Private health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover. If you plan to take out both hospital and general treatment cover, many insurers provide combined policies. Ambulance cover may be available separately, combined with other policies, or even covered by your state government.
Hospital cover
Public patient
Under Medicare, you can be treated as a public patient in a public hospital, at no charge, by a doctor appointed by the hospital. You can choose to be treated as a public patient, even if you are privately insured.
As a public patient, you cannot choose your own doctor and you may not have a choice about when you are admitted to hospital.
Private patient
As a private patient you have the right to choose your own doctor, and decide whether you will be treated at a public or a private hospital that your doctor attends. You may also have more choice as to the timing of the treatment.
If you choose to be treated as a private patient in a hospital (public or private), Medicare will cover you for 75% of the Medicare Benefits Schedule (MBS) fee for associated medical costs.
You will be charged for the remaining 25% of the MBS fee for doctors' services, plus some or all the costs of:
- hospital accommodation,
- theatre fees,
- intensive care,
- drugs, dressings and other consumables,
- prostheses (surgically implanted),
- diagnostic tests,
- pharmaceuticals,
- any additional doctor's fees.
Private health hospital treatment cover insures you against some or all of these additional costs of being a private patient in either a public or private hospital. It also allows you to choose your own doctor or specialist, and the timing for any treatments required.
As with any other insurance policy, you can choose comprehensive cover with higher premiums, or pay lower premiums for reduced cover. You can also reduce your premiums by opting to pay some of the costs through an excess or co-payment.
Some insurers also offer 'gap cover' to cover some or all of the difference between the doctor's fee for services provided in hospital and the combined Medicare benefit and health insurance benefit.
With hospital cover, you can choose to be treated under either the public Medicare system, or in the private system, or in combination:
| Choice of hospital | Choice of doctor | |
| Public patient, public hospital | No | No |
| Private patient, public hospital | No | Yes |
| Private patient, private hospital | Yes | Yes |
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