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Depending on the policy you take out, private health insurance:
You can still choose to be a public patient in a hospital if you have private health insurance. Types of coverPrivate health insurance policies offer hospital cover and extras cover (general treatment). If you want both, you can take out combined cover or mix and match separate policies to meet your needs. You can also take out ambulance cover if your state or territory government doesn’t cover it for you. Hospital treatment coverHospital cover helps with the costs of treatment as a private patient in hospital. Extras and ambulance coverExtras cover helps with the cost of out-of-hospital health services that Medicare does not cover. Ambulance cover can help with the cost of emergency transport and medical care. What isn’t coveredBy law, private health insurance does not offer cover for out-of-hospital medical services including:
Medicare covers these services. Private health insurance policies can’t cover some natural therapies. Ask your insurer, or see our fact sheet on changes to cover for natural therapies. Out-of-pocket costsYou may have to pay out-of-pocket costs if your specialist charges more than the Medical Benefits Schedule (MBS) fee. Your out-of-pocket cost is the difference between the amount charged, and the combined amount paid by Medicare and your insurer. You may also have out-of-pocket costs for hospital charges such as accommodation, theatre, or medical device fees. Your insurer may cover some or all of the hospital charges. Check what your policy includes and what they restrict or exclude. Waiting periodsYou might have to serve a waiting period before you can claim some medical costs. There is a once-only exemption for some mental health services and treatments. Find out more about waiting periods and exemptions for mental health. Cost of cover (premiums)Your premiums will depend on the policy you take out. Your premiums will be higher if you want: Government rebates and loadings may also affect your premiums. Premium increasesYour insurer must let you know in advance if your premium is going to increase. This gives you time to shop around and compare health insurance policies. Premium increases are governed by private health insurance laws. Problems with your coverIf you’re not happy with your health insurer’s service, contact the Commonwealth Ombudsman.
Most people who purchase private health insurance find that they get good service from their health fund and have no problems when they need to use or claim on their insurance. However, thousands of people each year seek the Ombudsman’s help with health insurance problems. Our Office has prepared this list of 10 tips to help avoid problems with your private health insurance.
You can usually switch to a different fund without having to re-serve waiting periods if the switch is to the same level of cover and you have served the appropriate waiting periods with your original health fund.
More Information: see our brochure The Right to Change or visit privatehealth.gov.au More Information The Ombudsman has a number of other brochures and publications for consumers on private health insurance issues. These are available on our website ombudsman.gov.au. For general information about private health insurance and to compare health insurance policies, contact the Ombudsman at privatehealth.gov.au or 1300 737 299. If you have a complaint about your health fund, you contact the Ombudsman on 1300 362 072 or ombudsman.gov.au |