What Is Combined Hospital & Extras Cover?

21 Nov 2019 5 min read

What Is Combined Hospital & Extras Cover?

What is combined Hospital and Extras cover?

When you start to look at health cover options, you’ll see there are three choices of cover:

  1. Hospital

  2. Extras

  3. Combined Hospital and Extras

The two main cover options are Hospital or Extras, and your budget, stage of life and circumstances will help determine whether you need just one or both.

Each of the main options (Hospital or Extras) cover you against a range of costs related to your health. Each of these options is a totally different form of cover from the other as one covers in-hospital costs and the other covers anything that’s considered “extra”. Within these, you can choose cover based on which services you think you may need now or in the future, ranging from basic to more comprehensive protection.

Many health funds offer a combined policy of Hospital and Extras cover. We will explore some key features of these different forms of cover so you can decide whether combining them is best for you. 

Hospital cover

Hospital cover helps pay for costs associated with in-hospital services such as surgery, anaesthesia, private rooms, and theatre fees. Your out-of-pocket costs will vary according to the Hospital excess you choose, your health fund, the medical professionals required, and the procedure involved. Generally speaking, if you’re young and healthy you may only require a basic Hospital cover. But if you’re getting to a stage in your life where you’re slowing down or chronic illness / complaints are starting to appear, you may want to think about a more extensive level of cover. If you ever find yourself facing a stay in hospital, having Hospital cover could allow you to choose whether a private hospital is better for you and which doctor you would like. 

Hospital tiers and categories

By 1 April, 2020, Hospital covers across all health funds will be assigned to one of four tiers - Basic, Bronze, Silver and Gold. To be categorised into a certain tier, each Hospital product must cover a minimum set of services as defined by the Government. These hospital services have been standardised across the whole industry and are referred to as ‘clinical categories’. This will make it easier for you to identify, compare and choose a health cover that’s right for you.

Health insurers can choose to include additional services on top of the minimum clinical categories required to create ‘Plus’ products, eg ‘Bronze Plus’. The different levels will include the below types of services: 

  • Basic - All Basic covers must include Hospital Rehabilitation, Hospital Psychiatric Services and Palliative Care on a restricted basis as a minimum requirement.

  • Bronze - Have the same required inclusions as Basic. In addition, Bronze covers include 18 further hospital services, such as brain and nervous system, joint reconstructions and ear, nose and throat.

  • Silver - Have the same required inclusions as Bronze, and include an additional 8 groupings of hospital services, such as heart and vascular system, dental surgery and lung and chest.

  • Gold - All Gold covers must not exclude or restrict any Medicare recognised hospital services, making Gold the most comprehensive cover.

There are other things to consider if you’re weighing up whether to take out Hospital cover:

  • If you earn a certain level of income and don’t have private Hospital cover, you’ll incur a Medicare Levy Surcharge. This is a tax applied by the government and is designed to take the burden off the Medicare system. If you’re single earning above $90,000 or a couple earning above $180,000 then you could be liable for the surcharge which will increase as your salary rises.

  • If you’re aged 18–29, with some funds you could be eligible for up to 10 percent off your Hospital insurance premiums and the discount lasts until you turn 41. From 41 years of age, the discount will be reduced by 2% each year until it reaches 0%. 

  • If you don’t have private Hospital cover by 1 July following the time you turn 31, a loading will be added to your premium when you do decide to take it out. The Lifetime Health Cover loading results in an additional 2% charged for every year you don’t have Hospital cover, up to a max. of 70%. Once you commence with a Hospital insurance policy, if you hold it continuously for 10 years, this loading will be removed. 

Extras cover

Extras cover is different (also known as ‘general treatment’ or ‘ancillary’ cover). This helps to pay for things that are an “extra” to in-hospital services – and that are often not covered by Medicare. Things such as dental, physiotherapy, optical cover, remedial massage, and more. The difference being that you won’t necessarily be ill or injured to use it – which is when you might claim on your Hospital cover. 

Much the same as Hospital cover, there are different levels to opt in to depending on your needs and life stage. For instance if you think you’re going to need extensive dental work in the next few years, or you might need injury rehabilitation, you may opt for a higher level of Extras cover. 

Extras cover may come with some limitations to how many times you can make a claim and the total value of those claims each year. The good news is, most funds are very clear on these. View our Qantas Health Insurance cover options to see the inclusions and limits of our Extras covers. For more detail refer to our Policy booklet. There may also be waiting periods set for your Extras cover, these usually fall between 2 and 12 months however, if you’re switching between funds your new fund will usually recognise waiting periods you’ve already served for comparable services – meaning you could start claiming straight away on those Extras services within that product.

Click here for a Qantas Health Insurance quote today, or to learn more, call one of our experts on 13 49 60.

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