Hospital Cover

Hospital policies help cover the cost of in-hospital treatment by your doctor and hospital costs such as accommodation and theatre fees.

Generally, any medical services listed under the Medicare Benefits Schedule (MBS) can be covered on some form of private hospital insurance.

Some services which are not listed on the MBS, such as elective cosmetic surgery or laser eye surgery, are only covered by private hospital insurance to a limited extent or not at all.

  • With hospital cover you have the right to choose your own doctor, and decide whether you will be treated at a public or a private hospital that your doctor attends.
  • You may also have more choice as to when you are admitted to hospital.
  • When you are admitted to hospital, you can choose to be treated under either the public Medicare system or in the private system
  • Private health hospital cover insures you against some or all of the additional costs of being a private patient in either a public or private hospital. Medicare will cover 75% of the Medicare Benefits Schedule (MBS) fee for associated medical costs.
  • You will be charged the remaining 25% of the MBS fee for doctors’ services and any amount above the MBS fee they have chosen to charge. Depending on the extent of your private cover, you may also be charged for some or all the costs of hospital accommodation, theatre fees, intensive care, drugs, dressings and other consumables, prostheses (surgically implanted), diagnostic tests, pharmaceuticals, and any additional doctor’s fees.
  • Some funds also offer ‘gap cover’ to cover some or all of the difference between the doctor’s fee for services provided in hospital and the combined Medicare benefit and health insurance benefit.
  • As with any other insurance policy, you can manage your cover by choosing comprehensive cover with higher premiums, or pay lower premiums for reduced cover. You can also reduce your premiums by opting to pay some of the costs through an excess or co-payment.

Private hospital cover is now classified in 4 easy to understand tiers:


Top cover

Most hospital treatment


Mid-level cover

Some exclusions not all people need (e.g. pregnancy)


Mid-level cover

More exclusions (e.g. hearing devices)


Basic cover

Low-cost price point

Click here to view the hospital treatment product tiers table.

General Treatment Cover

General Treatment Cover (also called ancillary cover or extras cover) provides insurance against some or all costs of treatment by ancillary health service providers. The extent of your cover depends on the type of policy you select and may include services such as:

Dental treatment


Chiropractic treatment

Glasses and contact lenses

Home nursing

Protheses (e.g. hearing aids)

General treatment policies may be offered separately or combined with hospital cover. There are 3 general categories for general treatment policies. The classifications are based on the services that are shown as covered on an insured person’s Private Health Information Statement (PHIS).

  • Comprehensive – a high level general treatment policy providing cover for most or all of: general dental, major dental, orthodontics, optical, physiotherapy, chiropractic, occupational therapy, pharmaceuticals, podiatry and hearing aids.
  • Medium – general treatment policy providing cover for most or all of: dental, major dental, optical, physiotherapy, chiropractic, podiatry, occupational therapy, but without orthodontics, health management, appliances, etc.
  • Basic – a basic level of general treatment policy, which covers at least one of general dental, optical, physiotherapy or chiropractic services.


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