Private health insurance

Private health insurance can help cover eligible hospital, general treatment or ambulance costs, depending on the policy. It does not pay for every healthcare service and is separate from Medicare. Cover categories, exclusions, waiting periods, limits and provider arrangements determine what you may receive and what you still pay yourself.

What is the difference between hospital and extras cover?

Hospital cover concerns eligible treatment as a private patient in hospital. Extras, also called general treatment cover, relates to specified services outside hospital, such as some dental or allied health care. Ambulance arrangements may be separate or included with conditions.

A policy's name or tier does not explain every benefit. Read the specific policy information and ask the insurer about the service you plan to use. The same insurer may offer several products with different restrictions.

For the Australian guidance behind this explanation, see Australian Government Department of Health, Disability and Ageing: What is covered by private health insurance? - PrivateHealth.gov.au.

Does insurance cover an online GP fee?

Do not assume it does. Routine outpatient medical services, Medicare arrangements and insurance rules interact in specific ways. Ask the insurer whether your exact service is covered, rather than relying on a general statement that you have comprehensive insurance.

Also check whether the provider participates in any relevant insurer arrangement. A recognised service type does not necessarily mean every provider or charge is covered. Ask for an estimate of out-of-pocket costs before planned care.

What should I check before hospital treatment?

Confirm waiting periods, exclusions, restrictions, excesses and separate doctor or other professional fees. A hospital admission can involve several bills. Obtain informed financial consent where practical and clarify what happens if additional treatment is needed.

See Doccio's pricing information for its own fees. This glossary does not promise private insurance reimbursement for a Doccio consultation. If cost affects your ability to follow a care plan, discuss it with the clinician and insurer; do not alter treatment or delay emergency care based on an unconfirmed assumption about cover.

Where to go next

Read consultation pricing to understand the relevant service. A doctor decides whether a consultation, examination, referral or another pathway is appropriate for your situation.