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?

  • Accident cover boost: With our Accident cover boost, you’ll be eligible for top hospital benefits if you have an Accident, regardless of your level of cover.~
  • Unlimited Emergency Ambulance: Hospital cover that gives you more with unlimited emergency ambulance.*
  • 24/7 Medibank Nurse: Members with hospital cover can call our phone service to speak to a Medibank nurse about their health concerns at any time of the day or night.1
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 what it 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 dental check-ups twice a year on eligible extras: With eligible extras cover you get 100% back on up to two check-ups each year at a Members’ Choice Advantage Dentist (including bitewing x-rays where clinically required).#
  • 100% back on optical on eligible extras: When you join eligible Medibank extras you get 100% back on optical items at all recognised providers up to annual limits.2
  • 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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Our interactive tool reveals the common procedures, what you might pay out-of-pocket and how health insurance could help manage the costs.

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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.3

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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.

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Thing you need to know

~ For Accidents that occur after your cover starts and for which treatment is sought within 7 days. Excludes claims covered by third parties such as WorkCover and our Private Room Promise. Out of pockets may apply.

* 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.

# Eligible members on Medibank extras (excluding Healthy Living Extras and Gold Ultra Health) can claim a maximum of two 100% back dental check-ups per member, per year at a Members’ Choice Advantage provider (including bitewing x-rays where clinically required). For members on eligible extras, the first two check-ups do not count towards your annual limit. Members with Healthy Living Extras can get 100% back on one dental check-up each year at a Members’ Choice Advantage provider (including up to two bitewing x-rays, where clinically required) or at a Members’ Choice provider (excluding x-rays). Members with Gold Ultra Health can get 100% back on up to three dental check-ups at a Members’ Choice or Members’ Choice Advantage provider. Members’ Choice and Members’ Choice Advantage providers are not available in all areas. Two month waiting period applies.Some products may have other dental benefits, check your cover summary for details.

1 OSHC members should call the Student Health & Support Line on 1800 887 283.

2 Excludes Healthy Living Extras and select products that are no longer available for sale (for more information check your cover summary or check this page). Applies to prescription glasses and select contact lenses. Some glasses lens coatings and contact lenses are excluded. To find which specific items are included or excluded, call us on 132 331. 6 month waiting period applies.

3 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. Where annual income for Medicare Levy Surcharge purposes is over $97,000 as a single (or $194,000 as a couple/family).