Private Hospital Cover: What You Need To Know

Hospital cover is a type of private health insurance policy that assists with covering all or part of the cost of in-hospital treatment as a private patient in either a private or public facility. Here's what to expect from your health fund if a hospital visit is scheduled.

As a private patient, you have a greater chance to choose your treating doctor. You also have more control of when and where you will be treated. Even better, you can skip the public hospital waiting queues because private health insurance generally means your waiting time for elective surgery is a lot shorter compared to the public system.

There's also the comfort factor to consider. Private patients can have their own hospital room as opposed to being in a shared ward with other patients, and depending on the hospital and availability, you can access extra features such as a private bathroom or cable television.

The financial side

Private health insurance pays for ambulance cover and hospital expenses. As a privately insured patient, it's important to note that you may still be subject to some out-of-pocket expenses. This is totally dependent on your policy's level of cover, your doctor and the federal government's Medicare Benefits Scheme (MBS) – a set fee used to work out how much Medicare will pay towards services it recognises.

The current MBS fee is 75 per cent per item number for a private patient having in-hospital treatment. Your health fund covers the additional 25 per cent, provided that you're eligible for those benefits under your health insurance policy. Doctors have the right to charge their patients more than the scheduled MBS fee. If they do, this is the extra 'gap' amount you may be expected to pay.

It's important to ask your doctor if they offer a 'no-gaps' service for their time and expertise. Otherwise, ask them to explain their fees and decide whether you agree to these fees before they provide their services.

Alternatively, patients can reduce their out-of-pocket expenses by choosing to be treated as a private patient in a public hospital. The downside is that your choice of treating doctor and facility location is limited. Your procedure date is also set by the hospital, which means you will be placed on a waiting list according to the severity of your condition.

To get the most value out of private health insurance, find a policy offering hospital and extras benefits that are suitable for your lifestyle needs, and budget.

This is general advice only: Choosi is owned by Hollard Financial Services Pty Ltd (ABN 53 128 692 884), the information on this website does not take into account your personal objectives, financial situation or needs. You should consider the relevant Product Disclosure Statement (PDS) for more information and to ensure the product suits your needs.