With hospital cover you can:
- Be treated as a private patient
- Greater choice of who treats you
- Avoid the Medicare Levy Surcharge if it applies to you
- Lock in your Lifetime Health Cover age
- Have peace of mind knowing you are covered for unexpected medical bills
There are two types of costs associated with private treatment while you're an inpatient in a registered hospital – hospital costs and medical costs.
- Hospital costs are for charges like your bed, your meals and theatre.
- Medical costs are charges from specialists like surgeons, radiologists and anesthetists.
Having hospital cover means your health insurer will help pay these costs.
What is Private and Public hospital cover?
Hospital cover offers you protection for the Hospital and Medical costs incurred whilst in either a private hospital or a public hospital as a private patient. Depending on the level of cover you have chosen you may get both private and public hospital or at a very basic level of cover you may have only public hospital where you are treated as a private patient in a public hospital and you are able to choose your doctor.
How hospital costs are paid by health insurers
In a public hospital with health insurance - referred to as 'private patient in a public hospital' - provided your membership does not exclude this procedure the only amount that you will have to pay for hospital costs is your excess, that is if you have one. All other costs are billed to health insurer after you've gone home.
In a private hospital with health insurance - provided that the hospital cover you have chosen is on the health fund’s participating hospital list and your membership does not exclude this procedure, the only amount that you have to pay for hospital costs is your excess, that is if you have one. All other costs are billed to health insurer after you've gone home.
If you choose to have no excess on your hospital cover, there will be nothing to pay.
How medical costs are paid
Medical costs are processed differently to hospital costs. How they are paid depends upon whether or not your doctor is participating in your health fund's Gap Cover Scheme. You can find out if your doctor is participating by asking them prior to treatment.
| If your doctor is participating with your health insurer |
If your doctor is not participating with your health insurer |
- The bill for your medical costs is sent to Medicare and your health insurer.
- Medicare and your health insurer pay their portion directly to the doctor.
- The doctor sends you a bill for whatever is not covered by Medicare or your health insurer (your out-of-pocket expenses).
|
- After you have left the hospital, take your paperwork to Medicare. They'll issue cheques and medical statements.
- You send the medical statements to your health insurer, and your health insurer will send you cheques for payment.
- You send these cheques and the Medicare cheques to your doctor.
- The doctor sends you a bill for whatever is not covered by Medicare or your health insurer (your out-of-pocket expenses).
|
GMHBA example with Gold Plus, Silver Plus, Gold, Silver or Silver Single Parents Hospital covers
You're skiing in Australia and have a nasty fall, badly injuring the ligaments in your knee. Ski patrol help you back to the ski resort's medical centre where the medical staff patch you up, but to properly fix your knee you're going to need a knee reconstruction.
The public health system will fix you up just fine for free, but you may have to wait some time before your operation, unless it is seen as critical.
If you have no private hospital cover you can elect to have your operation sooner in the private system, but while Medicare will pay for 75% of the Medicare Benefits Schedule (MBS) fee for your medical costs, anything over that plus all hospital costs are payable by you. This could add up to thousands of dollars.
GMHBA's Gold Plus, Silver Plus, Gold, Silver and Silver Single Parents Hospital covers help to protect you from those costs by covering all of your hospital costs and some or all of the medical costs not covered by Medicare (except if the service is excluded from that cover).
This diagram illustrates who pays for medical costs in the three different scenarios.
