What Is Hospital Cover?

3 February 2017
What does hospital cover health insurance include? Canstar explains hospital cover and the different levels of coverage you can get.

What is hospital cover?

Hospital cover is a type of private health insurance policy that covers a patient to be treated as a private patient in either a public hospital or a private hospital. This helps patients to cover the cost of in-hospital treatment by the doctor of their choice, accommodation to stay in a ward, and the theatre fees for surgery. Hospital cover includes cover for many elective surgeries as well as emergency or medically necessary surgeries.

What does hospital cover include?

Generally, any hospital and medical services listed under the Medicare Benefits Schedule (MBS) should be included in hospital cover. This includes treatments such as doctors and specialists, tests and examinations such as X-rays and blood tests, eye tests, surgeries and other therapeutical procedures performed by doctors, some dental surgeries, Cleft Lip and Palate treatment, and certain allied health services (e.g. psychologists, psychiatrists, chronic disease management). However, make sure you read the Product Disclosure Statement (PDS) and the terms and conditions of your policy.

How to buy hospital cover

Hospital policies can be purchased separately as Hospital Only policies, or Extras cover can be added to a Hospital policy (Hospital + Extras policies) if the patient wishes to be covered for additional medical services such as dental, optical, chiro, and physio.

You can compare different types of Hospital cover policies on our website:


Levels of hospital cover

Hospital policies provide four different levels of coverage of health insurance depending on your choice of policy:

What is hospital cover? Top Private Hospital Cover has no restrictions or exclusions on MBS-payable items (medical services provided by doctors in hospital).
Medium Private Hospital Cover does not exclude any items on the MBS, but has restrictions on some MBS items; only limited benefits are paid for restricted items.
Basic Private Hospital Cover excludes one or more MBS items; no benefits are paid for excluded items.
Public Hospital Cover covers default benefits for treatment in public hospital only.

Source: Health.gov.au

However, the government has been contemplating switching to an easier-to-understand ‘Gold, Silver, Bronze’ system for the coverage level categories, so watch this space.

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