Hospital Cover
When you are covered by HCI hospital cover you have the confidence to say ‘yes’ to treatment in a private hospital or treatment as a private patient in a public hospital. HCI has agreements with over 460 private hospitals around the country.
HCI hospital cover has no exclusions for treatment that is clinically necessary. If you have served the relevant waits and other standard conditions, you're covered.
Premier Hospital Cover
Provides comprehensive cover for members admitted to private facilities. Premier hospital cover provides the following:
- 100% cover for accommodation and theatre fees in all contracted hospitals and day surgery facilities in Australia.
- Up to 100% coverage of surgically implanted prosthesis. It is recommended that if you require surgery involving a surgically implanted prosthesis, discuss with your doctor the option of using the prosthesis item that is on the the no gap list.
- Private room accommodation (if available)
- Cost of the majority of hospital prescriptions relating to the admission. (Subject to hospital agreement details)
- Dental Theatre Costs for surgical tooth extraction by an oral surgeon.
- Difference between the Medicare refund and the Medicare Schedule Fee on medical expenses for services received during a hospital stay.
- HCI Access Gap Cover scheme.
The following are not covered:
- Cosmetic surgery - benefits are only payable for cosmetic surgery where it is required for a medical purpose
- Hospital benefits are not payable where the professional service performed is not eligible for Medicare benefits. Excess options are available for premier hospital cover.
Public Hospital Cover
Public hospital cover provides the following benefits as a private patient in a public hospital:
- Choice of doctor.
- 100% of the cost of hospital accommodation fees.
- Up to 100% of the cost of surgically implanted prostheses (as listed by the Federal Government).
- 100% of the cost of the difference between the Medicare refund and the CMBS fee for medical services provided during a hospital admission.
- Up to 100% of the cost of medical services provided during a hospital admission where the doctor charges above the CMBS fee and chooses to use Access Gap Cover.
If you have Public Hospital cover you will face significant out-of-pocket expenses if treatment is provided in a private hospital.
This level of cover is considered inadequate for treatment in a private hospital.
What is an excess?
An excess is an amount that you elect to pay towards any overnight hospital treatment. The excess is only payable once in any calendar year. Through choosing an excess you can reduce the amount of your contribution. The larger the excess, the lower the premium. You can choose an excess option ranging from $200 to $1000. With HCI, there is no excess on day procedures and Medical and Extras benefits remain excess free.
Excess - Family/ Couples Safety Net. The total excess is split in two and divided between the first two adults to claim in any one year.
There is no excess payable for child admissions under the age of 18.
Access Gap
Reduces out-of-pocket costs
All HCI hospital cover includes our Access Gap Cover at no extra charge, helping to reduce or eliminate out-of-pocket (gap costs) between the Medicare Benefits Schedule Fee and the doctor’s charge for in-hospital medical treatment. If your doctor agrees to treat you under Access Gap Cover, you will either have no out-of-pocket expenses or you will know the amount of any out-of-pocket expenses before your hospital treatment.
Contact HCI before going into hospital to ensure you are informed about benefit payments.
Note: Health Funds cannot pay any medical benefits for treatment not involving a hospital admission, such as surgical procedures conducted in doctors’ rooms.