Health insurance for travel and accommodation expenses

When you’re suffering from an illness or injury, sometimes it’s not possible to access the medical treatment you need close to home – especially if you live in a remote area. If this is the case, you may need to travel to the nearest city or regional centre where the treatment you need is available. However, this can be an expensive exercise, as travel and accommodation costs can quickly add up.

The good news is that if you have private health insurance cover, your policy may provide cover for your medical-related travel and accommodation costs. Let’s take a closer look at which policies provide protection and what costs are covered.

Does health insurance cover travel and hotel expenses?

Many private health funds in Australia pay a benefit for travel and accommodation costs when you need to travel a long distance from home to receive medical or hospital treatment. Travel benefits are designed to cover the expenses you incur to get to the place of treatment, including petrol costs if travelling by car, or train, bus or airfares if using other forms of transport.

Accommodation benefits are designed to cover the cost of accommodation near to the place of treatment for the patient and a carer or attendant. This refers to accommodation in a hotel or motel (not hospital), and can help you afford the cost of staying overnight and accessing the medical or hospital treatment you need. While some funds will require your carer to also be a member in order to cover their accommodation costs, other funds will also cover your carer’s accommodation expenses even if they are not a member.

The exact level of cover provided varies depending on the health fund and the individual policy you choose, but limits will apply. This could be one overall limit for both travel and accommodation benefits, or separate limits for each individual benefit.

When does health insurance cover travel expenses?

Private health funds cover medical-related travel and accommodation costs when the following conditions are met:

• The medical or hospital treatment must be medically necessary.
• The treatment must not be available locally.
• The total return trip distance must exceed a specified limit, usually 200km.

It’s also worth pointing out that your health fund may impose limits on when it will cover accommodation costs. For example, cover may only be available for one overnight stay, while other policies may provide cover for accommodation one night before and one night after the treatment. Check the details of your policy for more information.

Is cover provided by hospital or extras policies?

Travel and accommodation benefits are included as part of extras health insurance cover. However, this feature is not included on all policies, so you’ll need to select high-level extras cover if you want to access travel and accommodation benefits. Check with your health fund for details of which of its products include this cover feature.

How do I lodge a claim for travel and accommodation costs?

Your health insurance fund will most likely provide you with a special claim form you can fill out to lodge a claim for travel and accommodation costs. Although these forms may vary slightly between funds, you will usually have to provide the following information:

• Your full name
• Your membership number
• Your address and contact details
• The type of transport (e.g. car, bus, train)
• The date(s) of travel
• Your destination and the distance travelled
• The cost of travel (including receipts where required)
• The name of the medical specialist or hospital that you travelled to in order to receive treatment
• The name of the doctor that certified travel (your GP will need to sign a declaration that it was necessary for you to travel to receive specialist medical or hospital treatment because that treatment was not available locally)
• If claiming for accommodation costs, you will also need to provide details about the length of your stay, the hotel or motel where you stayed, and the cost of your accommodation

When aren’t you covered?

It’s also important to be aware that there are situations and expenses for which your health fund will not provide any cover. These include:

• Overseas travel and accommodation – health insurance can only cover health care expenses incurred in Australia
• If no referral is provided by your GP or treating doctor
• If the medical or hospital treatment you need is available locally
• If you do not provide receipts (for petrol, travel and accommodation costs etc) to back up your claim
• If the total distance of your return trip is less than a specified limit, usually 200km
• If your claim is for hospital accommodation costs (this cover is provided by a separate part of your health insurance hospital cover policy)

Frequently Asked Questions

• What are the waiting periods for travel and accommodation benefits?

  Standard waiting periods apply to travel and accommodation benefits similar to other extras services. These can vary between health funds and policies but are typically 2 to 6 months. Some higher level benefits or specific conditions might require a 12-month waiting period. Always check your specific policy details or Product Disclosure Statement for accurate information about applicable waiting periods.

• Does private health insurance cover travel and accommodation for medical consultations or diagnostic tests?

  Generally these benefits are focused on specialist medical or hospital treatment. Some policies may extend to cover essential pre-treatment, consultations or diagnostic tests if they are directly linked to medically necessary treatment and meet all other policy conditions such as distance and local unavailability. It is best to confirm with your health fund before travelling for consultations or tests.

• How do benefit limits for travel and accommodation typically work?

  Health funds usually impose annual limits on the total amount you can claim for travel and accommodation benefits. This might be a combined limit for both travel and accommodation or separate limits for each. Additionally there could be daily limits for accommodation expenses or limits on the number of nights covered per treatment episode. Always check your policy details for the specific limits that apply to your cover.

• Can I choose any accommodation provider or are there specific requirements?

  Most health funds allow you to choose any commercial accommodation provider, such as a hotel or motel, provided it is located close to the treatment facility. However receipts are always required for your claim. Some policies may specify a maximum benefit per night or a maximum number of nights covered. It is wise to verify any specific requirements or preferred providers with your fund before making arrangements.

• Does Medicare or the public health system provide assistance with medical travel and accommodation costs?

  While private health insurance can offer benefits for travel and accommodation, Medicare generally does not cover these costs. However some state and territory governments operate patient travel assistance schemes for eligible residents who need to travel long distances for specialist medical care. These schemes often have strict eligibility criteria and benefit limits so you should investigate government programs relevant to your state or territory.

• Beyond receipts what other documentation do I need for a claim?

  In addition to receipts for your travel and accommodation costs you will typically need a referral or declaration from your GP or treating doctor. This declaration confirms that the specialist medical or hospital treatment was medically necessary and not available locally. You may also need evidence of your appointment or admission at the specialist or hospital. Keeping all relevant medical and financial records is important.

• Is interstate travel for specialist care covered?

  Yes if the specialist medical or hospital treatment is not available in your local area and you meet your policy's distance requirements, interstate travel for specialist care can be covered. The key conditions are that the treatment must be medically necessary and unavailable closer to home. Your policy will detail the exact conditions for interstate claims so always confirm with your fund.

• How long do I have to submit my claim for travel and accommodation expenses?

  Most health funds require claims to be submitted within a specific timeframe, often between one to two years from the date the service was incurred. It is crucial to check your health fund's specific terms and conditions regarding claim submission deadlines to ensure your claim is processed. Always submit your documentation as soon as possible after your treatment or travel.

• Are travel and accommodation costs covered for recurring treatments such as chemotherapy or dialysis?

  Cover for recurring treatments like chemotherapy or dialysis depends on your specific health insurance policy and the fund's rules. Some high-level extras policies may offer benefits for ongoing travel and accommodation needs if each instance of treatment continues to meet the criteria for medically necessary care and local unavailability. You should discuss your specific circumstances and treatment plan with your health fund to understand your entitlements.