What are the benefits of private hospital cover?
Private health insurance can be a tricky topic, leaving many of us unsure about how it works. Frank is about simplifying things and providing affordable options. We’ve written this guide to help explain private hospital cover, its benefits, and dispel any myths surrounding it.
Accident Only Hospital (Basic)
- Emergency Ambulance Cover
- Upgraded cover in the event of an accident
- Emergency Ambulance Cover
- Dental Surgery
- Joint Reconstruction
Private Hospital (Bronze)
- Emergency Ambulance Cover
- Bone, joint and muscle
- Digestive system
* The price shown is per week and applies to a Single, aged 30, living in VIC. It excludes LHC loading and includes a Base Tier Government Rebate
| Extras services (when included on cover) |
|---|
| All extras benefits except as specified below. Waiting Period: 2 Months |
| Optical, home and domestic aids and medical aids. Waiting Period: 6 months |
| Major dental services (including full & partial dentures, orthodontics, crown & bridgework, endodontic services such as root canal, gold fillings, indirect restorations, surgical extractions of a tooth/teeth including wisdom teeth). Waiting Period: 12 Months |
| Health appliances including nebuliser pump, blood glucose monitor, pressure garments, sleep apnoea monitor, extremity pump, hearing aids, orthopaedic appliances (GMHBA approved), prostheses (GMHBA approved non-surgical), tens monitor, podiatry surgical procedures and orthotic appliances (foot). Waiting Period: 12 Months |
| Hospital services (when included on cover) |
|---|
| Accidents - bodily injuries resulting from accidents which occur after the date of joining GMHBA or upgrading to a higher cover. Waiting Period: No |
| Obstetrics and maternity. Waiting Period: 12 months |
| Pre-existing ailment, illness or condition (other than psychiatric, rehabilitation and palliative care). Waiting Period: 12 months |
| Any other benefit for hospital (or hospital substitution) treatment. Waiting Period: 2 months |
A pre-existing condition is one where signs or symptoms of your ailment, illness or condition, in the opinion of a medical practitioner appointed by GMHBA (not your own doctor), existed at any time during the six months preceding the day on which you purchased your hospital insurance or upgraded to a higher level of hospital cover and/or benefit entitlement.
A special waiting period applies to obtain benefits for hospital treatment for new members who have pre-existing conditions. The waiting period also applies to existing members who have recently upgraded their level of hospital cover. If the ailment, illness or condition is considered pre-existing:
New members
New members must wait 12 months for any hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members (transferring or upgrading)
Members transferring/upgrading to a higher hospital cover must wait 12 months to get the higher hospital benefits (other than psychiatric, rehabilitation and palliative care).
Existing members (with at least 12 months membership)
Existing members with at least 12 months membership in total across their old and new cover are entitled to the lower benefits on their old cover.
Silver Hospital cover provides the same single room coverage as Gold Hospital, but co-payments of $100 per day up to a maximum of $700 per admission apply. Co-payments are not the same as hospital excess. Please note: Some private hospitals only have single rooms and co-payments will apply.
Co-payments do not apply.
Two types of cover: hospital and extras
Private health insurance offers two main types of cover: Hospital cover and extras cover.
Hospital cover helps you with the expenses incurred during your stay in a private hospital. You do not need private health insurance to be admitted to a private hospital. The benefits of having private hospital cover is that it simply helps you pay the costs associated with your admission and treatment.
On the other hand, extras cover takes care of outpatient treatments that aren't covered by Medicare like dental, optical, physio, chiro, osteo, some pharmaceuticals and often a few others.
Benefits of private hospital cover
- Fast-track your treatment: Non-urgent medical procedures often face long waiting lists of months or even years in the public system. With private hospital cover you often get access to treatment quicker via your own doctor and may avoid delays for elective surgeries like wisdom teeth removal, knee reconstructions, and more.
- Doctor of your choice: In public hospitals, you're assigned a doctor based on availability. In a private hospital, you have the freedom to choose your doctor (subject to their availability) and ensure consistency throughout your treatment.
- Pregnancy peace of mind: People thinking of starting a family often opt for private care to have the reassurance of an obstetrician throughout their pregnancy.
- Comfort: Private hospitals generally offer a higher level of comfort, including being more likely to get your own room.
The Medicare Levy Surcharge
The federal government implemented a Medicare Levy Surcharge of 1% to 1.5% for high income earners to incentivise them to take out private health insurance. You will be liable to pay the surcharge if you don't have complying hospital cover with a private health insurer; and have a taxable income of more than $93k for an individual or $186k for a couple or family. Learn more here.
Lifetime Health Cover
Private health insurance is optional - however if you don't purchase hospital cover by the 1st of July following your 31st birthday, you will pay the Lifetime Health Cover loading on top of the premium of any hospital cover you later purchase. Learn more here.
Should you get private hospital cover?
Just ask yourself these key questions:
- Would I otherwise be liable for the Medicare Levy Surcharge or Lifetime Health Cover loading?
- Do I plan to have a baby in the next 3 years? If so, would I like to choose my own obstetrician and have the baby in a private hospital?
- Am I likely to need elective surgery within the next 5 years?
- If something medical happens in the next 5 years, would I prefer to have the option to be treated in a private hospital?
Answered yes to any of these questions? Maybe it's worth considering private health insurance cover. There are cheap health insurance options available and Frank Health Insurance can offer you a range of different levels of cover to suit your individual needs without breaking the bank.
Want to explore your options? Let’s talk.
Get extras cover and save 15% - 40%* off dental treatments with smile.com.au
*Savings may vary between dentists. It is recommended that members obtain a quote prior to treatment.
