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What's hospital cover?

Private hospital cover helps reduce the costs associated with treatment in hospital (e.g. doctors' fees, accommodation, operating theatre, intensive care, and pharmaceuticals).

Having private hospital cover also allows you to choose your own doctor (e.g. your own surgeon) and choose when you have treatment for elective surgery.

overnight and same-day accommodation charges, less your excess (if applicable)
operating theatre and critical care fees
intensive care and Neo-natal intensive care
prostheses for covered services (up to the amount on the government Prostheses List)
emergency ambulance.

If you go to a non-participating hospital, HCF won't cover all of these fees and charges, and you may have significant out-of-pocket expenses.

medical and associated hospital benefits for which there’s no Medical Benefits Schedule item number or when the medical services aren't approved for payment by Medicare 
private room accommodation for same-day procedures 
experimental treatments
experimental and high cost non-PBS drugs
procedures normally performed in a doctor's surgery or as an outpatient 
private hospital emergency room fees 
respite care
nursing home patients who are limited to benefits set by the Commonwealth Department of Health
special nursing like your own private nurse
luxury room surcharge
donated blood and blood products and blood collection and storage
PBS pharmaceutical benefits in non-participating hospitals
pharmaceuticals (including PBS pharmaceuticals benefits) and other sundry supplies not directly associated with the reason for admission
take home items (e.g. crutches, toothbrushes and medicines)
personal convenience items (e.g. phone calls, newspapers or magazines)
massage and aromatherapy
some services provided while in hospital by non-hospital providers
a service that isn't covered for the payment of benefits in a hospital, and any associated items (e.g. medical gap, prosthesis, pharmacy)
the gap on government-approved gap-permitted prostheses items
any exclusions under your cover.

See our membership guide for all the conditions relating to hospital cover.

HCF hospital cover includes (for treatments listed on your cover and after waiting periods have been served):

overnight and same-day accommodation charges, less your excess (if applicable)
operating theatre and critical care fees
intensive care and Neo-natal intensive care
prostheses for covered services (up to the amount on the government Prostheses List)
emergency ambulance.

If you go to a non-participating hospital, HCF won't cover all of these fees and charges, and you may have significant out-of-pocket expenses.

HCF hospital cover excludes:

medical and associated hospital benefits for which there’s no Medical Benefits Schedule item number or when the medical services aren't approved for payment by Medicare 
private room accommodation for same-day procedures 
experimental treatments
experimental and high cost non-PBS drugs
procedures normally performed in a doctor's surgery or as an outpatient 
private hospital emergency room fees 
respite care
nursing home patients who are limited to benefits set by the Commonwealth Department of Health
special nursing like your own private nurse
luxury room surcharge
donated blood and blood products and blood collection and storage
PBS pharmaceutical benefits in non-participating hospitals
pharmaceuticals (including PBS pharmaceuticals benefits) and other sundry supplies not directly associated with the reason for admission
take home items (e.g. crutches, toothbrushes and medicines)
personal convenience items (e.g. phone calls, newspapers or magazines)
massage and aromatherapy
some services provided while in hospital by non-hospital providers
a service that isn't covered for the payment of benefits in a hospital, and any associated items (e.g. medical gap, prosthesis, pharmacy)
the gap on government-approved gap-permitted prostheses items
any exclusions under your cover.

See our membership guide for all the conditions relating to hospital cover.

Get a quote for hospital cover

What's the difference between public and private hospitals? 

Public hospitals

Pros

If you're treated as a public patient, you're fully covered under Medicare.
If you're treated as a private patient, your HCF hospital cover will pay for some of the costs associated with your treatment (if it's listed on your policy) and you may be able to choose your doctor.

Cons

You have little say over who treats you.
You have little control over when you get treated for elective procedures.

Private hospitals

If you're treated at a private hospital, Medicare will cover a portion of your medical costs, but won't cover your accommodation and theatre expenses. This is where hospital cover can help.

HCF covers these hospital costs for treatment included in your cover. The amount HCF pays will depend on the private hospital that you choose. If you choose a participating private hospital, you'll have less out-of-pocket expenses than if you choose a non-participating private hospital.

Our hospital cover contributes to the portion of costs for doctors that treat you in hospital and that isn't covered by Medicare: 

The government sets a dollar amount for in-hospital medical treatments, known as the 'schedule fee'. Medicare pays 75% of this and your hospital cover pays the remaining 25%.
Some doctors and specialists charge more than the schedule fee. The difference between the two is the 'gap', which falls to you to pay. If you choose an HCF participating doctor, you'll either pay no-gap or a known-gap (up to $500).

What's extras cover?

Extras cover helps reduce out-of-pocket expenses associated with managing or improving your health. Depending on your level of cover, you may be able to claim towards:

diagnostic and preventative dental
restorative dental (fillings), oral surgery, endodontic services 
orthodontics
dentures, crowns and bridges
optical
chiro, physio and osteo
occupational, speech pathology
pharmaceutical (HCF approved, non-PBS)
school accident cover
selected natural therapies
HCF-approved artificial aids
hearing aids
HCF-approved Health Management Programs.

Conditions of extras cover

You can't claim more than the actual cost of your treatment.
Waiting periods and service and annual limits apply.
Artificial aids and hearing aids: your entitlements may not renew every year. Please check with us before you incur any costs.
See our membership guide for all the conditions relating to extras cover.

HCF extras cover excludes:

goods and services while you're a hospital patient, except for eligible oral surgery
pharmacy items that aren’t on our approved pharmacy list (e.g. items listed on the PBS, items prescribed without an illness, items that are available without a prescription, or items that aren’t TGA approved)
goods or services that hadn't been provided at time of claim (e.g. pre-payment)
fees for completing claim forms and/or reports
goods and/or services received overseas or purchased from overseas (including items bought online)
where no specific health condition is being treated or in the absence of symptoms, illness or injury
routine health checks, screening and mass immunisations
more than one therapy service performed by the same provider in any one day
co-payments and gaps for government funded health services (e.g. the co-payment for PBS items)
where a provider isn't in an independent private practice
any exclusions under your cover.

Get a quote for extras cover

What does private health insurance cover?

Private health insurance helps pay for healthcare costs and treatments that Medicare generally doesn’t cover. This can include: 

private hospital admission
ambulance services
elective surgeries
general dental care
other extras like prescription glasses and remedial massage.

Learn more

Private health insurance works alongside Australia’s public healthcare system to offer you more choice, like your own doctor or hospital, and quicker access to some health services, like elective surgeries. It also helps lower your out-of-pocket costs on a range of extras* like dental check-ups and physio appointments, and other extras that Medicare generally doesn’t cover.

Learn more

^* Depends on level of extras cover. Waiting periods and annual limits apply. 

Medicare is Australia's public health system. It provides free or subsidised healthcare to Australian citizens and permanent residents. Medicare is partly funded by a levy on taxable income. It covers services like public hospital treatment and doctors' services.

Private health insurance helps pay for healthcare costs that Medicare doesn’t cover. There are 2 types of private health insurance – hospital and extras cover. Watch this video to learn more about the benefits of having private health insurance.

Watch video

While Medicare is acknowledged as one of the world's best public health systems, it mainly covers things like:

treatment with general and specialist practitioners
treatment at public hospitals
a portion of the cost of medical treatment in private hospitals by surgeons, anaesthetists and other specialists.

Hospital insurance can cover you for hospital accommodation and theatre fees at private hospitals (for services listed on your policy) and emergency ambulance travel, depending on your level of cover.
Extras insurance can cover you for day-to-day health services, like dental treatments, prescription glasses and contact lenses and physiotherapy, depending on your level of cover.

Learn more

While nursing homes can provide round-the-clock care for residents, you don't need private health insurance to become a resident of a nursing home. Private health insurance can provide additional benefits to nursing home residents like covering the costs of private hospital admissions when the resident needs to access hospital, particularly for elective surgeries, which often have long waiting lists in a public hospital. Private health insurance helps fill these gaps and offers residents more protection and flexibility for their healthcare.

How does private health insurance work?

Learn more

^* Depends on level of extras cover. Waiting periods and annual limits apply. 

What's the difference between Medicare and private health insurance?

Watch video

What does Medicare cover?

While Medicare is acknowledged as one of the world's best public health systems, it mainly covers things like:

treatment with general and specialist practitioners
treatment at public hospitals
a portion of the cost of medical treatment in private hospitals by surgeons, anaesthetists and other specialists.

What can private health insurance cover that Medicare doesn't?

Hospital insurance can cover you for hospital accommodation and theatre fees at private hospitals (for services listed on your policy) and emergency ambulance travel, depending on your level of cover.
Extras insurance can cover you for day-to-day health services, like dental treatments, prescription glasses and contact lenses and physiotherapy, depending on your level of cover.

Learn more

Do I need private health insurance in a nursing home?

What doesn’t private health insurance cover?

In addition to the hospital and extras exclusions listed above, there are situations where HCF health insurance doesn't cover you, including:

where there are exclusions on your cover
claims made 2 years or more after the date of service 
when you or your dependants have the right to recover the costs from a third party other than us, including an authority, another insurer (like motor vehicle or workers compensation), or under an employee benefit scheme 
treatment for pre-existing ailments or conditions within waiting periods
goods and services received during any period where your payment is in arrears, your membership is suspended or you’re within waiting periods
treatment that we deem inappropriate or unreasonable, after receiving independent medical or clinical advice
any service where the treatment doesn't meet the standards in the Private Health Insurance Accreditation Rules 2011 or as amended
services that aren’t delivered face-to-face, like online or phone consultations, unless you’re participating in one of our chronic disease management or health improvement programs
goods or services supplied by a provider not recognised by us
goods or services provided outside Australia, which don’t meet the requirements under the Private Health Insurance Act (2007)
claims that don’t meet our criteria.

Learn more

Does health insurance cover ambulance services?

Many people don't know that Medicare doesn't cover you for the cost of ambulance services. And ambulances can be expensive, especially if you live in a rural or remote area.

HCF hospital and extras covers include emergency ambulance services provided by State Government Services if you need hospital or on-the-spot treatment in Australia. HCF covers emergency ambulance transport to the nearest appropriate hospital able to provide the level of care you need (HCF doesn't cover transport between hospitals).

Some levels of cover also include State government non-emergency ambulance services that are medically necessary. This is payable if your doctor requests ambulance transport because your condition requires monitoring and support in transit (on some covers, there's a limit of $5,000 per person per calendar year).

HCF covers have a waiting period of 1 day for emergency ambulance cover and 2 months for non-emergency ambulance cover (if it's included in your cover). Under some HCF covers, there's an annual limit of 1 service per person and 2 services per policy. In some States and Territories, the government covers certain ambulance services. Here’s a high level explanation of how it works across Australia:

Emergency ambulance services for residents aren’t covered by the State government unless you hold certain government concession cards.

If you have HCF hospital cover, you may be entitled to fully covered state emergency ambulance transport under a levy arrangement. If you have standalone HCF extras cover, you may be covered for an emergency ambulance for transport. We recommend checking your policy for more information.

You don’t need separate private health insurance as residents are covered by the State ambulance service scheme Australia-wide.

If you're a resident of Tas, you're covered by your State ambulance service scheme for ambulance services within Tas. In other States and Territories, the scheme generally covers road ambulance services only. It doesn’t cover the cost of ambulance services in Qld and SA.

You may be able to claim for emergency ambulance services not covered by your State scheme under your HCF hospital or extras cover.

If you live in SA, Vic, NT or WA, your State or Territory government doesn’t cover the cost of ambulances. There are some exceptions for concession card holders, otherwise you’ll need either private health insurance, which includes ambulance cover, HCF Ambulance Only cover or an ambulance subscription.

Residents of NSW and ACT

Emergency ambulance services for residents aren’t covered by the State government unless you hold certain government concession cards.

Residents of Qld

You don’t need separate private health insurance as residents are covered by the State ambulance service scheme Australia-wide.

Residents of Tas

You may be able to claim for emergency ambulance services not covered by your State scheme under your HCF hospital or extras cover.

Residents of SA, Vic, WA and NT

What are private health insurance waiting periods?

Waiting periods must be served before you can claim for a service. They apply to:

members that are new to private health insurance
existing HCF members who upgrade to a higher level of cover or reduce excess payable (you need to serve the necessary waiting period for the higher entitlement)
members who switch from another fund who haven't already completed the required waiting period for equivalent benefits
members who switch from another fund who upgrade to a higher level of cover
members who switch from another fund and have a gap of more than 30 days before joining HCF
new dependants, unless they switch from another fund where they've completed the required waiting period for equivalent benefits
members who cancel their policy for a period of time and then rejoin HCF after more than 30 days without having cover with another insurer during the gap period.

Waiting periods are common to all private health insurers and protect regular fee-paying members against inheriting the cost of large medical bills from people with serious conditions who might join, receive treatment, then quickly leave the fund.

Using your private health insurance, or making claims, will depend on how long you're waiting periods are. The maximum waiting periods that a private health insurer can impose for hospital treatment or hospital-substitute treatment are set by the Australian Government:

12 months for treatment of pre-existing conditions. This doesn't apply to psychiatric care, rehabilitation or palliative care which has a 2-month waiting period for pre-existing and new conditions.
12 months for pregnancy and birth-related services.
2 months for psychiatric care, rehabilitation and palliative care, plus all other hospital treatment.

The waiting periods for extras cover differ to hospital cover and vary between 2 and 12 months. Ambulance waiting periods also vary between 1 day and 12 months.

Hospital waiting periods:

Palliative care: 2 months
Hospital psychiatric services: 2 months
Rehabilitation: 2 months
Pre-existing ailments or conditions: 12 months
Pregnancy and birth: 12 months
All other hospital services, including treatments under Accident Safeguard: 2 months

Extras waiting periods:

Health management programs: 2 months
Artificial appliances (e.g. low visions aids, blood glucose monitors): 12 to 24 months
Foot orthotics: 12 months
Minor podiatric procedures: 12 months
Dental bleaching, bridges and crowns, indirect fillings: 12 months
Dentures: 12 months
Endodontics: 12 months
Hearing aids: 12 months
Occlusal therapy: 12 months
Oral surgery: 12 months
Orthodontics: 12 months
Periodontics: 12 months
Pre-existing ailments and conditions: 12 months
Prosthodontics: 12 months
Dental Veneers: 12 months
School accident benefit: 2 to 12 months
All other extras services: 2 months

Ambulance waiting periods: 

Emergency ambulance (where not for pre-existing ailments): 1 day 
Medically necessary non-emergency ambulance (where not for pre-existing ailments): 2 months
Pre-existing ailments: 12 months

^* Members who have held a hospital cover for at least 2 months and upgrade to receive hospital benefits (or a higher level of hospital benefits) for hospital psychiatric services may elect to be exempted from the 2 month waiting period for hospital psychiatric services that usually applies to members when they upgrade their hospital cover. Members who have held a hospital cover for less than 2 months may elect to serve a reduced waiting period of 2 months minus the length of time that the member held hospital cover. This exemption or reduction can only be accessed once in a member’s lifetime.

A waiting period waiver doesn’t apply to all waiting periods. The waiver only applies to extras with waiting periods equal to or less than the waiver period. Services with waiting periods longer than the waiver period aren’t included.

Waivers are only available to new members taking both hospital and extras cover. All hospital services and ambulance services are excluded from the waiver offer. 

Why do private health funds have waiting periods?

How long do I need to serve a waiting period before I can use my cover?

12 months for treatment of pre-existing conditions. This doesn't apply to psychiatric care, rehabilitation or palliative care which has a 2-month waiting period for pre-existing and new conditions.
12 months for pregnancy and birth-related services.
2 months for psychiatric care, rehabilitation and palliative care, plus all other hospital treatment.

The waiting periods for extras cover differ to hospital cover and vary between 2 and 12 months. Ambulance waiting periods also vary between 1 day and 12 months.

Hospital waiting periods:

Palliative care: 2 months
Hospital psychiatric services: 2 months
Rehabilitation: 2 months
Pre-existing ailments or conditions: 12 months
Pregnancy and birth: 12 months
All other hospital services, including treatments under Accident Safeguard: 2 months

Extras waiting periods:

Health management programs: 2 months
Artificial appliances (e.g. low visions aids, blood glucose monitors): 12 to 24 months
Foot orthotics: 12 months
Minor podiatric procedures: 12 months
Dental bleaching, bridges and crowns, indirect fillings: 12 months
Dentures: 12 months
Endodontics: 12 months
Hearing aids: 12 months
Occlusal therapy: 12 months
Oral surgery: 12 months
Orthodontics: 12 months
Periodontics: 12 months
Pre-existing ailments and conditions: 12 months
Prosthodontics: 12 months
Dental Veneers: 12 months
School accident benefit: 2 to 12 months
All other extras services: 2 months

Ambulance waiting periods: 

Emergency ambulance (where not for pre-existing ailments): 1 day 
Medically necessary non-emergency ambulance (where not for pre-existing ailments): 2 months
Pre-existing ailments: 12 months

Does a waiting period apply to me if I joined during a waiver period?

Waivers are only available to new members taking both hospital and extras cover. All hospital services and ambulance services are excluded from the waiver offer. 

What are 'pregnancy and birth-related services'?

These are services that are directly related to hospitalisation for pregnancy and childbirth. They include things like pregnancy complications, the delivery and prenatal and postnatal care of the mother.

What type of cover do I need if I want to cover the childbirth?

You need to be on cover that includes pregnancy and birth-related services at least 12 months before you give birth, as there's a 12 month waiting period.

To check your cover, view your product summary at online member services, or call us on 13 13 34.

What's a pre-existing condition?

A pre-existing condition is an ailment, illness or condition that you had at any time in the 6 months before a health insurance policy started. The condition may not have been diagnosed by a doctor or specialist and you may not have been aware of the condition, but if signs and symptoms were present in those 6 months, the condition will likely be considered ‘pre-existing’.

This applies if you’re upgrading to a higher level of health cover, adding a dependant or child to your policy, or if you’re new to private health insurance or had a gap in cover.

A waiting period of 12 months will be applied for treatment of a pre-existing condition if:

the treatment wasn’t covered under your previous cover
you didn’t have health cover before.

A symptom is an indication of the existence of a condition or ailment. A doctor may find signs of a condition even if you have no symptoms, so you may have a pre-existing condition without realising it. It’s important to note that a diagnosis doesn’t have to be made for a condition to be pre-existing.

If your condition or illness falls within the first 12 months of joining HCF or upgrading your cover, then we’ll request that you complete a pre-existing condition assessment. If you join HCF within 30 days of leaving another fund, and you've already served the 12-month waiting period for the required service, you won’t need to complete a pre-existing condition assessment.

The pre-existing condition assessment involves HCF having a medical professional look at information from your doctor and specialists, as well as any other relevant medical or claim details. The decision of whether you had signs or symptoms of your condition in the 6 months before your cover started is in the hands of our fund-appointed medical professional, not your own doctor, and takes about 5 days to complete once all required information is received.

The above definition of a pre-existing condition is set out under government legislation which also requires the assessment to be made by a medical practitioner appointed by HCF. 

Your medical practitioner will need to complete a Certificate of Attendant (COA) form available on our website.

We may also ask for documentation like:

doctors’ notes
referral letters from your doctor to a specialist
medical certificates signed by a doctor
emergency department notes if you were treated in an emergency department.

In order to carry out a full assessment, we may require you to provide us with your medical records from your doctor(s). You have a right to gain access to all the information held about you. We, as a third party, are bound by the Privacy Act, which means we’re unable to request this documentation directly without your consent. 

What are signs and symptoms?

What's a pre-existing condition assessment?

The above definition of a pre-existing condition is set out under government legislation which also requires the assessment to be made by a medical practitioner appointed by HCF. 

How do you determine if my condition is pre-existing or not?

Your medical practitioner will need to complete a Certificate of Attendant (COA) form available on our website.

We may also ask for documentation like:

doctors’ notes
referral letters from your doctor to a specialist
medical certificates signed by a doctor
emergency department notes if you were treated in an emergency department.

What's restricted cover?

Restricted cover is where certain services are specified as being restricted services under a hospital product and where minimum benefits are applicable.

In a private hospital: these benefits wouldn't cover all hospital costs and are likely to result in large out-of-pocket expenses. 
In a public hospital: if the minimum benefits are less than what your chosen public hospital charges, you may have out-of-pocket expenses to pay.

What’s an exclusion?

If you need treatment for any procedures listed as an exclusion on your hospital cover, you won't receive any benefits from us and may have significant out-of-pocket expenses.

Make sure you've reviewed the exclusions list before buying your cover. 

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^* Our Life and Recover Cover products are issued by our own HCF Life insurance Company Pty Ltd. ABN 37 001 831 250. AFSL 236 806 (HCF Life). HCF Life is a wholly owned subsidiary of The Hospitals Contribution Fund of Australia Limited ABN 68 000 026 746, AFSL 241414 (HCF). Terms and conditions apply. Please read the relevant Product Disclosure Statement, Policy Document and Financial Services Guide available by calling 1800 560 855 or visiting hcf.com.au/lifeinfo, and consider your financial situation, objectives, and needs before deciding on these products as any advice provided does not take these into account. In addition to these documents, you should also read the Target Market Determination (TMD) for the product, which is available at hcf.com.au/lifeinfo. The premiums for Recover Cover products are paid to HCF Life. HCF receives commission from HCF Life for their sale of up to 40% of the first year’s premium plus an additional commission of 80% of HCF Life’s underwriting profit each year calculated as premiums less claims and expenses. HCF’s staff may receive an incentive depending on the annual premium of these products which they sell. This will not exceed 15% of the first year’s premium.

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About Private Health Insurance

What's hospital cover?

What's the difference between public and private hospitals?

What's extras cover?

What does private health insurance cover?

What doesn’t private health insurance cover?

Does health insurance cover ambulance services?

What are private health insurance waiting periods?

Hospital waiting periods:

Extras waiting periods:

Ambulance waiting periods:

Hospital waiting periods:

Extras waiting periods:

Ambulance waiting periods:

What are 'pregnancy and birth-related services'?

What's a pre-existing condition?

What's restricted cover?

What’s an exclusion?

Private health insurance that’s right for you

Singles

Couples

Families

Life

Looking for something else?

Call us

Report a fraud or scam

Important Information

Get in touch

Get help

Insurance

About us

Other resources

Compare & Switch

Health

Overseas Visitors Health Insurance (OVHC)

HCF Life and Recover Cover

Travel

Pet, Home & Car

Flip

About HCF

About Private Health Insurance

What's hospital cover?

What's the difference between public and private hospitals?

What's extras cover?

What does private health insurance cover?

What doesn’t private health insurance cover?

Does health insurance cover ambulance services?

What are private health insurance waiting periods?

Hospital waiting periods:

Extras waiting periods:

Ambulance waiting periods:

Hospital waiting periods:

Extras waiting periods:

Ambulance waiting periods:

What are 'pregnancy and birth-related services'?

What's a pre-existing condition?

What's restricted cover?

What’s an exclusion?

Private health insurance that’s right for you

Singles

Couples

Families

Life

Visit our help hub for more support

Looking for something else?

Call us

Report a fraud or scam

Important Information

Get in touch

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What's the difference between public and private hospitals? 

Ambulance waiting periods: 

Ambulance waiting periods: 