Hospital cover is a part of health insurance that helps pay for the cost of treatment when you are admitted to hospital as an inpatient.
It is designed to help cover costs such as hospital accommodation, theatre fees and other inpatient hospital services that would otherwise be expensive to pay yourself.
This article explains what hospital cover is, how it works and some of the important things to understand before choosing a hospital policy.
Key Points
- Hospital cover helps pay for treatment received as an admitted inpatient.
- Hospital cover is designed to help cover costs such as hospital accommodation and theatre fees.
- Hospital cover does not cover every treatment or medical cost.
- Different hospital policies cover different treatments and services.
What does Hospital Cover include?
Hospital cover can include treatment for a wide range of medical conditions and procedures performed in hospital.
Depending on the policy, this may include services such as joint replacements, heart treatment, pregnancy and birth, psychiatric services and rehabilitation.
Hospital policies are grouped into Gold, Silver, Bronze and Basic tiers, with higher tiers generally covering a broader range of treatments. Read more about Hospital Product Tiers.
Depending on the policy, some treatments may be fully included, while others may be restricted or excluded.
What doesn’t Hospital Cover include?
Hospital cover does not cover every medical expense or healthcare service.
In most situations, hospital cover only applies when you are formally admitted to hospital as an inpatient.
This means services such as GP appointments, outpatient specialist consultations, scans and tests performed outside of a hospital admission are usually not covered by hospital cover.
Some of these services may instead be covered by Medicare or Extras cover depending on the treatment and your level of cover.
How does Hospital Cover work?
If you need treatment in hospital, your doctor will usually arrange for you to be admitted as an inpatient.
If the treatment is included under your policy and you have served any relevant waiting periods, your hospital cover helps pay some of the costs associated with your hospital admission.
In many situations, the hospital will bill your health insurer directly for costs such as accommodation and theatre fees.
Your doctor and any specialists involved in your treatment may bill separately, which is why there can still be out-of-pocket costs depending on your treatment and policy.
Do I need Hospital Cover?
Whether you need hospital cover depends on your health needs, budget and personal circumstances.
Many Australians choose hospital cover for reasons such as:
- Greater choice around where they receive treatment
- Choice of doctor in the private hospital system
- Access to treatment in the private hospital system avoiding the public hospital waiting lists
- Reducing or removing the Medicare Levy Surcharge (MLS)
- Preventing Lifetime Health Cover Loading (LHC) later in life
- Taking advantage of the Age-Based Discount available to Australians aged 18 to 29
Does Hospital cover have waiting periods?
Waiting periods are periods of time where you must hold your hospital cover before you can claim benefits for certain treatments or services.
Different waiting periods apply depending on the treatment and the type of hospital cover you hold.
For example, a 12 month waiting period applies for pregnancy and birth related services and treatment for pre-existing conditions.
We explain waiting periods in more detail in our guide to Waiting Periods.
Can you still have out-of-pocket costs with Hospital Cover?
Yes. Having hospital cover does not always mean every cost associated with your treatment will be fully covered.
Depending on your policy and treatment, you may still have out-of-pocket costs such as hospital excesses, co-payments or additional medical charges from doctors and specialists involved in your treatment.
Out-of-pocket costs can also depend on the hospital, doctor and specialists involved in your treatment.
Is Hospital Cover different to Extras Cover?
Yes. Hospital cover and Extras cover are designed for different types of healthcare services.
Hospital cover helps pay for treatment received as an admitted inpatient in hospital, while Extras cover helps pay for services received outside of hospital such as dental, optical, physiotherapy and other everyday healthcare services.
Some people choose hospital cover only, some choose extras cover only while others combine Hospital and Extras cover together in one policy. It really depends on your individual needs and budget.
How do you choose the right Hospital Cover?
The right hospital cover depends on your health needs, budget and the types of treatment you want included under your policy.
Some people choose higher levels of cover for services such as pregnancy and birth, joint replacements or heart treatment, while others prefer lower cost policies that cover more basic hospital treatment.
Understanding what treatments are included, restricted or excluded under a policy can help you choose cover that better suits your needs.
If you’re comparing hospital cover options, you can explore Phoenix Health hospital cover options online or call our team on 1800 028 817 and we’ll be happy to help explain the different levels of cover.
