In Australia, health insurance (or health cover) is broken into two parts. There’s extras cover and hospital cover. You can take out them out separately or bundle them together (hospital and extras cover).
Extras cover offers many out-of-hospital treatments that Medicare doesn’t subsidise, including dental treatments, optical, physio and more.
While hospital cover, on the other hand, can cover surgeries as a private patient, including pregnancy and birth related services, women’s health related services such as hysterectomies or mastectomy surgery or even weight loss surgery such as gastric banding, sleeve gastrectomy and gastric bypass.
Bear in mind that hospital insurance is categorised into different tiers: Basic, Bronze, Silver and Gold. Each tier is required to include certain treatments.
Also, waiting periods (of up to one year) apply before you can claim on surgeries, in which time you must have held a policy.
Depending on the health fund, through some extras cover products, you can get cover for fitness-related expenses, including:
These weight-loss treatments are covered through what’s called a lifestyle program or wellness benefits
Extras cover can also cover general physio and physio relating to women’s health, e.g., pelvic floor issues, abdominal separation and back issues post birth.
Gold hospital (and some lower tier ‘plus’ policies) covers pregnancy and birth-related services, including the cost of private care during your pregnancy journey, accommodation, labour ward costs and doctors’ fees. While hospital insurance doesn’t cover consultations before you’re admitted to hospital as a patient, you can claim a portion of these costs through Medicare.
Health insurance can also provide money towards assisted-reproduction, like in-vitro fertilisation (IVF).
There is a 12-month waiting period before you can claim expenses for pregnancy and birth-related services on your health insurance, so it’s vital to take out cover before you start trying – if you plan on receiving private care during your pregnancy.
On the other hand, if you aren’t planning on having a child, some extras policies can help with costs associated with prescribed contraceptives from a pharmacy.
This is handy if you’re using one of the more expensive contraceptive pills, plus any other non-contraceptive medications you might need.
With extras cover for prescriptions, any medicine that isn’t on the Government’s Pharmaceuticals Benefits Scheme (PBS) and costs more than the capped PBS price might be covered by your insurance.
Several menstrual and reproductive conditions affect many women in Australia, and the right type of health insurance can help alleviate the stress and financial burden.
For example, if you have Poly-Cystic Ovary Syndrome (PCOS), you might need specific medications that aren’t covered by the PBS. This is where an extras policy might help alleviate some of this cost.
If you suffer from endometriosis, a private hospital policy, which includes gynaecology treatment (available in Bronze, Silver and Gold policies), will help you avoid public waiting lists if you need treatment.
While the public health system does provide cover for cancer treatment, a private hospital policy means you can:
Some cancers are specific, or generally far more common, to women, including cervical cancer, ovarian cancer and breast cancer.
The level of health insurance you may require is influenced by which part of the body is affected by cancer. Silver tier hospital and above is the best option for peace of mind when it comes to including cancer treatments in your policy as all it includes any area of the body that may be impacted.
Yes, you can still get cover if you’ve been diagnosed with a pre-existing health condition, and your coverage will not cost more than if you didn’t have the condition. However, you’ll typically have a 12-month waiting period before you can claim treatment relating to your pre-existing condition.
Some waiting periods for health insurance are set by the Australian Government and vary, depending on the treatment. These waiting periods are the same across all health insurance providers regardless of sex.
Waiting periods for specific hospital treatments are:
| Hospital treatment | Waiting period |
| Psychiatric care in hospital | 2 months |
| Rehabilitation | 2 months |
| Palliative care | 2 months |
| Pre-existing conditions | 12 months |
| Pregnancy and birth-related service | 12 months |
Waiting periods for extras cover vary between providers, and will generally be two months, six months or 12 months depending on the treatment. Some services, like orthodontics may attract even longer waiting periods so read your policy document carefully.
If you’re moving from a single policy to a single parent policy or family policy, there will be a price increase.
But good news, it doesn’t cost extra to add dependent children to your existing family policy. Although, you may need to pay more for dependents over the age of 21 who aren’t studying.
Dependents can be insured up to the age of 21 to 25, depending on the health fund and whether your child is studying, employed full-time or married.
Some policies do cover alternative therapies under extras cover. It’s important to note that, as a part of 2019’s health insurance reforms, 16 natural and alternative therapies were removed from cover, including yoga, Pilates and group classes. Since this change, the alternative therapies you can claim for are remedial massage, acupuncture and Chinese medicine. Remedial massage, acupuncture and myotherapy are commonly included on extras products.
If you want to buy health insurance to help cover medical expenses, there are a few factors that might impact your decision on when you should take out cover:
These initiatives are designed to encourage Australians, whether they’re men or women, to take out health insurance earlier in life.
There are also other incentives for cover, such as:
Let us do all the heavy lifting for you when it comes to gather health insurance quotes. Our free health insurance comparison service allows you to filter by price, coverage and more, putting the power of comparison in your hands.
1 Admitted patient care: 2017-18. Australian Institute of Health and Welfare, Australian Government. 2019
