What's next private health insurance covers?

General treatment cover

General treatment cover (also called ancillary cover or extras cover) provides insurance against some or all costs of treatment by ancillary health service providers, depending on the type of policy you select, such as:

• dental treatment,
• chiropractic treatment,
• home nursing,
• podiatry,
• physiotherapy, occupational, speech and eye therapy,
• glasses and contact lenses,
• prostheses.

You can purchase general treatment insurance on its own or with hospital cover.

Ambulance cover

Health insurers may pay or reimburse you for all or part of your annual subscription to your state ambulance authority or the costs associated with transportation.

In Queensland and Tasmania, the state government pays the full costs of ambulance cover. Residents are charged a levy for this.

In other states, ambulance cover can be purchased from your private health insurer. If you are a pensioner or a low-income earner in NSW or ACT, your premium may be reduced because you may be entitled to free ambulance cover.
You can also arrange ambulance cover yourself from the ambulance authority in your state.

Note that ambulance cover can vary - some insurers provide cover for all ambulance travel, while others only cover a basic service. Check the details with your insurer to ensure you obtain ambulance cover that best suits your needs.

You may not be covered if you require ambulance transport in a state other than the state in which you reside. Contact your State Government for more information on the arrangements that apply in your state.

What is not covered?

The health insurance policy you buy will have some limitations on the services it will pay for.

Limitations on hospital treatment might include:

• specific services that are not covered at all (known as 'exclusions'),
• services that are covered to a limited extent, which means you will have greater out-of-pocket expenses (known as 'restrictions'),
• benefit limitation periods, which pay reduced benefits on one or more services for a set period of time after the waiting period, then pay full benefits after this period,
• cosmetic surgery and other hospital treatment for which Medicare will not pay a benefit (Medicare pays a benefit on all medical services necessary to maintain your health, but does not cover optional treatments such as elective cosmetic surgery).

Nearly all services covered under general treatment are only covered to a limited extent. There are various limits that may apply, for example, a limit per service, per year, or lifetime limits. Some services may not be covered at all.

You should check the Standard Information Statement and obtain detailed information from your fund about these limitations.

Long stay patients

If you are in hospital for more than 35 days in succession, you will be regarded as a long stay or nursing home type patient, unless your doctor specifies otherwise.

This means you will have to pay more for the cost of hospital accommodation after the initial period. The Health Insurance Act 1973 does not allow health insurers to insure for this cost.