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Medium hospital cover

Learn more about medium hospital insurance and how it can deliver a broad range of cover without breaking the bank.

Medium hospital is an intermediate level of private health insurance that covers more services than basic hospital cover, but not all of them. There are four levels of hospital cover offered by private health insurers:

  • Public. Public hospital covers minimum benefits for treatment in public hospital only but waiting lists apply.
  • Basic: Covers only the basic treatments listed under the Medicare Benefits Schedule (MBS) and benefits are usually limited.
  • Medium: Covers all the services included in basic plus more, although some treatments are still excluded or restricted.
  • Top: Covers all MBS treatments, with few or no restrictions or exclusions.

Medium hospital cover is suited to those who want more than the rudimentary protection offered by basic cover, but who don’t need or wish to pay for top hospital cover. It offers a broad range of benefits along with more affordable premiums.

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What's covered by this type of policy?

Medium hospital includes all the treatments that basic hospital insures you for, while providing cover for additional medical services such as:

  • Emergency ambulance
  • Accident-related treatment
  • Surgical treatment of a hernia
  • Digestive disorder procedures (e.g. bowel surgery)
  • Cancer-related services (e.g. chemotherapy)
  • Tonsils and adenoid removal
  • Appendix, kidney stone and gallstone removal
  • Cardiac-related services
  • Non-cosmetic plastic surgery
  • Rehabilitation
  • Gastric banding and obesity surgery
  • Psychiatric care
  • Palliative Care

What are the exclusions?

There are some services that are restricted or excluded in both medium and basic cover. These typically include:

  • Pregnancy and birth-related services
  • Assisted reproductive services (IVF and GIFT)
  • Major eye surgery
  • Hip, knee and joint replacements
  • Renal dialysis
  • Sterilisation
  • Non-medical cosmetic surgery
  • Treatments performed outside of Australia
  • Non-Pharmaceutical Benefits Scheme medicines
  • Long-stay accommodation (longer than 35 days)
  • Treatments for which Medicare does not pay a benefit
  • Prostheses costs over the Government benefit limit

If these treatments are not excluded from medium hospital cover, they may be subject to restrictions such as lower benefit limits, higher excesses or longer waiting periods. If you require any of these services, you may need to look at taking out top hospital cover.

Additionally, the following exclusions will apply to all levels of private health insurance:

  • Cosmetic surgery not deemed medically necessary
  • Treatments or services performed outside of Australia
  • Long-stay accommodation (longer than 35 days)
  • Treatments for which Medicare does not pay a benefit

Who is medium hospital cover suited for?

Medium hospital cover insures for a broad range of treatments and services, and can be most relevant for:

  • Those with families who have varying health needs, particularly when taken out in conjunction with extras cover for non-hospital related services such as dental and optical.
  • Younger people not yet ready to start a family or to older people who no longer require cover for things such as pregnancy and assisted reproductive services.

It’s also beneficial for those wishing to avoid government taxes that penalise those who don't have private health insurance (but who want a higher level of cover than basic hospital) such as:

  • The Medicare Levy Surcharge (MLS). Those who earn more than $90,000 for singles or $180,000 for families and do not have basic hospital cover with a maximum excess of $500 for singles or $1,000 for families will pay additional tax of 1-1.5%, depending on their income.
  • Lifetime Health Cover (LHC) loading. For every year after your 31st birthday that you don’t have private hospital cover, it will cost you an additional 2% to take out cover. This increase is capped at 70% and the loading is removed after you have held hospital cover for 10 years.

If you're looking for more general information around health insurance, head to our comprehensive FAQ

Final things to keep in mind

If you are thinking of taking out medium hospital cover, you should be aware of:

  • Gap payments: Because medium hospital cover offers lower benefit limits than top hospital, you will need to check that your insurer has a No Gap agreement with your doctor before being admitted to hospital. If not, you will have to pay the difference out of your own pocket if your chosen doctor charges more than the MBS fee.
  • Excesses: Medium hospital cover may include an excess (a payment you need to contribute towards your treatment), so make sure you find out how much it is and ensure that you can afford to pay it if you need to be admitted to hospital. Also be aware that in order to avoid the MLS, your cover policy can not have a higher excess than $500 for singles and $1,000 for families.
  • Waiting Periods: There may also be waiting periods of up to a year for some treatments, so don’t take out medium hospital cover if you know you’re going to need treatment in less than 12 months.

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Image: Shutterstock

William Eve

Will is a personal finance writer for specialising in content on insurance. While he cannot give personal advice to clients, Will enjoys explaining the intricacies of different types of protective cover to help individuals and businesses find affordable cover that won't leave them underinsured.

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2 Responses

  1. Default Gravatar
    SueApril 16, 2018

    Mid cover with eye cover but no cosmetic surgery, pregnancy or psychiatric care services and how does co payment work and how is the amount set.

    • finder Customer Care
      JoshuaApril 17, 2018Staff

      Hi Sue,

      Thanks for getting in touch with finder.

      To start searching for the right policy, you may want to use our free online form found on this page. Our search engine allows you to narrow down your options by using different filters.

      In most cases, insurers allow one person to be the primary beneficiary of the policy. However, if multiple people would like to contribute, then they may still do so even if the policy is named after one person. Moreover, you can also work out a payment plan with your insurer by directly getting in touch with them. That way you can also know more about their payment options and see which one will be ideal for your situation.

      You will know more about how much your premium will cost by also using our search engine. Once you have specified the type of insurance you are looking for, our search engine will display the results along with the premium cost.

      I hope this helps. Should you have further questions, please don’t hesitate to reach us out again.

      Have a wonderful day!


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