HCi Hospital Cover


HCi hospital cover helps pay for any necessary hospital treatment for your and your dependants. And you choose the level of cover to suit your needs.

Solid orange icon of an hospital for HCi hospital cover » HCi ​HCi Gold Hospital has got you covered with a range of excess options, no exclusions, no restrictions and no benefit limitations. So you can have confidence that if you go to hospital, you can concentrate on getting better, knowing we’ll take care of the rest.

HCi hospital cover options in summary

Accident cover

If you have an accident requiring hospital for treatment not related to any pre-existing illness, injury or condition, HCi will pay towards your treatment and accommodation fees.

Accident cover

If you have an accident requiring hospital for treatment not related to any pre-existing illness, injury or condition, HCi will pay towards your treatment and accommodation fees.

For full details of HCi hospital cover options, including all terms and conditions, definitions and exclusions, please refer to our Guide to Cover.

You can combine HCi Gold, Silver Plus Advantage, Silver Plus Secure, Bronze Plus or Basic Plus Hospital cover with our Extras cover for a more comprehensive package.

HCi hospital cover options compared

Procedure Gold Silver Plus Advantage Silver Plus Secure Bronze Plus Basic Plus
Assisted reproductive services
Back, neck and spine
Blood ✔ (R)
Bone, joint and muscle
Brain and nervous system
Breast surgery (medically necessary)
Chemotherapy, radiotherapy and immunotherapy for cancer
Dental surgery
Diabetes management (excluding insulin pumps)
Dialysis for chronic kidney failure
Digestive system
Ear, nose and throat
Eye (not cataracts)
Gastrointestinal endoscopy
Heart and vascular system
Hernia and appendix
Hospital psychiatric services ✔ (R) ✔ (R) ✔ (R) ✔ (R)
Implantation of hearing devices
Insulin pumps
Joint reconstructions
Joint replacements
Kidney and bladder
Lung and chest
Male reproductive system
Miscarriage and pregnancy termination
Pain management
Pain management with device
Palliative care ✔ (R)
Plastic and reconstructive surgery (medically necessary) ✘*
Podiatry surgery (by a registered podiatric surgeon)
Pregnancy and birth
Rehabilitation ✔ (R) ✔ (R) ✔ (R) ✔ (R)
Sleep studies ✔ (R)
Tonsils, adenoids and grommets
Weight loss surgery
All other inpatient services where Medicare pays a benefit

(R) This is a Restricted Service.
* For Bronze Plus Hospital, plastic surgery which is medically necessary and related to the treatment of a skin-related condition is covered under the “Skin” clinical category.

Basic Plus and Bronze Plus Hospital cover include Accident Cover to help you pay for any necessary hospital admission due to an accident. An accident is any unforeseen event due to chance or caused by an external force or object, which results in an involuntary injury to the body requiring immediate or urgent medical treatment in hospital.

For the services listed above, HCi hospital cover includes

  • Up to 100% of hospital accommodation costs and theatre fees in all contracted hospitals and day surgery facilities in Australia.
  • Private room accommodation (if available).
  • Up to 100% of the cost of surgically implanted prostheses (as listed by the Federal Government).
  • Dental theatre costs for surgical tooth extraction by an oral surgeon.
  • Up to 100% of the cost of most hospital prescriptions relating to the admission, subject to hospital agreement details.
  • 100% of the cost of the difference between the Medicare refund and the Commonwealth Medical Benefit Scheme (MBS) 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 Commonwealth Medical Benefit Scheme (MBS) fee and chooses to use Access Gap Cover.

All the above applies to you and any dependants listed as part of your membership.

HCi hospital cover excludes the following:

  • Cosmetic surgery
  • Extra services beyond the hospital treatment plan
  • Personal expenses like phone calls, newspapers and TV rental
  • Hospital services not eligible for Medicare benefits
  • Pharmaceutical items supplied or prescribed on discharge
  • Medicare gap (ie out of pocket expenses)
  • Surgically implemented prosthesis gap
  • Medical treatment provided in a doctor’s rooms out of hospital

Managing hospital costs

Remember Medicare covers public hospital treatment for Australian residents, and emergency patients usually go to a public hospital with Intensive Care Units.

With HCi hospital cover, you can elect to be a private patient in a public hospital.

You can choose your doctor and have a private room if available. However, you will still be subject to waiting lists for elective procedures.

Medical fees

HCi hospital cover enables you to get full private hospital access to services, a doctor of your choosing at a convenient time with no (or reduced) waiting periods.

Under the Commonwealth Medical Benefits Schedule (MBS) fees are determined and accordingly split between HCi and Medicare. It is important to discuss fees with your doctor prior to treatment as there may be out of pocket expenses. If your doctor charges above the MBS fee, HCi does not cover these expenses. Read our factsheet on The Gap for more information.

HCi’s Access Gap

HCi has relationships with over 500 private hospitals and day hospital facilities around Australia. See our comprehensive list of our contracted hospitals in your local area.

If you need specialist care in hospital, your doctor can use HCi’s Access Gap Cover – a much simpler billing system to eliminate out of pocket expenses altogether – or let you know exactly what you have to pay prior to treatment.

Remember to ask your doctor:

  • Will you treat me under HCi’s Access Gap?
  • Can you send the bill to HCi directly?
  • Will I have any out-of-pocket expenses? Please provide a formal quote of these costs.
  • If I need any assisting doctors, will they also use Access Gap Cover? If so, how can I obtain a quote for their services?

See our participating health providers for one that suits your needs.

Gap Cover and surgically implanted prostheses:

Surgically implanted prostheses are sometimes required during a medical procedure, such as a replacement lens for a cataract surgery, an artificial hip joint, a pacemaker, or a heart valve.

For medical procedures covered by Medicare, HCi fully covers the cost of at least one prostheses – this is referred to as a ‘no gap’ prostheses. However, some items listed on the Prostheses Schedule are not or only partially covered. Therefore, please review the list with your doctor prior to surgery.

Based on your level of HCi hospital cover, you have a choice of excess options. An excess is what you pay towards your hospital treatment.

  $250 Excess $500 Excess $750 Excess
Silver Plus Advantage
Silver Plus Secure
Bronze Plus
Basic Plus

HCi has arrangements with the following private hospitals to minimise your out-of-pocket expenses

About the Hospital Search

HCi has agreements with most private hospitals that are likely to be accessed by members. These agreements ensure that an agreed schedule of fees (including in-patient accommodation, theatre and special unit accommodation fees as appropriate) is charged by the hospital and paid by HCi on your behalf. Please note your entitlements are affected by factors such as your level and type of cover, and the financial status of your membership. This will affect the amount HCi reimburses to the hospital.

HCi strongly recommends you contact us on 1800 804 950 to confirm your entitlement prior to receiving hospital treatment.

If you choose a non-agreement hospital, please note you may incur out-of-pocket expenses for hospital related services irrespective of your level of cover.

Please note that search results will include any private hospitals HCi has previously accepted contracts with, until HCi  terminates a contract. Thus the search results will display information relating to a private hospital where the relevant contract is up for renewal but HCi has not yet decided whether or not to renew the contract. HCi uses its best endeavours to respond promptly to renewals so that search results are as accurate as is reasonably possible.

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