Plain English explanations of everything you need to know about private health insurance in Australia.
Hospital cover pays for treatment as a private patient in hospital. This includes accommodation, theatre fees, and a contribution toward medical costs. It gives you the right to choose your own specialist, access private hospitals, and in most cases avoid long public waiting lists for elective procedures.
Extras cover (also called ancillary or general treatment cover) pays for out-of-hospital healthcare that Medicare does not fully cover. This includes dental, optical, physiotherapy, chiropractic, psychology, podiatry, and more. You can hold one or both.
Since 2019 the Australian Government requires all hospital policies to be classified into one of four tiers. Every fund must include a minimum set of clinical categories at each tier, making it easier to compare across funds.
The most comprehensive level. Covers all 38 clinical categories including maternity, cardiac, joint replacements, weight loss surgery, and IVF.
NSW, single, age 30, $750 excess
Covers most hospital procedures. Typically excludes maternity, weight loss surgery, and IVF. Silver Plus policies add some Gold categories.
NSW, single, age 30, $750 excess
Core hospital services. Some categories are Restricted. A practical option for younger adults who want private hospital access at a lower premium.
NSW, single, age 30, $750 excess
The minimum level. Most categories are Restricted. Mainly used to avoid the Medicare Levy Surcharge or Lifetime Health Cover loading.
NSW, single, age 30, $750 excess. Source: Finder, March 2026
This is one of the most misunderstood parts of private health insurance. When a clinical category is listed as Restricted, it does not mean you are completely uncovered. It means the fund pays only the minimum government-set benefit toward your treatment.
In practice, if you are treated in a private hospital for a Restricted category, the minimum benefit will almost certainly not cover the full cost of your accommodation and theatre fees. You will likely face significant out-of-pocket expenses.
If you are treated as a public patient in a public hospital for a Restricted category, the benefit is usually sufficient because public hospital costs are lower.
When you first take out private health insurance, or upgrade to a higher level of cover, most benefits have a waiting period before you can claim. This prevents people from taking out cover only when they know they need treatment.
| Type of treatment | Standard waiting period |
|---|---|
| General hospital treatment | 2 months |
| Pre-existing conditions (hospital) | 12 months |
| Obstetrics and pregnancy | 12 months |
| Psychiatric care, rehabilitation, palliative care | 2 months maximum (even for pre-existing) |
| General extras (dental check-ups, optical) | Typically 2 months |
| Major dental | Typically 12 months |
| Orthodontics | Typically 12 months |
| Emergency ambulance | 1 day or immediate |
Your PDS is the legal document describing exactly what your policy covers. Every fund must provide one. Key sections to check:
Extras cover varies enormously between funds and policy levels. Unlike hospital cover there are no government-regulated tiers for extras. Each fund sets its own annual limits and benefit amounts. Common categories include: