. Hospital cover in Australia is usually divided into four tiers; as you move up the levels, you can expect more comprehensive coverage across a wider range of clinical categories. However, before committing to a policy, you need to carefully review each level of cover to ensure that you’re selecting a policy that suits your individual needs

With limited features and the most exclusions, Basic tier hospital policies are the lowest level of policy available. Basic tier hospital cover typically covers essential services like accidents and emergency treatments.  It’s worth noting that in certain states of Australia, Basic tier hospital policies may also include ambulance cover. This means that the policy can provide financial assistance for emergency ambulance services if your state government doesn’t already cover these costs.
Bronze and Bronze Plus tier hospital policies are a popular choice for those seeking a balance between affordable premiums and a substantial range of benefits. The Bronze/ Bronze Plus tier sits between the Basic and Silver tiers, and generally covers up to around 18 out of the 38 clinical categories, often including common procedures such as brain surgery, gynaecology services, colonoscopies/endoscopies and joint reconstruction. Some funds slightly differ on what is included in a Bronze or Bronze Plus, so it’s important to seek guidance first. 
Providing unrestricted coverage for around 26 of the 38 clinical categories, Silver hospital cover is the middle tier between the Bronze and Gold tiers. It means that when you need hospital treatment for any of the clinical categories included in your policy, you’ll be covered as a private patient in a private or public hospital. Some very common categories that may require a Silver level of hospital cover are Heart & Vascular (Cardiac), Lung & Chest and Back, and Neck & Spine. Different health insurance providers may offer varying levels of coverage under a Silver hospital policy. To make sure you have the right coverage for your individual health needs, it’s best to speak with us first for advice.
Silver Plus hospital cover is for people who would like the benefits of a Gold level of hospital cover but with some unrequired categories removed, including but not limited to Pregnancy and IVF, Weight Loss Surgery, and Psychiatric Services. This level of hospital cover generally best matches someone over the age of 60 that may need to start covering things like joint replacements, cataracts, rehabilitation and palliative care. Removing unnecessary albeit high-cost procedures like Pregnancy can significantly reduce the policy cost, without losing the benefit of a “top” level of hospital cover. Once again, each fund includes and excludes different combinations of clinical categories on Silver Plus, so please contact us for a quote before making a decision.
The Gold tier is the top tier of hospital cover in Australia, providing the highest level of coverage for hospital procedures. The Gold tier covers all in-hospital procedures listed on the Medicare Benefits Schedule as a private patient in either a private or public hospital. This means you can be assured that there are no category exclusions as long as the procedure has a Medicare item number and is deemed medically necessary. Most people who require a Gold level of hospital cover do so because they specifically need Pregnancy and IVF, Weight Loss, or Psychiatric Services. Some funds may also require Gold hospital cover for Insulin Pumps, Hearing Implants, Pain Management, and Sleep Studies (although some other funds cover these on Silver Plus). Contact our helpful health insurance advisers to compare Gold hospital cover options.
GET STARTED

How Many Levels of Hospital Cover Can I Choose From?

When you opt for private hospital cover, you can be assured that you will receive benefits towards your hospital treatment as a private patient in a private or public hospital, for the categories included in your policy. This includes hospital costs like your accommodation, theatre fees, and approved prostheses.

When it comes to selecting hospital cover in Australia, there are typically multiple levels of cover to choose from. Hospital cover in Australia is usually divided into four tiers; as you move up the levels, you can expect more comprehensive coverage across a wider range of clinical categories. However, before committing to a policy, you need to carefully review each level of cover to ensure that you’re selecting a policy that suits your individual needs

With limited features and the most exclusions, Basic tier hospital policies are the lowest level of policy available. Basic tier hospital cover typically covers essential services like accidents and emergency treatments.  It’s worth noting that in certain states of Australia, Basic tier hospital policies may also include ambulance cover. This means that the policy can provide financial assistance for emergency ambulance services if your state government doesn’t already cover these costs.
Bronze and Bronze Plus tier hospital policies are a popular choice for those seeking a balance between affordable premiums and a substantial range of benefits. The Bronze/ Bronze Plus tier sits between the Basic and Silver tiers, and generally covers up to around 18 out of the 38 clinical categories, often including common procedures such as brain surgery, gynaecology services, colonoscopies/endoscopies and joint reconstruction. Some funds slightly differ on what is included in a Bronze or Bronze Plus, so it’s important to seek guidance first. 
Providing unrestricted coverage for around 26 of the 38 clinical categories, Silver hospital cover is the middle tier between the Bronze and Gold tiers. It means that when you need hospital treatment for any of the clinical categories included in your policy, you’ll be covered as a private patient in a private or public hospital. Some very common categories that may require a Silver level of hospital cover are Heart & Vascular (Cardiac), Lung & Chest and Back, and Neck & Spine. Different health insurance providers may offer varying levels of coverage under a Silver hospital policy. To make sure you have the right coverage for your individual health needs, it’s best to speak with us first for advice.
Silver Plus hospital cover is for people who would like the benefits of a Gold level of hospital cover but with some unrequired categories removed, including but not limited to Pregnancy and IVF, Weight Loss Surgery, and Psychiatric Services. This level of hospital cover generally best matches someone over the age of 60 that may need to start covering things like joint replacements, cataracts, rehabilitation and palliative care. Removing unnecessary albeit high-cost procedures like Pregnancy can significantly reduce the policy cost, without losing the benefit of a “top” level of hospital cover. Once again, each fund includes and excludes different combinations of clinical categories on Silver Plus, so please contact us for a quote before making a decision.
The Gold tier is the top tier of hospital cover in Australia, providing the highest level of coverage for hospital procedures. The Gold tier covers all in-hospital procedures listed on the Medicare Benefits Schedule as a private patient in either a private or public hospital. This means you can be assured that there are no category exclusions as long as the procedure has a Medicare item number and is deemed medically necessary. Most people who require a Gold level of hospital cover do so because they specifically need Pregnancy and IVF, Weight Loss, or Psychiatric Services. Some funds may also require Gold hospital cover for Insulin Pumps, Hearing Implants, Pain Management, and Sleep Studies (although some other funds cover these on Silver Plus). Contact our helpful health insurance advisers to compare Gold hospital cover options.
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How Does Private Hospital CoverWork?

How Does Private Hospital Cover Work?

Depending on your treatment needs and when you purchased your policy, you may have to wait a certain period of time before you can start claiming benefits. The waiting period varies for different types of treatment. For example, if you need in-hospital psychiatric services, you may have to wait two months, while those with birth-related and pre-existing conditions have a waiting period of 12 months.

Don’t forget, you don’t have to re-serve waiting periods when switching from another health fund where that clinical category is already covered and waiting periods are already served. This is health insurance law and all funds abide by it.

Are there any out of pocket expenses? 

Typically, if you have private hospital insurance, your insurer will cover 25% of the Medicare Benefit Schedule fee (MBS), while Medicare will cover the remaining 75%. Additionally, your health fund will cover theatre room fees, accommodation, and food.

The MBS fee refers to the price for medical treatments that have been set by the government. However, private hospitals and doctors may charge more than this fee, which means you might have to pay the gap as an out-of-pocket expense. Some hospitals may have an agreement with your health fund, which could lower the gap you need to pay or eliminate it altogether. Before getting any treatment, always check with your health fund and doctors if you need to pay extra money.

What is excluded from hospital cover?

Your hospital insurance only covers you when you’re admitted to the hospital as an inpatient. It’s important to understand that outpatient services such as diagnostic services and scans including MRI, X-ray, Ultrasound, and pathology/blood tests are not covered by your private hospital cover; you will incur the gap cost for these services after the Medicare rebate. If you need services like dental checkups, physiotherapy, chiropractic treatments, remedial massages, or optometry, you’ll also need extras cover. These services are considered outpatient services and are usually covered by ancillary policies.

Other than that, the treatments covered by your policy will also depend on your tier level. For example, if you have a Silver policy, you won’t be able to claim weight loss surgery or any birth-related services, as these services aren’t part of the minimum requirements for the Silver tier.
 
Finally, it’s important to understand that your private health fund needs to have a contract in place with the private hospital where your surgery is booked. If the private hospital you wish to visit doesn’t have a participating agreement with your health insurance provider, you will incur significant out-of-pocket expenses

What are the financial benefits of private hospital cover? 

Depending on your age and annual income, you could be eligible for an Australian Government Rebate on the cost of your hospital cover. You can choose to receive this rebate as a discount on your premium or with your tax return. Other than that, getting private hospital cover is a good way to avoid the Medicare Levy Surcharge if you’re a high-income earner and avoid paying the Lifetime Health Cover Loading (as long as you take out hospital cover before the 1st of July following your 31st birthday).

Comparing Private Hospital Policies in Australia with Fair Health Care

At Fair Health Care, we believe that having the right private hospital cover is essential for your peace of mind and overall well-being. Private hospital cover can help you avoid long waiting times in the public system, giving you more control over your healthcare. In addition to that, you can also enjoy financial benefits that can help you save money on out-of-pocket expenses. By choosing a private hospital cover that suits your needs, you can have access to a range of hospital services and treatments.
 
We understand that everyone has unique health needs and budget considerations; that’s why our team of advisors is here to offer personalised solutions tailored to your individual requirements. Trust Fair Health Care to help you find a policy that fits your needs and budget so you can enjoy peace of mind knowing you have the coverage you need.

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Do I need Health Insurance?

Learn about Medicare, the public health system, private hospital and extras, and how health insurance might benefit you and your family.

Health Insurance Tax

Are you paying the Medicare levy Surcharge? If so, taking out private health insurance can help you avoid paying the MLS tax.

Health Insurance Rebate

The private health insurance government rebate is means tested, meaning your income could affect the cost of your health insurance.

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If you’re 31 or over, you may have a Lifetime Health Cover loading (LHC) penalty which will increase the cost of your health insurance.
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Fair Health Care Pty Ltd (ABN 86 622 966 303) give health insurance advice in partnership with the ItsMy Group Pty Ltd (ABN 85 167 289 965), and their co-operative of for-profit and not-for-profit health funds. All advice is provided within strict adherence to the Private Health Insurance Intermediaries Code of Conduct.

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