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Private health insurance is divided into two main areas: hospital and extras cover. A combined hospital and extras policy can protect you against a range of health-related costs.
Here you can find some options from Finder partners. These hospital and extras packages cover accidents, emergency ambulance, dental and more.
Compare more hospital and extras combined options
Use our free tool to see quotes from health funds, simply select 'Hospital + Extras' on your type of cover.
What is combined health insurance?
Do you want cover for treatments you receive both inside and outside of a hospital? While you might assume that health insurance covers you for everything related to your health, it's only when you have a combined hospital and extras package that you're covered for hospital treatments as well as general (extra) treatments such as dental or physio.
If this sounds like what you want, then hospital and extras is for you. You will need to decide whether you want to get a pre-packaged hospital and extras policy. Choose your own tiers of cover from each cover type from the same fund or get your hospital and extras cover from two different health insurers.
How are hospital and extras policies different?
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 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 such as dental and physio. If you are older and starting to develop chronic complaints that might require surgery, then hospital cover may be a higher priority for you than extras. Other important differences include the following:
- Not having sufficient hospital cover when your income is above a specified level attracts a Medicare Levy Surcharge, while extras does not.
- 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. Extras policies don't have this penalty applied.
Hospital cover pays for your treatment and accommodation in a public or private hospital. If you are a Medicare cardholder, 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. Private hospital cover offers the following benefits:
- Treatment as a private patient in a public or private hospital
- Treatment by your own doctor
- Little or no waiting lists
Most health funds offer different levels of hospital cover:
- Public hospital. This covers you for most treatments, but only as a private patient in a public hospital. You get to choose your own doctor, but you have to wait in the public queue for your treatment and you'll most likely have higher out-of-pocket expenses than you would if you were a public patient on Medicare.
- Basic cover (also known as Basic or Bronze). This plan covers treatment in a private or public hospital, but often excludes cover for cardiac-related services, non-cosmetic plastic surgery, rehab, psychiatric services, palliative care and others.
- Medium cover (also known as Silver). This plan often covers much of what basic cover doesn’t, but frequently excludes pregnancy and birth-related services, IVF, cataract procedures, joint replacements and dialysis.
- Top cover (also known as Gold). This plan generally covers every service where Medicare pays a benefit.
Top hospital cover will usually include the following:
- 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 an injury or congenital defects
- Major eye surgery
- Renal dialysis treatment.
Whether services and procedures such as IVF, heart surgery and psychiatric services are covered will depend on the fund, but typically most will not cover cosmetic surgery, alternative medicines and any surgery or hospital treatments for which Medicare does not offer a benefit.
What can you claim on your extras policy?
While hospital cover is insurance you only claim on if you become ill or injured and need to go to hospital, extras can reimburse you for general services that aren’t covered by Medicare. These can include:
- General dental care (eg, cleaning, fillings and extractions)
- Major dental care (eg, orthodontics, wisdom teeth, crowns, bridges, root canal work and dentures)
- Optical care (eg, prescription glasses and contact lenses)
- Chiropractic care
- Hearing aids
Starting in April 2019, insurers will no longer offer cover for certain natural therapies that the government has found to be ineffective. These include naturopathy, herbalism, Buteyko, Yoga and Tai Chi. Acupuncture, physio and chiropractic will not be affected.
Like hospital cover, extras are usually available in three levels of protection:
- Basic. This plan covers the main services, including dental (general only), optical, physio, chiro, osteo and often emergency ambulance transport.
- Medium. This plan generally covers everything the basic policy covers, but with more generous benefit levels, plus some major dental, podiatry, occupational therapy and, in some cases, travel vaccines and immunisations.
- Comprehensive. This plan usually covers everything the medium policy does and typically applies larger benefit levels. It 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, many funds will allow you to mix and match your extras to suit your requirements (eg, 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.
When funds create their own packaged cover, it's common for them to pair a hospital policy with an extras policy on a similar rung. For example, if you're getting basic hospital, a health fund will typically package that with its lowest extras option.
Funds will also package policies that they think are suited to someone's life stage. In many cases, these will be placed in categories such as young and singles, family cover, couples cover and seniors cover. While these policies won't have been designed specifically for people that fit into these groups, the fund is making a suggestion about the type of cover you need if you identify with one of these demographics.
While this is not always the case, your best bet to find the option that's right for you is to choose your own levels of hospital and extras benefits rather than going with a preselected option.
How to mix and match
Mixing and matching your hospital and extras options is the best way to get the most out of your benefits. Say for example you're young and healthy and don't need a high level of hospital cover but still want peace of mind knowing that you have hospital cover. Add to this that you like to get a remedial massage, need glasses and are fastidious about your teeth and see the dentist a couple of times a year. In this hypothetical situation, you can choose a basic tier hospital policy with comprehensive extras.
To go a step further, when you're comparison shopping, make sure you're looking beyond just one provider for both options. You might find a better deal by taking out your hospital with one fund and your extras with another.
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