Questions

Health Insurance Questions: Frequently Asked Questions About Private Health Insurance Answered

Do you have private health insurance questions? Find the answers you need here.

Private health insurance can be confusing at times. It's a process of weighing up how much you're wanting to spend with the benefits that a policy provides and then seeing how that policy compares with what else is in the market.

Questions people ask themselves when looking for cover range from "Do I really need private health insurance?" to "What is the Lifetime Healthcare Loading and how can I avoid paying it?"

This page goes through various health insurance questions consumers have during the process of choosing a policy, the types of cover, what policies cover, important terms and conditions, and claiming.

If you have any questions that aren't answered on this page, leave it in the comment section and we will do our best to answer it for you.

Choosing a policy

Question: Why do I need private health insurance?

  • While the Medicare affords Australians access to a wide range of subsidised healthcare services, it can fall short at times. Private health insurance about peace of mind, allowing you to choose your hospital and your doctor, enjoy shorter waiting periods for treatment, and receive cover for the cost of a range of treatments and services not included in Medicare.

Question: How do I choose a private health fund?

  • To find the right health fund, compare the cover options available from a range of health funds and determine whether or not they meet your needs. How much does each fund pay benefits and how much do they charge for cover? Also consider whether they have a good reputation for providing prompt customer service if you ever have a question or problem.

Question: How do I know which health cover is right for me?

  • You’ll need to carefully consider your health care needs before choosing a policy. Consider your health situation, your budget, whether you have any dependants, the level of cover you want and if there would be any out-of-pocket expenses. Once you know what type of cover you want, you can compare the policies available from a range of health funds to find one that meets all your cover requirements.

Question: What if I’m young and I don’t have many medical expenses?

  • Most private health funds offer cover options to suit people at your life stage. These entry-level policies are designed to offer basic cover for a selection of essential medical expenses, making them as affordable as possible.

Question: How can I switch from one private health fund to another?

  • All you have to do is tell your new fund the name of your previous fund and the level of cover you held with that fund. Your new insurer will take care of transferring your membership over. If you’re applying for the same or a lower level of cover with the new fund, you will not have to re-serve any waiting periods.

Question: Does the cost of private health cover increase every year?

Question: Is there a cooling-off period?

  • Yes. Whenever you take out private health cover you have a period of time to change your mind, generally 30 days. If you decide to cancel cover during this period, you will receive a full refund of any premiums you've paid.

Types of cover

Question: What is the difference between hospital cover and extras cover?

Question: Can I get a policy that covers both hospital and extras cover?

  • Yes, you can choose pre-packaged cover that includes hospital and extras cover, or opt to mix and match your choice of hospital cover with your choice of extras cover from the same insurer to create health insurance that suits your needs.

Question: How can I choose a level of hospital cover?

  • There are three levels of hospital cover available: basic, medium and top. Basic policies offer cover for a limited range of essential treatments and services but exclude several high-cost benefits. Medium cover offers a combination between a broad range of benefits and affordable premiums, while top cover is designed to offer ultimate peace of mind and cover an extensive range of treatments and services.

Question: What is ambulance cover?

What does health insurance cover?

Question: Does hospital cover pay for the cost of all my in-hospital expenses?

  • No. Many health funds won't cover  in hospital expenses including telephone use, newspapers, physiotherapy and certain high-cost drugs.

Question: What are some of the services and treatments commonly included in extras cover?

  • Extras cover commonly include cover for general dental, optical, physio and chiropractic expenses. High-level extras cover adds other benefits such as major dental, orthodontic, exercise physiology, occupational therapy, psychology, osteopathy, remedial massage, speech pathology, immunisations and health management programs.

Question: Where can I see a list of general exclusions?

  • You can see a list of situations and events when your health fund won’t offer any cover in your member guide or product disclosure statement (PDS).

Question: What are some situations where I won’t be covered?

  • Some common exclusions from private health cover include services and treatment provided outside Australia, cosmetic surgery that is not medically necessary, and treatment received from a relative.

Question: Can I take out health cover for my whole family?

Question: Can I change my level of cover?

  • Yes. You can change your level of private health cover at any time. However, you may need to serve additional waiting periods if you upgrade your cover.

Important terms and conditions

Question: What is a pre-existing condition?

  • A pre-existing condition is any illness, injury or condition that produced signs or symptoms in the six months before you took out private health cover. Note that you will need to serve a waiting period after you join a health fund before any cover will be available for medical costs that arise due to your pre-existing condition.

Question: What is the Australian Government Rebate on private health insurance?

  • This rebate is offered by the government on your health insurance premium to help make it more affordable to take out cover. The rebate you are eligible to receive varies depending on your income and age, and it is available to Australians registered for Medicare who hold, hospital, extras or ambulance cover.
    The rebate levels applicable from 1 April 2016 to 31 March 2017 are:

    Rebate

    Singles≤$90,000$90,001-105,000$105,001-140,000≥$140,001
    < Age 65
    26.791%
    17.861%
    8.930%
    0%
    Age 65-69
    31.256%
    22.326%
    13.395%
    0%
    Age 70+
    35.722%
    26.791%
    17.861%
    0%
    Families≤$180,000$180,001-210,000$210,001-280,000≥$280,001
    < Age 65
    26.791%
    17.861%
    8.930%
    0%
    Age 65-69
    31.256%
    22.326%
    13.395%
    0%
    Age 70+
    35.722%
    26.791%
    17.861%
    0%

Question: What is the Medicare Levy Surcharge?

  • This Australian Government Medicare Levy Surcharge (MLS) initiative applies to high-income earners who don’t have private hospital cover. The extra 1% to 1.5% levy is charged at tax time.

    Medicare Levy Surcharge (MLS)

    Singles≤$90,000$90,001-105,000$105,001-140,000≥$140,001
    All ages
    0.0%
    1.0%
    1.25%
    1.5%
    Families≤$180,000$180,001-210,000$210,001-280,000≥$280,001
    All ages
    0.0%
    1.0%
    1.25%
    1.5%

Question: What is Lifetime Health Cover?

  • Lifetime Health Cover (LHC) is an Australian Government initiative that aims to encourage Australians to take out hospital cover earlier in life and keep that insurance in place. If, on July 1 following your 31st birthday, you do not have hospital cover in place with a private health fund, you will have to pay extra for your health insurance premiums when you do decide to take out cover. You’ll need to pay a 2% loading on top of your health cover premiums for every year you are aged over 30 when you first take out cover.

Question: Question: What are waiting periods?

  • A waiting period is the amount of time you must wait after taking out cover before you are eligible to receive a benefit. Different waiting periods apply to different benefits, including treatment of pre-existing conditions, pregnancy services and dental treatment.

Question: What are restrictions?

  • When a restriction applies to a benefit on your policy, it means that a certain treatment will be covered but only to a limited extent. For example, you may only be covered for the cost of a certain medical procedure performed as a private patient in a public hospital.

Question: What is an inpatient?

  • An inpatient is a person who is admitted to hospital.

Question: What is a co-payment?

  • Some policies also feature a hospital co-payment, which is similar to an excess but requires you to make an additional payment when you are admitted to hospital. A co-payment will usually apply for each day of your stay, up to a certain limit of days, while accepting a co-payment option entitles you to lower premiums.

Question: What are non-PBS pharmaceuticals?

  • The Australian Government’s Pharmaceutical Benefits Scheme (PBS) subsidises the cost of certain drugs, which means they are available to members of the public at a lower cost. If your health fund says it covers the cost of certain non-PBS pharmaceuticals - i.e, those that do not appear on this list - it’s a good idea to check out exactly which pharmaceuticals are covered.

Claiming

Question: How do I lodge a claim under hospital cover?

  • In the majority of situations, your health insurer will liaise with the hospital to ensure that your medical bills are paid. However, if you receive a bill for your doctor for medical treatment you received while in hospital, you’ll need to lodge a medical claim with Medicare first before submitting the details to your private health fund.

Question: How do I make a claim under extras cover?

  • In many cases you will be able to take advantage of on-the-spot electronic claiming through the HICAPS system when you visit your treatment provider - all you have to do is swipe your private health fund membership card. However, if this service is not available, you can typically submit your claim via email, post or fax.

Question: What is an excess and when will I need to pay one?

  • Many hospital cover policies feature an excess, which is the amount you need to pay if you are admitted to hospital. Agreeing to pay an excess entitles you to lower premiums, but there are some policies that do not require you to pay any excess if you are hospitalised.

Compare your options now with help from an adviser or go direct to a fund online

Details Features
High 65 / 75 / 85% - $0/$250/$500 Excess
High 65 / 75 / 85% - $0/$250/$500 Excess
Combines High Hospital Cover with its highest level of extras cover.
  • Cover starting from $44.74 weekly
  • 12 month waiting period for pregnancy
  • 65% back on extras
  • Choice of $0, $250 and $500 excess
Enquire Now More info
Premier Package
Premier Package
Top tier combined hospital and extras policy that covers you for an extensive range of hospital and general treatment services.
  • All the benefits of HCI's Premier Hospital policy
  • All the benefits of HCI's Premier Extras policy
  • Cover for pregnancy and IVF treatment
  • Cover for general and major dental
Get Quote More info
Deluxe flexi
Deluxe flexi
Deluxe flexi provides cover for a range of treatments including hip replacement, spinal fusion, dialysis and major eye surgery.
  • No excess for kids
  • All joint replacements
  • Major eye surgery
  • Rehabilitation
Enquire Now More info
GoldStar
GoldStar
Premium hospital cover with complete cover for hospital expenses. Save 4% when you pay for 12 months of your cover upfront.
  • All theatre fees covered
  • Unlimited maternity cover
  • Choose no excess or $200, $400, $500 per admission
Get Quote More info
Smart Combination
Smart Combination
Smart combination provides a high level of cover for both hospital and extras.
  • Claim up to $2725 back on extras
  • Hip and knee replacements
  • General and major dental
  • Physio
Enquire Now More info
Prestige
Prestige
Highest level of combined cover offered by CBHS. Includes the same benefits as Comprehensive Hospital and Top Extras plus more. Restricted fund: Only current or former staff (and their families) of Commonwealth Bank Group and their subsidiaries which include Aussie, Bankwest, Colonial First State and more can join.
  • No excess or co-payments on hospital cover
  • Non-student dependent under 25 can be kept on policy
  • Access to Chronic Disease Management Programs
  • Widest range of extras including orthodontics
Enquire Now More info
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
Bronze Hospital (no pregnancy) and Bronze Extras Set Benefits
High level of hospital cover and extras cover for a range of popular services including knee and should reconstructions.
  • Most comprehensive hospital options
  • Cover for general and major dental
  • Shared or single room in a private hospital
  • Intensive and coronary care
Enquire Now More info
Premium Hospital and Silver Extras Cover
Premium Hospital and Silver Extras Cover
Comprehensive hospital cover including pregnancy cover. Also included affordable mid-level extras cover for dental, optical and therapies.
  • Cover from $39.50 per week
  • Pregnancy and birth-related services cover
  • Heart surgery cover
  • 100% cash back on two dental check per year
Enquire Now More info
Top Hospital with Top Extras
Top Hospital with Top Extras
Get comprehensive hospital and extras cover and tailor your policy to your needs.
  • Pregnancy and birth services cover
  • Back surgery cover
  • $1000 general dental annual limit
  • $600 physiotherapy annual limit
Enquire Now More info
Young Couples Combined Cover
Young Couples Combined Cover
Mid-level hospital and basic level Extras package with an excess for young, healthy couples that are not quite ready to start a family.
  • Emergency ambulance cover
  • Cancer-related surgery cover
  • 70% back on extras
  • $300 dental annual limit per person
Enquire Now More info
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