New to private health insurance

In Australia, Medicare covers most Australian residents for health care. However, Medicare does not cover everything and you can choose to take out private health insurance to give yourself a wider range of health care options and more comprehensive cover.

There are two main types of private hospital insurance; hospital cover and extras (also called general or ancillary) cover. You can choose to have only one type of cover or combine them to suit your health care needs, lifestyle and budget.

Hospital cover

As the name suggests, hospital insurance helps cover the cost of in-hospital treatment. Generally, it covers treatment in a private hospital for medically necessary treatment. Medicare covers 75% of the Medical Benefit Schedule (MBS) fee set by the Government for doctors’ charges and your insurance covers the remaining 25%. Note that there may be extra for you to pay if your doctor charges over the MBS.

Hospital insurance also covers hospital charges such as accommodation, theatre fees, intensive care, cardiac care, industry approved prostheses and hospital medication in almost all private hospitals in Australia. 

Some hospital products don't cover all services, or only partially cover them so it's important to check what your cover includes before you sign up and before you seek treatment.

If you take out hospital insurance after the age of 31, the government applies a loading of 2% per year for each year you're over 30. Find out more about Lifetime Health Cover Loading.

Extras cover

Extras cover provides benefits for ancillary services which may include, but are not limited to general dental, major dental, endodontic, orthodontic, optical, pharmaceuticals, physiotherapy, chiropractic, podiatry, psychology and hearing aids.

Each service (or group of services) has a maximum limit per person or per policy that is payable each year or another specified period of time. As with hospital treatment, it's important to check what is covered, how much benefit will be paid for each service and what the limits are for each service. 

Waiting periods

All new members have waiting periods to serve before they can claim benefits for treatment. These waits vary from two months to two years, depending on the service. 

There are no waiting periods for accidents that occur after you join private health insurance. See the individual product brochure for details of waits for specific services on that cover.

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For detailed information about private health insurance, visit www.privatehealth.gov.au.

Also see our Definitions, terms and conditions page for more information.