Operations ...: iSelect Health Insurance; How iSelect Adds Value; Participating Funds; Health Insurance Information; Health Insurance Regulation; Government Information; Intermediaries Association (PHIIA); Customer Complaints

Health Insurance Information

What is Private Health Insurance?

You may purchase private health insurance to cover all or some of the costs of health care as a private patient.

There are two types of private health insurance cover available: hospital cover and ancillary (or extras) cover.

Hospital insurance covers all or some of the costs of hospital treatment as a private patient including doctor's charges and hospital accommodation. This applies when you are a private patient in a public or private hospital or day hospital facility.

Ancillary cover helps with the cost of services such as physiotherapy, dental and optical treatment. Some funds offer packaged products that cover both hospital and ancillary services.

Generally, the more extensive the health cover, the greater the contribution rate (premium). When choosing your private health insurance, it is important to make sure it suits your particular needs, as well as your budget.

What are the benefits of Private Health Insurance?

Being a private health insurance member allows you to be treated in a private or public hospital as a private patient. This means that you may be able to choose the doctor that treats you, the hospital you are treated in and a time for treatment that suits you. Private health insurance also provides cover for services not covered by Medicare such as physiotherapy, dental, optometry and podiatry services. Many people rely on private health insurance to access services they would otherwise be unable to afford.

The decision to purchase private health insurance is a personal choice. People who cannot afford the premiums for private health insurance or do not wish to take out private health insurance for any other reason, continue to have the right to access the public hospital system through Medicare on the basis of clinical need.

What does private health insurance cover me for?

If you purchase hospital cover with a private health insurance fund, you will be covered for some or all of the costs of being a private patient in either a public or private hospital. Alternatively, you can still be treated as a public patient in a public hospital at no charge to you under Medicare, should you wish.

The exact amount of hospital treatment you are covered for depends on the level of hospital cover that you purchase, as well as the hospital and doctor you choose and whether they have an agreement with your health fund.

You can also purchase ancillary cover (also known as extras cover) that may offer you cover for services out of hospital that are generally not provided under Medicare, such as:

Dental treatment;
Ambulance;
Chiropractic treatment;
Home nursing;
Podiatry;
Physiotherapy;
Occupational therapy;
Speech therapy; and
Glasses and contact lenses.

What doesn't private health insurance cover?

Private health insurance does not cover medical services that are provided out of hospital and which are covered by Medicare. These services include GP visits and consultations with specialists.

Private health insurance may not cover the total cost of the doctors' services provided to you in hospital, which in turn may leave you with an out of pocket expense. This out of pocket expense is referred to as the Gap.

Individual health funds can inform you whether they offer a product that covers you for all or part of the Gap, and will provide details of the doctors and hospitals with which they have agreements to cover the Gap. You can check with your health fund to see what it offers.

Do people have to have private health insurance?

No. The decision to purchase private health insurance is a personal choice. People who cannot afford the premiums for private health insurance or do not wish to take out private health insurance for any other reason, continue to have the right to access the public hospital system through Medicare on the basis of clinical need.

Please note that even if you have private health insurance, you can still elect to be treated as a public patient in a public hospital under Medicare. Please visit www.health.gov.au/internet/main/publishing.nsf/Content/private-1 for further information.