What may not be covered under hospital insurance?
The exclusions and restrictions of hospital cover will vary from one policy to the next and depend on the health fund you choose. Checking what’s not covered under your chosen policy will help you ensure the cover matches your individual health needs and avoid any nasty out-of-pocket surprises if you do need treatment or surgery.
Typically, what’s not covered under hospital insurance are treatments that occur outside of a hospital setting such as dental check-ups, chiropractic treatment or a naturopathy consultation.
Some health insurance funds may exclude treatments such as reproductive services like IVF, psychiatric treatment or major heart surgery. Long-stay patients, some high-cost medications and non-medical cosmetic surgery also may not be provided cover until private hospital insurance.
It pays to keep in mind a budget hospital cover will have more limitations than a more expensive policy. However, you can always upgrade to a more comprehensive form of cover in the future as your circumstances change.
For example, a basic hospital cover may have suited you when you were a carefree, single young adult. But now you’ve coupled up or are considering starting a family, so a higher-level family hospital cover plan may match your health needs better.
As there may be waiting periods for some treatments, we recommend you review your cover annually to ensure you’re protected when it matters most.
Don’t forget to take into consideration waiting periods
You’ve probably heard a bit about waiting periods with private health insurance. It’s actually the most common question we get asked at Members Own.
For example, many people planning to start a family will want to take advantage of pregnancy services under their new private health insurance policy...but they’ll need to consider waiting periods.
Unfortunately, there’s no hospital cover with no waiting period.
If you’ve started a new hospital cover policy or have recently upgraded your level of cover, a waiting period will need to be served before you can utilise any of the benefits under that policy. This is to prevent people from signing up to a policy, making a big claim and then cancelling their membership once they’ve had the surgery or medical treatment.
Maximum limits on private health cover waiting periods are set by the Australian Government. To help guide you, below are some of the waiting periods outlined by the private health funds:
- Pre-existing conditions – 12 months
- Obstetrics services – 12 months
- Specific conditions such as rehabilitation and palliative care – 2 months
- All other hospital treatments and services – 2 months
Comparing the cover of Medicare and hospital insurance
Australia has one of the best health care systems in the world, so why would you need private health insurance?
Beyond the tax breaks, many people take out hospital only health cover as it provides them with a sense of security in case something unexpected arises. After all, the last thing you want to worry about it is how you’re going to finance hospital expenses when you’re ill or injured.
The reality is, major medical procedures can be expensive. A hip replacement may set you back $24,000, a caesarean delivery $9,000 or coronary bypass surgery more than $47,000.
The question you really need to ask yourself is whether you can afford to live without some form of private health insurance.
If you’re deciding whether to get covered, a good way to see if you’ll benefit is by comparing what’s covered by Medicare versus hospital insurance.