Hospital Cover

Looking for health insurance with hospital cover? Savvy is here to help you break down your options and ensure you get the best hospital cover for you!

Last updated on May 4th, 2022 at 03:30 pm by Bill Tsouvalas

Compare hospital cover options

Understanding your health insurance and hospital cover options is vitally important – you never know when you will need it! Here we go over the ins and outs of hospital cover and outline the benefits and disadvantages of it to better inform your decision making

What is hospital cover?

Hospital cover is a form of policy within private health insurance which covers patients so they can be treated as a private patient in private and public hospitals. This cover helps pay for the cost of hospital treatments by a doctor of the patient’s choosing, hospital accommodation to stay in a given ward, and the associated theatre fees if surgery is necessary. Hospital cover will also include cover against most types of elective surgery, plus emergency or medically required surgeries.

The primary benefit of extras cover is preventative treatment which can improve your overall health. When properly taken advantage of, extras cover can prove immensely beneficial to your health and finances should you claim back your full benefits.  

The difference between extras and hospital cover is that extras cover is steered towards non-essential services and treatments which help avoid injury or illness. This will help prevent the need for use of your hospital cover towards more serious minor or major medical treatment in hospital or at your GP. If you’re looking for complete comprehensive cover and to be best insured for both essential and non-essential medical treatment, combined cover is often the best option.  

What are the levels of hospital cover?

Hospital cover products are now offered in four different tiers of coverage. These are:

  • Basic – this basic category is the lowest level of hospital cover which a health insurer can offer. At the bare minimum, this cover will include treatment or service in rehabilitation, hospital psychiatric services and palliative care. These categories can be offered by the health fund on a restricted basis.
  • Bronze – the bronze policy has the same minimum requirements as a basic policy but also includes unrestricted cover for a further 18 clinical categories. In total, bronze policy cover insurers for a total of 21 clinical categories.
  • Silver – the silver tier will include all the clinical categories featured in basic and bronze policies, plus treatments and services under eight further clinical categories which are unrestricted. Therefore, silver policies cover at least 29 clinical categories in total.
  • Gold – The top tier of hospital cover, the gold category, provides unrestricted cover for every one of the clinical categories covered under the basic, bronze and silver tiers. In addition, the gold tier provides unrestricted cover for the remaining nine clinical categories. The gold tier is the all-inclusive hospital cover and offers the ultimate peace of mind and benefits.

Health funds can also provide cover for additional categories under the basic, bronze and silver tiers; these covers are known as basic, bronze, silver or gold ‘Plus’. For a full detailed list of each tier’s included clinical categories, click here.

How do I compare hospital cover only insurance?

When comparing hospital cover policies, it’s most important to figure out what policy factors are critical to you and your health situation. If you have a certain medical condition, you will need to prioritise that when choosing your cover. You may also need to ask yourself some basic questions such as:

  • What is your current life stage and how does it shape your hospital cover policy options?
  • Do I or my dependents on my health insurance have any pre-existing medical conditions?
  • What does my budget look like for premiums and excess?

When you know what policy inclusions you need and have made a financial decision on the excess you are willing to pay – or if you wish to have an excess option at all – you can begin comparing hospital cover options thoroughly.

While cheap hospital cover options may jump out to you and offer significant savings each month, you need to make sure you have the right hospital cover to avoid any frightening charges in the future. A cheap basic hospital cover option might look sufficient as it covers the most common and basic medical treatments or services, however, if an unlikely medical event occurs, you might be left wishing you had chosen otherwise when faced with an expensive medical bill which Medicare won’t cover in its entirety.

What does hospital cover include?

As a general rule, hospital cover policies will insure against any hospital or medical services which are featured in the Medicare Benefits Schedule (MBS). These services include:

  • Treatments from specialists and doctors.
  • Tests and examinations e.g. blood tests, eye tests and x-rays.
  • Surgeries
  • Certain therapeutical procedures
  • Some dental surgeries
  • Specific allied health services e.g. psychiatrists, psychologists, and chronic disease management services.

Inclusions under hospital cover will vary between policies so it’s important to read and understand your policy’s terms and conditions and its Product Disclosure Statement (PDS).

What does hospital cover exclude?

The exclusions of your hospital cover will depend on the tier of cover you opt for. Common exclusions for more basic hospital cover can include:

  • Heart surgeries
  • Hip and/or knee replacements
  • Cataract surgery
  • Pregnancy and birth-related services
  • Appointments with specialists or obstetricians outside of hospital

Contact a health insurer directly or once again read up on the relevant hospital cover’s terms and conditions and/or PDS to get a complete understanding of the relevant restrictions and exclusions. 

How much does hospital cover cost? 

The costs for hospital cover range significantly depending on the tier of your cover, your health condition, and your state or territory of residence. A rough guide to the expected costs of hospital cover based on a hospital cover only policy without extras is as follows:


Hospital cover tierHospital cover cost (per month)

How do I choose the best hospital cover policy?

Pros and cons of hospital cover


Allows you to choose a preferred doctor and/or hospital

Able to avoid elective surgery wait lists at public hospitals

If you earn over $90,000 annually, getting private health cover will avoid you having to pay the Medicare levy surcharge of between 1-1.5%

May be eligible for a rebate. Dependent on your income and age, the Australian government may provide a rebate on your hospital cover expenses. If eligible, this rebate will be processed with your tax return or by way of a discounted premium

Provides peace of mind. In the unfortunate event that a medical incident occurs, you can be assured that you and your family are covered by private health insurance and will receive the best care possible without financial concerns. 


The most obvious disadvantage of hospital cover is the cost. The cost of hospital cover is out of reach for many individuals and families who miss out on the benefits.  

Hospital cover can be complicated and overwhelming. The excluded treatments and out of pockets costs can be frustrating. 

The hidden restrictions and exclusions in the terms and conditions or PDS can be a hassle and leave customers blindsided.

If you need treatment for an illness or injury that your policy restricts or excludes completely, you may have to wait for 12 months until your new policy covers you.

Top tips for choosing a hospital cover policy

Read and understand the terms and conditions and PDS

Health insurance and hospital cover can prove a headache. This is especially the case when you find out that you’re not covered for something you thought you were. This can be draining when you now have to worry about the financial costs of treatments or services, in addition to your own health and wellbeing. To avoid this hassle, it’s best you read and understand your policy’s terms and conditions, as well as the PDS, back to front.

Enquire with your insurer about any annual limits

When choosing the right hospital cover for you, it is important you enquire with the insurer about any annual limits they may have hidden in their policy. These annual limits mean you can only claim up to a certain amount for each medical service or treatment before it resets after every 12 months.

Don’t pay for unnecessary extras

When choosing a hospital cover policy, don’t get sucked into paying for unnecessary extras you are very unlikely to use. This is just wasted money that could go towards getting you health cover at a higher tier.  

Common questions about health insurance and hospital cover

How do I get the best and cheapest hospital cover insurance quotes in Australia?

Choosing the best hospital cover option for you can be daunting. To get the best and cheapest option for you, it is important to research your options thoroughly and broadly. Get in contact with Savvy today to compare your options!

Who are the best hospital cover providers?

While there are many leading hospital cover providers, the best one depends on your medical and/or financial situation. At the end of the day, the best hospital cover provider is the one that affords you the best treatment and care possible, as well as offering the confidence that finances won’t be an issue.

If I must go to hospital, will I incur any costs or gaps?

Whether or not you will have any expenses or gaps to pay depends on the level of cover you opt for. Depending on your cover, you may be liable to pay a hospital excess or co-payment when you’re admitted to hospital. To find out what these costs will be, you can ask your specialist or surgeon to write you up a copy of the costs associated with your treatment or service and contact your insurer to find out what you will be required to pay.

What is a co-payment?

A co-payment is where you pay a specific amount for each day you spend in hospital. Co-payments may only begin after you have spent a certain period of time in hospital e.g. after 5 days. Co-payments may also have a yearly cap or only count towards stays in private rooms. They can be both limited and unlimited, but if you expect to have a long stay in hospital, it’s handy to know what your policy allows.

What is a hospital cover excess?

A hospital cover excess, like a car insurance excess, is a contribution you must make towards a hospital-related claim you make on your insurance policy. This excess is typically paid directly to the relevant hospital before or after treatment. Having a hospital cover excess will ensure your hospital cover remains cheaper, however, it is also possible to pay a higher premium for hospital cover with no excess.

Should I choose a hospital cover with excess or no excess?

Both options have their benefits, but it depends on your financial situation as well as lifestyle. If you live a high-risk lifestyle and may be more prone to medical accidents which result in hospitalisation or treatment, choosing a hospital cover with no excess may be the best choice for you. Alternatively, if you live a risk-free and perhaps more of a stay-at-home or sheltered lifestyle, opting for a hospital cover with excess could be the better option.

I have a pre-existing medical condition, will my hospital cover cost extra?

If you have a pre-existing medical condition, your hospital cover will cost more as you are more prone to injury or illness. As treatment and medical services are more likely, the insurer will take this into account. In this situation, it is most important to ensure you are choosing a hospital cover policy which covers your medical condition, even if the premium is significantly more expensive.

Does hospital cover include ambulances?

Most hospital cover policies will insure you for emergency ambulance services. Other policies may also allow you to claim up to a certain amount per person, per year on non-emergency ambulance trips. Cover for ambulances will vary between insurance providers and policies so it’s important to contact your insurer directly and find out.