What you're covered for in an emergency

Find out what hospital services and treatments are covered for an emergency and what you can expect when you need urgent care.

Person with knee injury

What’s covered in an emergency?

Emergency Ambulance Transport is covered under all GMHBA  hospital policies.  

Ambulance trips are not covered by Medicare and how you’re covered for ambulance varies from state to state.  

It is at the discretion of an ambulance service to classify a trip as emergency or non-emergency. To make sure you’re covered for all necessary ambulance trips make sure you have the right cover for where you live. 

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What if I am admitted through emergency?

In Australia, if you visit an emergency department, whether at a public or private hospital, you are generally treated as an outpatient until you are formally admitted.  

Because of this: 

  • Private health insurance cannot pay benefits for emergency department treatment, as insurers can only cover in‑hospital (inpatient) services.  
  • Private hospital emergency departments often charge an out-of-pocket facility fee. This fee is not claimable through Medicare or GMHBA. 
  • Medicare may cover some of the medical services you receive in an emergency (for example, the doctor’s assessment), but not the private emergency department facility fee itself.  

 

This means you may have to pay: 

  • A private emergency department facility fee, which cannot be claimed with Medicare or GMHBA. 
  • Any other outpatient costs, such as diagnostic tests or specialist assessments that are done before you are admitted. 

 

When your private cover does start applying:

  • Your hospital cover starts covering you only once you are admitted to hospital as an inpatient (for example, once you have moved from emergency into a ward or theatre).  
  • At that point, your usual excess and policy rules apply. 

If you are taken to a public hospital first, you may still have the option to be admitted as a private patient, depending on your health fund and policy. Staff will usually discuss your options with you once you’re stable.