Private hospital cover applies for medically necessary inpatient treatment as determined by law. Inpatient means you have been admitted to hospital for treatment. This includes hospital admissions for day surgery, which covers procedures that once required an overnight or extended stay. If you’ve chosen a cover with an excess, the same excess will apply for day surgery as for an overnight hospitalisation.
The law does not allow your health insurance to pay for outpatient hospital visits such as post-surgical follow-up consultations, prenatal visits, x-rays and blood tests, or emergency triage. Medicare covers 85% of the Medical Benefit Schedule (MBS) fee for outpatient treatments.
At the hospital
All our hospital covers include:
industry approved prostheses
for most admissions to any of our contracted hospitals or a public hospital as a private patient. Please check your product guide to see if any restrictions or exclusions on selected services apply to your hospital cover.
We have contracts with an extensive network of private hospitals which enables us to pay agreed benefits for services included on your cover. Usually, this means you have nothing to pay for a hospital stay unless you have an excess on your cover or there are medical out-of-pocket expenses.
You can also choose treatment as a private patient in a public hospital. However, as we don't have agreed contracts with public hospitals, your treatment may cost more. You can confirm the costs with the hospital prior to admission. Remember, you can be treated as a public patient in a public hospital at no charge, even if you have private health insurance.
Our hospital contracts vary from time to time and you may have additional out-of-pocket costs for stays in non-contracted hospitals, so please check our find a hospital list before each admission.
Inpatient medical services provided by your specialist, anaesthetist, pathologist, radiologist, or other medical practitioner are covered when you are admitted to hospital, except where exclusions apply to your policy.
Medicare pays 75% of the MBS fee for eligible inpatient services, and we pay the remaining 25%. If you are charged more than the MBS fee, you will be out of pocket for this additional amount unless billed under Access Gap Cover.
While you’re in hospital, you may receive treatments or services provided by other health professionals, such as physiotherapy. Some of our hospital contracts cover these treatments, so call us for more information. If the services aren’t covered in the hospital contract but you have an appropriate level of extras cover, you may still be able to claim a benefit.
Expecting a baby?
Click here for everything you need to know about private hospital admissions for pregnancy and childbirth.