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What is private health insurance?

More health cover and choice

Depending on the policy you take out, private health insurance pays for some or all of the costs of:

  • treatment in public or private hospitals as a private patient — this means you can choose your doctor and hospital at a time that suits you
  • health services that are not covered under Medicare (Australia’s public health insurance scheme) such as physiotherapy, dental and optical

Private health insurance also means you can get treated in a private hospital more quickly for some hospital services.

To get private health insurance, you need to:

  • take out a policy from a health insurer
  • pay regular premiums to stay covered

You don’t have to take out private health insurance, but you can choose to if you want cover for more health services and choice.

Find out more about what private health insurance offers.

You can still choose to be a public patient in a hospital if you have private health insurance.

Types of private health insurance policies

The main types of health insurance policies are:

  • hospital — cover for the costs of treatment as a private patient
  • extras — cover for the costs of services outside of hospital such as physiotherapy and dental
  • combined — cover for both hospital and extras
  • ambulance — cover for the costs of ambulance services

The health services that policies cover vary. To find out what services a specific policy covers, read that policy’s standard information statement or ask the health insurer.

Read how private health insurance works to find out more about what can be covered under different policies.

Private health insurance and public health care

Below is a short guide to what the public health care system and private health insurance cover.

Health service

Public health care

Private health insurance

In-hospital services

You may be treated as a public patient in a public or private hospital.

The public health care system will cover the cost of your treatment.

As a public patient, you cannot choose your hospital, doctor or specialist.

When you choose to be treated as a private patient in hospital:

  • your health insurer covers some or all of the hospital costs (such as accommodation)
  • Medicare covers some of the doctors’ costs
  • your health insurer covers some or all of the remaining doctors’ costs

As a private patient, you can choose your hospital, doctor and specialist.

Doctor and specialist services outside of hospital

Medicare covers some or all of the costs of services such as:

  • visits to a GP
  • visits to specialists in their rooms
  • diagnostic imaging
  • diagnostic tests
     

Not covered.

By law, health insurers can’t offer cover for most of these services.

Other services outside of hospital

Medicare covers some or all of the costs for other services outside of hospital including:

  • dental care for some children
  • eye checks by optometrists
  • allied health services, such as psychology, in some circumstances
     

You can choose policies that cover some or all of the costs for many services outside of hospital.

Prescription medicines

Prescription medicines are covered by the Pharmaceutical Benefits Scheme (PBS).

You can choose policies that cover some prescription medicines not covered by the PBS.
 

Prostheses

The costs of implanted prostheses are covered if you’re a public patient.

If your policy covers the procedure to implant a prosthesis, it will also cover some or all of the cost for the prosthesis itself. Find out more about prostheses and private health insurance.

Ambulance

Some state and territory governments provide ambulance cover.
 

You can choose policies that cover ambulance costs when they are not covered by your state or territory government.

For a more detailed comparison of Medicare and private cover, go to what is covered.

Who offers private health insurance?

To offer private health insurance, organisations must be a registered health insurer under the Private Health Insurance Act 2007.

Some health insurers are restricted funds. This means they only offer policies to people in certain industries, companies or groups.

Health insurers must also meet other legal requirements — find out more about private health insurance laws.

Last updated: 
17 February 2019