Wondering if you can claim for accidents on your health insurance? Learn what is covered in relation to accidents, waiting periods and more.
Accident health insurance provides cover for treatment of injuries that are the result of an accident. To be eligible for cover, you usually need to seek treatment at a hospital within 24 hours of an accident and have a treating doctor sign a form verifying your need for such treatment.
Keep reading to find out all you need to know about accident and health insurance.
What costs will your health fund cover?
Accident health insurance can include cover for:
- Emergency ambulance services. Ambulance transport to hospital when you can't be transported any other way due to your medical condition.
- Palliative care. Health care if you have a life-limiting illness.
- Psychiatric treatment. Emergency hospital-based treatment for psychiatric disorders or addiction.
- Rehabilitation treatment. Physical therapy and exercise programs after being admitted to hospital.
Will you be covered for accidents by health insurance?
| Fund | Accident and health insurance conditions | Waiting period |
|---|---|---|
 |
Vital Hospital covers emergency hospital treatment resulting from an accidental injury, surgical removal of wisdom teeth, tonsils, appendix and adenoids, minor gynaecological procedures, joint reconstruction and investigation and same-day accommodation and theatre fees for approved services. | 1 day |
 |
Base Hospital covers emergency ambulance transport, treatment for accidents, removal of tonsils, wisdom teeth, appendix and adenoids, joint reconstruction, dental surgery and Achilles tendon surgery. | 1 day |
 |
White Starter covers all medically necessary ambulance transport and air ambulance services such as CareFlight. It also provides restricted cover for rehabilitation following an inpatient admission, palliative care and psychiatric services. | 1 day |
 |
Basic Hospital covers emergency ambulance transportation, tonsil, appendix, adenoid and wisdom teeth removal, joint reconstructions and investigations plus restricted psychiatric and rehabilitation cover. | 1 day |
 |
Bronze Hospital covers accidental injury, removal of appendix, tonsils and adenoids, cardiac treatments, cancer treatment, intensive and coronary care, joint reconstructions and investigations, gynaecological procedures, psychiatric services, rehabilitation services, surgically implanted prostheses, cataract and corneal transplants, dental implant surgery, joint replacements, pregnancy related services and IVF and assisted reproductive services. | Nil |
 |
Basic Hospital covers emergency ambulance, accident-related treatment, removal of tonsils, adenoids, kidney stones, gall stones and appendix, surgical treatment of a hernia, digestive disorder procedures, cancer-related services, rehabilitation services, psychiatric services and joint investigations and reconstructions. | 1 day |
 |
Basic Hospital covers ambulance transport, treatment for accidental injury, appendix, tonsils and adenoid removal, colonoscopies, dental surgery, gastroscopies, treatment for ear infections, gynaecological services, hernia repair and joint investigations and reconstructions. | 1 day |
 |
Basic Hospital covers emergency ambulance transportation and same-day surgery and intensive care at a public hospital. | Nil |
What isn't covered by accident cover?
Accident-only cover doesn't normally cover:
- Joint reconstruction, replacement, surgery or investigations
- Removal of appendix, tonsils, adenoids or wisdom teeth
- Colonoscopies
- Heart-related medical and surgical treatments
- Obstetrics-related services or fertility treatments
- Plastic and reconstructive surgery
- Cataract and lens-related procedures
- Renal dialysis
Do you need health cover for accidents?
If you’re young and healthy, accident health insurance is a good option. While you might not envisage needing hospital treatment in the near future, no one can predict when an accident might occur, so being covered for such a possibility makes good sense. Accident cover may also help you to fulfil your obligations with regards to the Medicare Levy Surcharge (an additional tax levy you must pay if you earn above a certain amount and don’t have basic Hospital cover).
However, given that the main advantage of accident cover over Medicare is that you can be treated in private hospital emergency departments (Medicare only covers treatment in public hospitals), you would need to weigh up whether having such a basic level of cover is really worth the money, particularly if you live in Queensland or Tasmania, where emergency ambulance services are provided free to all residents.
Can you get ambulance-only cover?
Because Medicare provides free accident-related emergency treatment in a public hospital but does not cover ambulance transportation, another reason for taking out an accident-only policy might be simply to get ambulance cover, given that a ride in an ambulance can be a very costly trip. If that is your main motivation, you might be better off looking for stand-alone ambulance cover, which is offered by a number of insurers (often under ancillary benefits).
As mentioned previously, if you live in Queensland or Tasmania, your emergency ambulance transport is free and it is also provided free for veterans and various concession card holders in most other states and territories. There are two forms of ambulance cover: emergency and comprehensive. If you make frequent trips to hospital for treatment of a chronic condition, you might want to consider taking out comprehensive ambulance cover rather than simply emergency transport.
Issues with accident-only policies
Some accident health insurance are so basic they are known as “junk policies”. These are policies that only cover a fraction of hospital treatments and only in the event of an accident. They are offered by insurers to those concerned solely with price, and they’re often taken out simply to avoid the Medicare Levy Surcharge (MLS).
Given that the original purpose of the MLS was to encourage more people to take out private health cover to take the pressure off the public health system, such policies work against the concept, as they are rarely used by policyholders who, in the event of an accident, opt to use the public system instead.
As the above table demonstrates, some health funds offer basic policies that include accident cover, but also include cover for a range of other treatments as well. So perhaps in the long run, even if you’re seeking health insurance simply to avoid the MLS, it would be more beneficial to take out one of these policies that may actually be of use to you at some stage.Picture: Shutterstock
