What is Private Health Insurance?
Private health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover. Ambulance cover may be available separately, combined with other policies, or in some cases is covered by your state government.
In Australia, private health insurance is 'community-rated', rather than 'risk-rated' like most forms of insurance. Private health insurers cannot refuse to insure any person, and must charge everyone the same premium for the same level of cover, despite their risk profile and likelihood of using health services.
Hospital Cover
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. If you are a private patient at a private hospital, you may also have more choice as to when you are admitted to hospital. If you are a private patient in a public hospital, public hospital waiting lists still apply.
Generally, any medical services which Medicare covers and are listed under the Medicare Benefits Schedule (MBS) can also be covered to some extent by private hospital insurance. 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 may not be covered at all, depending on the policy.
Extras & Ambulance Cover
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:
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dental treatment;
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chiropractic treatment;
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home nursing;
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podiatry;
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physiotherapy, occupational therapy, speech therapy and eye therapy;
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glasses and contact lenses; and
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prostheses (e.g. hearing aids).
Ambulance
Medicare does not cover the cost of emergency or other ambulance services. You can organise cover for this service as part of your hospital or general treatment cover, or as a stand-alone cover. The options for ambulance cover vary depending on what state or territory you live in.
Waiting Periods
When you start a new private health insurance policy or increase your level of cover, you have to complete waiting periods before you can claim benefits under your new level of cover.
Hospital treatment waiting periods
The government sets the maximum waiting periods that insurers can impose for hospital treatment:
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12 months for pre-existing conditions,
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12 months for pregnancy and birth (obstetrics),
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two months for psychiatric treatments, rehabilitation or palliative care, even for a pre-existing condition,
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two months in all other circumstances.
General treatment waiting periods
The waiting periods for general treatment (ancillary or extras) cover are set by individual health insurers.
Generally, waiting periods vary from two to six months for items such as general dental, optical and physiotherapy, and up to 12 months or more for major items such as orthodontics or hearing aids.
Overseas Vistors & Students
If you are visiting Australia and hold a temporary visa you should consider taking out Overseas Visitors Health Cover (OVHC). If you need to visit a doctor or stay in hospital while you are here you could find yourself responsible for the full cost of treatment, which can be very expensive.
In some cases you may be required to take health insurance as part of your visa conditions - for example, students are required to take Overseas Student Health Cover (OSHC).
Applicants for working visas, such as subclasses 482 (Temporary Skill Shortage) or 485 (Temporary Graduate), are required to take OVHC that meets certain requirements. Other visitors may also be required to take OVHC.
Your Trusted Insurance Partner
Hippo Insurance has been delivering top-notch insurance services across Australia for more than 4 years. Our team of specialists have an accumulated experience of more than 20 years in the insurance and finance industry, protecting over 1,000 families and business.
We value our clients' trust and time. Especially, we treat them as individuals, not just numbers. Our team of experts is dedicated to providing you with the best insurance coverage at an affordable price.
We understand that every individual or business has unique needs, which why we empower you to tailor your own protection to your specific requirements.