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.
Imagine your health insurance is a combo meal – you order the burger (hospital cover) and the fries (extras cover). You don’t necessarily get a discount from ordering both together, but it definitely makes things a bit easier than going to two separate restaurants.
If you’re young and healthy, you might only want extras cover, which helps you with things like preventative care, such as seeing the dentist. But as you get older and even have kids of your own, you might want more out of your cover. Combined hospital and extras cover can be a convenient way to make this happen.
Hospital cover helps pay for treatment if you’re admitted as a private patient. That means:
Extras cover is the everyday safety net. It helps with services Medicare doesn’t usually touch, like:
Together, hospital + extras cover gives you more control over both the big unexpected costs and the little recurring ones.
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.
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.
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 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
Combined cover
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).
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.
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.
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.
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.
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.
With Konkrd you can:
