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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.
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Step 1/2 - About your cover
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*Prices updated September 2024, in line with Finder's database of health insurance policies. Prices reflect the cheapest available for a single individual with less than $97,000 income and living in Sydney with a $750 excess.
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Key takeaways
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.
Finder survey: What conditions have people made a hospital claim for?
Response
I've never made a hospital claim
36.7%
Gastrointestinal endoscopy
9.93%
Other
8.99%
Gynaecology
8.8%
Dental surgery
8.43%
Pregnancy and birth
8.05%
Ear nose and throat
7.3%
Cataracts
6.74%
Heart and vascular system
6.55%
Bone joint and muscle
6.37%
Hernia and appendix
5.43%
Cancer treatment
4.87%
Eye surgery (not cataracts)
4.49%
Joint replacements
4.31%
Rehabilitation
4.31%
Digestive system
3.75%
Skin
3.75%
Tonsils, adenoids and grommets
3.75%
Pain management
3.56%
Back neck and spine
2.81%
Joint reconstructions
2.81%
Sleep studies
2.81%
Hospital psychiatric services
2.62%
Male reproductive system
2.25%
Lung and chest
2.06%
Kidney and bladder
1.87%
Blood
1.69%
Brain and nervous system
1.69%
Breast surgery
1.69%
Weight loss surgery
1.69%
Assisted reproductive services
1.5%
Miscarriage
1.5%
Pain management with device
1.5%
Plastic or reconstructive surgery
1.12%
Podiatric surgery
1.12%
Palliative care
0.94%
Diabetes management
0.75%
Dialysis for chronic kidney failure
0.37%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
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 Category
Definition
Examples
Maximum recommended wait time
Urgent
A condition that's an emergency, or could deteriorate quickly and become an emergency
Limb amputation, heart valve replacement
Admission within 30 days
Semi-urgent
A condition that causes some pain, dysfunction or disability but is not likely to deteriorate quickly or become an emergency
Hip replacement, prostate removal
Admission within 90 days
Non-urgent
A condition that causes minimal or no pain, dysfunction or disability, is unlikely to deteriorate quickly and does not have the potential to become an emergency
Varicose vein removal, septum reconstruction
Admission within 365 days
Source: Bureau of Health Information (Jan-Mar 2021)
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 $97,000 income and living in Sydney.
Each month we analyse over 10,000 hospital insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare hospital cover a bit faster.
Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. Each policy is given a price score and feature score. These are then combined to determine each policies's Finder Score.
Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
Email me my results (optional)
To get a copy of your results for later, add your email below
You'll pay the same price as going direct - we don't
charge fees
We don't ask for your phone number to see prices
Hang tight - we're fetching policies just for you!
Comparing quotes from 40+ funds...
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:
Septoplasty
Surgery to correct a damaged nose bone: 277 days
Myringoplasty
Repairing a hole in the eardrum: 214 days
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.
Frequently asked questions about elective surgery
An elective surgery is one that's booked in advance as it doesn't involve a medical emergency, such as cataract surgery. Whereas non-elective surgery needs to be done urgently, including to preserve life. For example, after the trauma of a car accident.
Getting in sooner can also have health implications. For example a clogged artery is extremely serious, but not sufficiently life-threatening to qualify as an emergency.
Just be aware that not all insurance companies cover all surgeries. For example, you'll probably need a top-tier policy if you want to have major heart surgery covered.
Waiting periods are fairly standard on most health insurance policies around Australia and you can expect a waiting period for most treatments no matter what fund you are with. These waiting periods range from 0-2 days for accidents and ambulance cover to 12 months for pregnancy and pre-existing conditions.
This means it's not possible to just take out health insurance the moment you need it. Fortunately, once you have cover you can switch between different health funds without needing go through the waiting periods again.
It depends. You typically won't need to if you had equivalent cover with another fund. But if you didn't previously have cover for a service that your new policy includes, then it's likely you'll need to serve a waiting period.
If your condition gets worse, and your surgery becomes more essential, there's a chance your procedure will be rearranged.
If you're waiting for surgery, make sure to stay in regular contact with your GP. They'll help keep you fit and healthy so you're ready for the surgery when it is rearranged, and they'll make contact with the hospital if there are any changes in your condition while you're waiting.
If you have any medical questions or concerns, you should always speak to your doctor.
James Martin was the insurance editor at Finder. He has written on a range of insurance and finance topics for over 7 years. James often shares his insurance expertise as a media spokesperson and has appeared on Prime 7 News, WIN News, Insurance News, 7NEWS and The Guardian. He holds a Tier 1 General Insurance (General Advice) certification and a Tier 1 Generic Knowledge certification, both of which meet the requirements of ASIC Regulatory Guide 146 (RG146). See full bio
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