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What is changing with NSW Private Room Rates from 1 October 2026?

From 1 October 2026, if you're admitted to a NSW public hospital as a private patient and choose to stay in a private room, you may need to pay the difference between the private room rate and the sh…

Who do these changes affect?

If you have Gold tier cover, nothing changes for you. If you choose to be treated in a private room, you'll continue to be covered where one is provided. If you have any other level of cover, includi…

When does this start?

The changes apply to planned admissions from 1 October 2026. The changes will not affect members admitted to a NSW public hospital as a private patient before 1 October 2026.

What's the difference between a private room and a shared ward?

A private room is a single room just for you. A shared ward is a room you share with other patients. Either way, you get the same clinical care from the same medical team.

Will this change affect my treatment or care?

No. This will not affect your clinical care, treatment decisions, access to hospital services, your healthcare team or access to a private room if it's clinically necessary for your care. You'll stil…

Will this change what I pay for my treatment?

No, the cost of your medical care, your procedure, your doctors and the services you claim for isn't changing. The only thing changing is the accommodation rate paid towards a private room, where a m…

Is this a change to my policy or product?

No, this isn't a change to your product or policy. It's a change of how our funding of a private room accommodation charges in a NSW public hospital. Your cover and the services you're entitled to cl…

Can I use my private health cover in a public hospital?

If you're admitted to a public hospital, you can usually choose to be treated as a public patient under Medicare or use your private health cover as a private patient. As a private patient, you use y…

Can I still choose a private room?

Yes, you can still choose a private room where one's available. For affected members, we'll pay the shared ward accommodation rate. Your admitting hospital may require you to pay the difference betwe…

Are there cover options that continue to include private room accommodation benefits?

Yes. We will continue to cover private room accommodation benefits, including on Gold tier cover. If private room accommodation is important to you, it's worth reviewing whether your current cover st…

What happens if I go to hospital in an emergency? Do I have to ask to be put in a shared ward to avoid paying for a private room and what if none are available?

If you need emergency treatment at a hospital, your health comes first. The hospital will focus on providing the care you need, so you won't be expected to choose a room before receiving urgent treat…

I'm booking in for elective surgery. What should I ask my specialist, doctor or hospital?

From 1 October, if you have a planned admission to a NSW public hospital as a private patient, it's worth contacting the hospital for updated informed financial consent to understand any potential ou…

I'm being admitted before 1 October 2026, will my room be covered?

These changes will not affect planned admissions in a NSW public hospital before 1 October 2026.

Do I need to do anything differently to claim after the change?

In most cases, no - claiming for hospital works the same way it does today. When you're treated in a NSW public hospital, the hospital usually bills us directly for your accommodation, so there's not…

Will this affect my premium?

No, this change doesn't affect your premium. Health insurance premiums are reviewed separately each year and any changes must be approved by the Australian Government as part of the industry's annual…

How can I reduce potential out-of-pocket costs?

Before going to hospital, go to your member account for help understanding your options, choosing a hospital and reducing potential out-of-pocket costs.

Why we're making this change

We know getting value from your cover matters. Healthcare costs are continuing to rise. This change helps us manage those rising costs while keeping your cover valuable for the long term.

Does this mean I am no longer covered in NSW public hospitals?

No, we'll keep covering accommodation for privately insured members treated in NSW public hospitals. These hospitals are an important part of the healthcare system and play a vital role in caring for…

Have further questions on the changes to NSW Private Room Rates from 1 October 2026??

If you have any questions or would like to understand more about your options, we're here to help. You can contact us on 13 49 60 (Monday to Friday, 8am-6pm AET) or check what you're covered for in y…

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