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How to choose the right private health cover

Finding the right private health cover can be confusing. Watch this video to help you understand your options and make sure you get insurance that does what it’s supposed to: help you stay healthy and cover you when you need it.

What type of cover do you need?

The first question is do you want hospital, extras or both?

  • Hospital cover gives you more control if you need to go to hospital – like getting treated sooner by a doctor of your choice. Having hospital cover can also help you at tax time.
  • Extras cover helps with the cost of day-to-day services like dental, optical and physio – you could get 100% back on selected extras if you visit a participating provider*. Depending on your level of cover, you could also access a range of health programs to help you be proactive about staying healthy. 
  • Ambulance cover is included on all HCF hospital and extras insurance, but we also offer standalone cover for NSW and ACT residents. You don’t need ambulance cover if you live in some Australian states. See state-by-state guide.

Who are you covering?

We offer cover for singles, couples and families. If your situation changes down the track we can help you find cover that suits your new needs.

What level of cover do you need?

From April 2019, all hospital cover in Australia will be classified as Gold, Silver, Bronze or Basic. This will make it easier for you to understand what’s included and excluded, and compare policies across different funds.

You can find what you’re covered for in the product summary. Before you buy, make sure you read through it and think about what’s important to you, and anyone else on your cover.

Here are a few things to consider:

  • Do you want the reassurance that comes with a higher level of cover? With hospital cover you’ll be able to claim for a wider range of services. It’s the same with extras, plus you’ll get more back in benefits on the services you claim for.   
  • Would top level cover mean you’re paying for services you don’t need? You can change your cover when your needs change, so think about what you want to be covered for now and in the near future.
  • Do you have a health condition or treatment you want to be covered for?
  • Do you want cover for pregnancy and birth?

What excess are you prepared to pay?

When you take out hospital cover you’ll be asked to choose your excess. This is the amount you agree to contribute if you’re admitted to hospital for planned treatment.

If you choose a higher excess, you’ll lower the cost of your cover. Choosing a lower, or zero excess, means you’ll pay less if you go to hospital, but the cost of your cover will be more.

If you have to pay an excess, that’s the maximum amount you’ll pay, per adult, per calendar year. You won’t have to pay an excess for any treatment as a result of an accident+, or for any kids on your cover. 

Also consider…

When considering your cover options, it’s important to be clear about not just what you can claim for, but when you can claim. If you’re unsure if either of the below apply to you, call us on 13 13 34 before booking any treatment.

Waiting periods

If you’re new to private health insurance, upgrading to a higher level of cover, or changing your excess, you’ll have to wait before claiming on certain services. Waiting periods vary depending on the service.

For hospital cover, you’ll have to serve waiting periods for things like pregnancy and birth and pre-existing conditions (see below).

For extras, this may include orthodontics or other major dental work, hearing aids and foot orthotics.

The product summary details which services have waiting periods, and how long they are. If you’re already an HCF member you can log in to view yours.

Pre-existing conditions

If you had the signs or symptoms of an illness during the 6 months before you joined HCF (or upgraded your cover) it’s considered a pre-existing condition. Even if it wasn’t diagnosed by a doctor.

You’ll have to wait 12 months before claiming on your hospital or ambulance cover for a pre-existing condition.

A medical practitioner will decide whether a condition is pre-existing by reviewing your doctor’s notes and the details of your claim. 

Note: You don’t pay more for health cover because of a pre-existing condition. And treatment doesn’t have to stop while you’re serving a waiting period for a pre-existing condition. You can still access treatment through the public system.

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* Benefits on these services depend on your level of cover and available limits. Waiting periods apply.

+ Excludes Accident Only cover