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Types of private health cover
You are here: PrivateHealth.gov.au > Health insurance explained > How insurance works > Types of cover
There are two basic types of private health insurance policies available:
- Hospital, and
- General Treatment (sometimes known as ancillary or extras).
You can take out either of these types of private health insurance on their own or most health insurers offer 'Combined' policies that provide cover for both hospital and general treatment services. Private health insurance does not cover visits to your local doctor, which are covered under Medicare.
Hospital cover
Hospital policies help cover the cost of in-hospital treatment by your doctor and other costs such as hospital accommodation. Services listed under the Medicare Benefits Schedule (MBS) include those medical services (ie doctors bills) necessary to maintain your health. Some services are not covered by MBS, such as elective cosmetic surgery.
Hospital policies fall into four general categories:
- Top Private Hospital Cover - has no restrictions or exclusions on MBS-payable items (medical services provided by doctors in hospital),
- Medium Private Hospital Cover - does not exclude any items on the MBS, but has restrictions on some items,
- Budget Private Hospital Cover - excludes one or more MBS items,
- Public Hospital Cover - covers default benefits for treatment in public hospital only.
Insurers generally offer several different policies within these categories, with different monthly premiums for different levels of co-payments and/or excesses.
General Treatment cover
General treatment policies (also known as ancillary or extras cover) provide benefits for ancillary services such as physiotherapy, dental and optical treatment.
General treatment policies may be offered separately or combined with hospital cover. There are three general categories of policies:
- Comprehensive Cover - includes at least general dental, major dental, orthodontics, optical, physiotherapy, chiropractic, occupational therapy, pharmaceuticals, podiatry, and hearing aids,
- Medium Cover - includes at least general dental, major dental, optical, physiotherapy, chiropractic, podiatry, occupational therapy, but does not include orthodontics, health management, appliances, etc,
- Budget Cover - includes at least one of general dental, optical, physiotherapy and chiropractic.
These services are explained in more detail in the Glossary.
Combined cover
Many health insurers offer packaged policies that provide cover for both hospital and general treatment services. Some insurers have pre-packaged policies, while others allow you to mix and match a few different options, eg a budget hospital combined with a comprehensive general treatment policy.
Corporate health policies
Some health insurers provide health cover policies tailored for specific companies or organisations, which may be part of the company's benefits package.
For more details on the availability and features of these policies, contact the relevant health insurer.
Other forms of cover
Some insurers also offer specific policies for: