hospital and extras cover

Hospital and Extras Cover

Find out what you need to know before taking out a combined hospital and extras policy.

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.

Keep reading to find out more about the benefits, costs covered and reasons why a combined hospital and extras policy might be right for you.

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What is a combined hospital and extras policy?

A combined health insurance policy 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 fund. There is also the incentive of possibly obtaining a discount for purchasing both types of cover through the one fund.

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.

What benefits does hospital policy cover?

Hospital cover pays for your treatment and accommodation in a public or private hospital. As an Australian permanent 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. 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:

  • Basic cover. 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. 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. 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
  • Colonoscopies
  • 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 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
  • Physiotherapy
  • Osteopathy
  • Podiatry
  • Acupuncture
  • Naturopathy
  • Hearing aids

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.

What waiting periods and limits apply to combined policies?

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 2 months for other hospital benefits (apart from accidents, in which case the waiting period is waived).

What are waiting periods?

Waiting periods for extras vary with funds but most apply a 2-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 fund, but affects every other health fund member because premiums would rise rapidly if this practice was allowed to occur.

What are claims limits?

Benefit limitation periods are another form of waiting period. These vary between funds, 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, 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.

Do you need to have hospital and extras with the same fund?

The main advantage of choosing a combined hospital and extras policy through one fund is convenience. You only have one premium to pay and one fund to deal with. The downside of this is you may not be getting the most value for money 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 get more benefits from a combined policy or by purchasing your hospital and extras insurance separately to take advantage of deals from two different funds. There is also the question of discounts and bonuses. If your current fund offers great hospital cover but less attractive extras, 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.

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10 Responses

  1. Default Gravatar
    dallasSeptember 28, 2017

    Im a 70 female. Im with NIB at the moment. What hospital and extra cover is right for me?

    • Staff
      MaySeptember 29, 2017Staff

      Hi Dallas,

      Thank you for your inquiry.

      If you like to get the combined hospital and extras cover from nib, you can fill out the form from this page to compare health insurance from nib and request a quote from a consultant.

      You can also compare your options for hospital and extras cover offered by other insurers if you will fill out the form above and click on the orange “Search Policies” button.

      Hope this helps.


  2. Default Gravatar
    LESLEYJuly 6, 2017

    I am looking for Seniors Health but noticed you are asking if I am having a baby. I want a fund that is for seniors only.

    • Staff
      RenchJuly 6, 2017Staff

      Hi Lesley,

      Thanks for reaching out to us.

      You can check this page for helpful information and you may make use of the search filter from there and compare your options.

      Hope this helps.


  3. Default Gravatar
    rayFebruary 27, 2017

    have been a member of MEDIBANK for 36 years now
    cost to wife and myself are 70 years old.
    look for new private hospital and extras policy.

    • Staff
      ZubairFebruary 28, 2017Staff

      Hi Ray,

      Sorry to hear you’re having issues with the price rise. If you would like to compare your options in hopes of finding a more affordable option, you can do so by entering your details into the quote comparison tool at the top of the page.

      Once you have done so you will be able to review quotes from every fund in Australia and sort these quotes by price or by the value of the policy. While we are able to provide quotes for every fund in Australia, you will only be able to apply for cover with the funds in our panel.

      All the best,

  4. Default Gravatar
    ReneeFebruary 9, 2017

    my husband and I are both over 60.
    currently members of hcf -hospital advanced savings and multicover.

    important to us :Dental, optical and ambulance.
    is there a better option cost wise, other than HCF for us as we have only a moderate income.


    • Staff
      RichardFebruary 9, 2017Staff

      Hi Renee,

      Thanks for getting in touch. To review your options, please enter your details into the comparison tool above. Once you’ve done so you will be able to review policies from 30+ funds based on the value of the policy or simply on price.

      All the best,

  5. Default Gravatar
    July 21, 2016

    where do I get health cover to satisfy 410 visa please?

    • Staff
      RichardJuly 28, 2016Staff

      Hi Derick,

      Thanks for your question. Unfortunately, none of the funds in our panel cover retirement visas. Bupa sill have it listed on its OVHC page as an option why selecting cover.

      I hope this was helpful,

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