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What's The Different Between Hospital And Extras Cover?

When purchasing health insurance, the difference between hospital and extras cover can be confusing. Do you need both? What kind of extras are included? And why are there so many levels of cover?

The kind of health insurance that is best for you will depend on lots of factors, like your age, medical history, and any pre-existing conditions. It’s important to compare options to find the best deal for your circumstances, and to understand exactly what you’re paying for.

What Is Private Health Insurance Hospital Cover?

Hospital cover includes any treatment or procedures you receive as a patient in a hospital. This means that external healthcare – such as visits to a GP, specialist appointments, or things like dental check-ups and optometrist visits – are not covered.

Hospital cover comes in tiered categories, with each category including more services than the one beneath it. These have been standardised by the Federal Government, which means that no matter which insurer you choose, the services you receive on a specific tier won’t differ.

The tiers are called Basic, Bronze, Silver and Gold. Basic will give you cover for only the essentials, while Gold will cover you for most treatments and procedures.

What Does Hospital Cover Include?

Here are some common inclusions for each tier.

  • Basic: tonsil removal, joint reconstructions, gastrointestinal endoscopy
  • Bronze: brain-related, nervous system and blood conditions, chemotherapy, ear, nose and throat conditions
  • Silver: heart and vascular, palliative care, diabetes management, medically required reconstructive surgery
  • Gold: pregnancy and birth, assisted reproductive services, sleep studies, psychiatric services, rehabilitation, joint replacement.

What Is Private Health Insurance Extras Cover?

Extras cover refers to the additional medical treatment you receive outside a hospital. Some of this extra care is covered by Medicare and won’t require private health insurance, such as visits to a GP. An extras insurance policy commonly covers things like prescription glasses and contact lenses, physiotherapy, dental check-ups, and more.

There are tiers of extras cover, but these are not government mandated. This means that different providers will have varying offers. If there is a service that you are particularly interested in – for example, you wear glasses and know that you will need regular optometry – then you need to carefully check the policy you are purchasing to ensure your needs are covered.

What Does Extras Cover Include?

Different health insurance funds will include different extras in their choices of cover. Basic extras cover will often include general dental, physiotherapy, optical, podiatry and osteopathy. Gold extras cover can include all additional healthcare, such as occupational therapy, hearing aids, health management, and even travel and accommodation associated with essential medical or hospital treatment if you are unable to access this treatment where you live.

What Are Other Differences Between Hospital And Extras Cover?

There are other ways in which private health hospital and extras cover differ. For hospital cover, the government sets maximums on the waiting periods that funds can impose on different treatments. For extras, insurers set their own waiting periods. These are another important thing to look at when buying health insurance.

Hospital cover is more expensive than extras cover; however, this shouldn’t mean you choose to forgo hospital cover and just get extras insurance. Without private hospital cover, you can face long waiting times in the public system. Additionally, you need hospital cover to avoid the Medicare Levy Surcharge, which is a tax for people earning over $90,000 who don’t have health insurance.

Sally Writes 01 Apr 2021