Hospital & Extras Insurance
Hospital and extras cover is one of the most common ways Aussies take out private health insurance – but most people don’t really know what they’re paying for. We break it down in plain English, so you know the difference between hospital cover, extras cover, and how to mix them without paying for stuff you’ll never use.
What is Hospital & Extras Cover?
Hospital cover helps pay for treatment if you’re admitted as a private patient. That means:
- You can choose your doctor and hospital (depending on your policy and fund).
- You avoid public hospital waiting lists for certain surgeries.
- You may get a private room – though this depends on availability and your policy.
- It covers costs like accommodation, theatre fees, and in some cases intensive care.
Extras cover is the everyday safety net. It helps with services Medicare doesn’t usually touch, like:
- Dental – from routine check-ups to braces and dentures.
- Optical – prescription glasses, contact lenses, even prescription sunnies.
- Physio & chiro – help when your back, neck, or knees aren’t playing nice.
- Other allied health – psychology, podiatry, dieticians, remedial massage, acupuncture.
Together, hospital + extras cover gives you more control over both the big unexpected costs and the little recurring ones.
Who Needs Hospital & Extras Cover?
Singles
Great if you want peace of mind for emergencies without blowing your budget. Add extras only if you’ll use them – like optical if you wear glasses, or physio if you’re into sport or staying active.
Couples
Cover that balances both partners’ needs. Couples’ cover is often recommended when both individuals have similar services, they need covered. If they are completely different, two singles levels of cover might be more beneficial.
Families
Kids mean extra dentist visits, physio for sports injuries, and sometimes braces. Extras cover really starts paying off here. Hospital cover ensures you’re not stuck with surprise costs if little ones need care, oh and don’t forget about parents.
Older Aussies
As you get older, cover priorities shift. Hospital cover gives peace of mind for surgeries (hips, knees, cataracts), while extras help with ongoing needs like dental and optical.
Hospital vs Extras – The Breakdown
Hospital Cover
Think broken bones, surgery, or in-hospital specialist treatment. Without it, you could be stuck on a waiting list or hit with thousands in out-of-pocket costs.
Extras Cover
More about maintenance than emergencies. If you know you’ll see a dentist twice a year or you’re always needing new glasses, extras cover often pays for itself.
Combined cover
A flexible package that balances long-term health needs and unexpected accidents. For many families, this is the “set and forget” option.
Key Things to Watch Out For
Waiting periods
New to cover? You’ll usually wait 12 months for pregnancy and pre-existing conditions, and 2 months for most other hospital treatments. Extras often have shorter waits (ranging from claiming straight away to more common 2–6 months).
Excess
This is what you pay upfront if you go to hospital. Policies let you choose a higher excess for lower premiums, similar to how it works with your car insurance – but make sure it’s an amount you could actually pay if needed.
Gap fees
Doctors can charge more than what your policy pays. This is called the “gap” – and it can be hundreds of dollars. Some funds have “gap cover” schemes that reduce or remove this.
Annual limits
Extras cover comes with yearly limits. For example, you might get $500 back on dental per year. Once you hit the cap, you’re paying full price until your policy resets. These resets change by fund, so make sure you know how this works.
Common Questions About Hospital and Extras
What’s the difference between hospital and extras cover?
Hospital covers big treatments in hospital, ranging from broken bones to pregnancy whilst extras cover everyday services like dental check-ups and cleans to hearing aids.
Do I need both?
Hospital covers big treatments in hospital, ranging from broken bones to pregnancy whilst extras cover everyday services like dental check-ups and cleans to hearing aids.
How do I compare health insurance in Konkrd?
Most health funds have waiting periods before you can claim on extras when you first take out cover. If you switch health insurance, any waiting periods you’ve already served will carry over, so you won’t need to serve them again for the same services, unless your new policy has a higher limit or additional benefits.
Can I change my cover later?
There are no lock-in contracts with private health insurance, so your cover should always match your needs. That doesn’t mean you need to switch funds often, but it’s important to make sure you’re on the right policy.
Just remember, if you upgrade your cover or add new services, you’ll have a waiting period before you can claim the higher benefits.
✧ Konkrd AI