Are you interested in a combined hospital and extras policy? Find out what you need to know before getting cover
Private health insurance is divided into two main areas: hospital and extras cover. And whether you'll need hospital, extras or a combination of the two will depend on your situation. This guide looks at the different types of cover, when you might need them and whether to buy them individually or as a package.
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What's combined hospital and extras cover?
Combined hospital and extras cover is health insurance that includes both of the main types of health insurance:
- Hospital cover for in-hospital treatment
- Extras cover for ancillaries such as optical, dental and physio
Many health funds offer combined packages and this often suits people who want all of their health insurance needs taken care of in one single policy. The main advantage of combined health cover is the convenience of only having to purchase, review, maintain and claim on one policy from one provider. There is also the incentive of possibly obtaining a discount for purchasing both types of cover through the one insurer.
Hospital and extras insurance are totally different forms of cover. Hospital cover is to help pay for treatment and accommodation in a hospital during an illness or injury, while extras cover is to help cover the costs of ancillary health services that we all may require, but which aren’t usually covered by Medicare. Personal circumstances will dictate whether one form of cover is more important to you than the other. If you are young and healthy, you may only require basic hospital cover and opt for more comprehensive extras cover such as dental and physio. If you are older and starting to develop chronic complaints that could see you having surgery or spending time in hospital, then hospital cover may be a higher priority for you than extras cover. Other important differences between hospital and extras cover include:
- Not having sufficient hospital cover when your income is above a specified level attracts a Medicare Levy Surcharge, while extras cover does not.
- A health insurance rebate is available when you purchase hospital cover, but no such rebate applies to extras cover.
- You are charged a Lifetime Health Cover (LHC) loading of 2% for every year you don’t take out hospital cover after you turn 31 years of age. There is no such penalty for extras cover.
What does hospital cover?
Hospital cover pays for your treatment and accommodation in a public or private hospital. As an Australian resident, you are entitled to hospital treatment under Medicare, but many people take out private hospital cover because it offers several advantages over the public healthcare system:
- Treatment as a private patient in a public or private hospital
- Treatment by your own doctor
- Little or no waiting periods
Most health funds offer three levels of hospital cover:
- Basic cover. Covers treatment in a private or public hospital, but usually excludes cover for cardiac-related services, non-cosmetic plastic surgery, rehab, psychiatric services and palliative care.
- Medium cover. Covers most of what Basic cover doesn’t, but usually excludes pregnancy and birth-related services, IVF, cataract procedures, joint replacements and dialysis.
- Top cover. Covers every service where Medicare pays a benefit.
Top hospital cover will usually include:
- Treatment as a private patient in a private hospital
- Emergency ambulance treatment and transport
- Surgical procedures such as joint reconstructions and removal of appendix, tonsils, adenoids and wisdom teeth
- Palliative care
- Psychiatric treatment
- Approved rehabilitation programs
- Major heart surgery
- Childbirth and inpatient pregnancy services
- Fertility treatments such as IVF
- Plastic and reconstructive surgery to repair injury or congenital defects
- Major eye surgery
- Renal dialysis treatment.
Whether services and procedures such IVF, heart surgery and psychiatric services are covered or not will depend on the insurer, but typically most insurers will not cover cosmetic surgery, alternative medicines and any surgery or hospital treatments for which Medicare does not offer a benefit.
While hospital cover is insurance you only claim on if you become ill or injured and need to go to hospital, extras cover is insurance that you claim on regularly to reimburse you for general services that aren’t covered by Medicare. These can include:
- General dental care (e.g. cleaning, fillings, extractions)
- Major dental care (e.g. orthodontics, wisdom teeth, crowns, bridges, root canal work and dentures)
- Optical care (e.g. prescription glasses, contact lenses)
- Chiropractic care
- Hearing aids
- Basic. Covers the main services including dental (general only), optical, physio, chiro, osteo and often emergency ambulance transport.
- Medium. This covers everything covered by Basic, but with more generous benefit levels, plus some major dental, podiatry, occupational therapy and in some cases travel vaccines and immunisations.
- Comprehensive. Covers everything Medium does with the highest benefit levels and also includes orthodontics, psychology, speech pathology and some prescription medicines not covered by the PBS.
Because people have different needs when it comes to ancillary services, most insurers will allow you to mix and match your extras cover to suit your requirements (e.g. optical and dental only if that is all you need), although benefit levels are usually restricted to an amount per person per year and waiting periods apply to most services.
Both hospital and extras health insurance cover are subject to waiting periods and benefit limits. In the case of hospital cover, the Private Health Insurance Act stipulates that the waiting period for pre-existing medical conditions and obstetrics (pregnancy) must be no longer than 12 months and no longer than two months for all other hospital benefits (apart from accidents, in which case the waiting period is waived).
What are waiting periods?
Waiting periods for extras cover vary with insurers but most apply a two month waiting period for services such as optical, general dental, physio, osteo and chiro and up to 12 months for major dental or 36 months for hearing aids. The reason waiting periods exist is to prevent people with pre-existing medical conditions from taking out private health insurance, obtaining the benefit and then cancelling their policy. This not only costs the insurer, but affects every other health fund member, because premiums would rise rapidly if this practice was allowed to occur.
What are limitations?
Benefit limitation periods are another form of waiting period. These vary with insurers, with some applying restrictions to certain hospital products, where only a minimum benefit is payable for up to three years. They can also apply to extras cover, where only minimum coverage for dental may be available in the first year, increasing after three years. Like waiting periods, benefit limitation periods are used to keep private health costs down, to prevent people from jumping the queue and to ensure that loyal members get the services they need in the long term.
The main advantage of choosing a combined hospital and extras policy through one insurer is convenience. You only have one premium to pay and one insurer to deal with. The downside of this is you may not be getting the best deal on one type of coverage or the other. So it really comes down to knowing what you need and doing the research via a comparison website to see whether you would be better off with a combined policy or purchasing your hospital and extras insurance separately to take advantage of better deals from two different insurers. There is also the question of discounts and bonuses. If your current insurer offers great hospital cover but less attractive extras cover, this may be offset by the fact that they also provide loyalty bonuses for years of membership and for taking out combined hospital and extras insurance cover.
Speak with a broker about getting private health insurance
Hospital and extras cover are different forms of health insurance, but both are necessary in their own ways. We need hospital cover to avoid the penalties and take advantage of the incentives and we need extras cover to counter the rising cost of health services not covered by Medicare. So in the end, the question is not whether you need them, but where you buy them, and that depends on your own particular circumstances.
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