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Hospital and extras cover explained

A general guide to give you a rundown of how hospital and extras cover works.

Private health insurance generally consists of hospital cover and extras cover, but what's the difference between the two? Below is a general walkthrough of hospital cover and extras cover.

What is hospital cover?

Hospital cover can pay towards services you receive when you’re admitted to hospital and treated as a private patient. It can’t pay towards any services when you’re not admitted to hospital (e.g. seeing your GP or specialist).

With hospital cover, if you're an Australian resident with private health insurance, you can choose to be treated as a private patient at either a private or public hospital (provided the service is included under your cover and you have served your waiting periods), or a public patient at a public hospital.

If you're a private patient at a private hospital, you may also have more choice as to when you're admitted to hospital. If you are a private patient in a public hospital, the hospital waiting lists still apply for elective surgery.

There may still be out-of-pocket costs depending on things like the hospital you're admitted to and what services are included or restricted under your cover.

With private health insurance it's always best to contact your private health insurer before arranging treatment to find out what they pay towards the treatment, and whether there will be out-of-pocket expenses related to your treatment.

What are some the benefits of Medibank hospital cover?

  • Accidental Injury Benefit: if you have an Accident you will get the benefits of our top level of hospital cover, no matter what level of cover you have.*
  • Unlimited Emergency Ambulance: Hospital cover that gives you more with unlimited emergency ambulance^.
  • 24/7 Health Advice Line: members with hospital cover can call a Medibank nurse on our Health Advice Line, for health advice and/or health support, anytime - 24/7.
More information: Why Medibank

What is extras cover?

Extras cover helps with the cost of services generally not covered by Medicare and focuses on keeping you on top of your health. Extras include things like dental, glasses, physiotherapy and a range of other services.

The extent of your cover depends on the type of policy you select and may include. For example: a yearly trip to the dentist is one of one of the most commonly used treatments.

There are limits that may apply, for example: a limit per service, per year, or lifetime limits. Some services may not be included at all. Get familiar with your policy so you know what your cover includes.

What are some of the benefits of Medibank extras cover?

  • 100% back on a dental check-up: every Medibank Member with extras cover for 2 months or more gets an annual dental check-up at a Members' Choice dentist on us. Excludes X-Rays.
  • 100% back on optical: See better value with 100% back on optical items at all recognised providers up to annual limits. Some lens coatings excluded.1
  • Members' Choice Network: with over 13,000 providers, it's the largest in Australia. At these health providers, we've negotiated great deals for Medibank members including capped pricing and a set percentage return for certain services. You'll generally have lower out-of-pocket costs than you would if you used a provider outside our network.
More information: Is Extras Cover worth it?

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Useful resources

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Is health insurance 'better' for you?

When it comes to health, 'better' is different for everyone. Work out if health insurance is better for you. Use our 'People Like You' tool to get an idea of common hospital procedures for people like you.

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How much extra tax could you pay without hospital cover?

Use the Medicare Levy Surcharge Calculator to find out if you're eligible, or discover how much extra tax you may be paying by not having Hospital cover for a full tax year.#

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Understanding Health Insurance

Health insurance can be tricky to understand. To help, we have put some handy guides together to get you started.

Thing you need to know

* - Out of pockets may apply. Excludes claims covered by third parties such as WorkCover, For accidents after join date for which treatment is sought within seven days.

^ - Waiting periods apply. For ambulance attendance or transportation to a hospital where immediate medical attention is required and your condition is such that you couldn't be transported any other way. TAS and QLD have State schemes that cover ambulance services for residents of those States.

1 - 6 month waiting period applies.

# - This calculation is a guide only. For a more detailed quote of what you might pay we recommend speaking to a financial advisor who will be able to take into account your income and personal situation.