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Health insurance for elective surgery

An elective surgery is one that's scheduled in advance because it's considered 'non-urgent'. With private health cover, you may expect a shorter waiting time and perks such as a private room.

What you need to know

  • Elective surgery is a hospital procedure that's booked in advance and isn't a medical emergency.
  • Private health cover can unlock shorter waiting times for a range of elective procedures.
  • Not all elective surgery is covered by health funds. For example, non-medical plastic surgery.

What is an elective surgery?

Elective surgery is a type of surgery that's scheduled in advance as it doesn't involve a medical emergency. Generally, if your surgery can't be put off by more than 24 hours, then it's considered an emergency.

Elective doesn't mean unnecessary - after all, they can include cancer-related procedures or operations to address blood vessel problems - and some people will need their elective surgery performed sooner rather than later. So, doctors will monitor your condition and schedule your elective surgery according to how urgently you need it.

3 types of elective surgery

There are 3 levels of urgency doctors use to decide who's first in the queue for elective surgery: urgent, semi-urgent and non-urgent.

Here's how each is defined and what you can expect based on what category your surgery belongs to:

Urgency CategoryDefinitionExamplesMaximum recommended wait time
UrgentA condition that's an emergency, or could deteriorate quickly and become an emergencyLimb amputation, heart valve replacementAdmission within 30 days
Semi-urgentA condition that causes some pain, dysfunction or disability but is not likely to deteriorate quickly or become an emergencyHip replacement, prostate removalAdmission within 90 days
Non-urgentA condition that causes minimal or no pain, dysfunction or disability, is unlikely to deteriorate quickly and does not have the potential to become an emergencyVaricose vein removal, septum reconstructionAdmission within 365 days

Source: Bureau of Health Information (Jan-Mar 2021)

Finder survey: What conditions have people made a hospital claim for?

Response
I've never made a hospital claim36.7%
Gastrointestinal endoscopy9.93%
Other8.99%
Gynaecology8.8%
Dental surgery8.43%
Pregnancy and birth8.05%
Ear nose and throat7.3%
Cataracts6.74%
Heart and vascular system6.55%
Bone joint and muscle6.37%
Hernia and appendix5.43%
Cancer treatment4.87%
Eye surgery (not cataracts)4.49%
Joint replacements4.31%
Rehabilitation4.31%
Digestive system3.75%
Skin3.75%
Tonsils, adenoids and grommets3.75%
Pain management3.56%
Back neck and spine2.81%
Joint reconstructions2.81%
Sleep studies2.81%
Hospital psychiatric services2.62%
Male reproductive system2.25%
Lung and chest2.06%
Kidney and bladder1.87%
Blood1.69%
Brain and nervous system1.69%
Breast surgery1.69%
Weight loss surgery1.69%
Assisted reproductive services1.5%
Miscarriage1.5%
Pain management with device1.5%
Plastic or reconstructive surgery1.12%
Podiatric surgery1.12%
Palliative care0.94%
Diabetes management0.75%
Dialysis for chronic kidney failure0.37%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023

Is elective surgery covered by private health insurance?

Elective procedures are one of the main reasons people get private health insurance. Depending on your level of cover, private health insurance will cover a large number of elective surgeries. After all, everything except emergency, life-saving surgeries are considered to be elective.

There are some elective surgeries that are excluded from all but a few of the most premium policies, including weight loss surgery and in vitro fertilisation. Almost no policy offers cover for non-medical plastic surgery.

Getting private health cover lets you access treatment in a private hospital. In turn, you can get around some of the high wait times for elective surgery.

How much is private health insurance for elective surgery?

Private health insurance is available in a range of different tiers. That means the cost of health insurance for elective surgery is a bit like telling you how long a piece of string is. Here's a long list of hospital policies from Finder partners that offers some cover for elective surgery - they're all at the Bronze tier or above. All prices are based on a single individual with less than $93,000 income and living in Sydney.

1 - 10 of 68
Name Product Treatments Price Apply
starter bronze
Bronze$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$88.70
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +18 other treatments covered
$91.11
per month
Bronze Hospital 750
Bronze$750 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$92.14
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$93.64
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$93.71
per month
starter bronze
Bronze$500 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$94.96
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$95.14
per month
Bronze Hospital 500
Bronze$500 excess
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +14 other treatments covered
$96.98
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +18 other treatments covered
$99.25
per month
  • Joint reconstructions
  • Ear nose and throat
  • Blood
  • Back neck and spine
  • Dental surgery
  • Eye excluding cataracts
  • Cancer
  • Lung and chest
  • +15 other treatments covered
$100.31
per month
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How long might I have to wait for elective surgery?

Recent figures from the Australian Institute of Health and Welfare show an average increase of 2.5%, each year, in the number of patients added to elective surgery waiting lists between 2014–15 and 2018–19.

Here are the procedures with the longest median wait times:

Nose

Septoplasty

Surgery to correct a damaged nose bone: 277 days

Knee

Myringoplasty

Repairing a hole in the eardrum: 214 days

Ear

Total Knee replacement

Replacement of weight-bearing surfaces of the knee: 223 days

In 2019–20, the median wait time for elective surgery (including urgent ones) in public hospitals was 39 days, with an unfortunate 2.8% having to wait more than a year.

The actual wait times may be even longer, because these figures only reflect the period of time between being added to the waitlist and being admitted for surgery. It doesn’t factor in the time it takes for prior check-ups and the time it takes to get put on the waiting list.

How to compare health insurance for elective surgery

When you compare hospital health insurance policies, it’s important to understand what's covered and what's not. For example, if major eye surgery is excluded, then that means cataract removals won’t be covered.

Most brands offer three to four levels of cover: top, medium, basic and public hospital. What's included in each differs from brand to brand, but here is how the levels commonly look:

  • Top hospital cover. Covers most of what Medicare does, although you might have to do a little digging to find cover for relatively uncommon elective surgeries like weight loss surgery.
  • Medium hospital cover. Covers most of what you'd find with top cover, but without cover for some of the most expensive and complicated elective surgeries like hip replacements.
  • Basic hospital cover. Covers most basic procedures, but excludes everything mid cover excludes plus a handful of other somewhat complicated procedures like heart procedures and minor joint replacements.
  • Public hospital cover. A form of basic cover that lets you choose your private doctor, but only in a public hospital. It covers many of the same treatments as basic, but has higher out-of-pocket fees and you must join the public queue and wait for your treatment.

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