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– The excess is the amount you pay towards hospital treatment as a private patient – Some policies have a capped excess per year, which means you don’t have to pay another excess for additional hospital treatments that year – Sometimes a ‘same day excess waiver’ means no excess for hospital treatments without overnight accommodation.
If you’re planning to use your Hospital Cover for a private hospital procedure, it’s important to know how much you’ll have to pay towards your treatment – including your excess. The excess on a private hospital policy works differently to other types of insurance, like car or house policies. There are a few pitfalls around Hospital Cover claims that can catch people out. Here are the 3 excess questions you need to ask before you claim.
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1. How much is the excess?
Check your policy to find out the excess amount. This is the amount you’ll have to pay to the hospital if you’re admitted to a private hospital, or as a private patient in a public hospital.
On a newer policy, the excess is most commonly $750 for single adults, or $1,500 for couples, single parents or families. Excesses are usually waived for kids, but may be applied to adult dependants aged 18+. If it’s an older policy the excess could be anything from $100 upwards – or in some cases, perhaps even $0.
Can’t find the excess on your policy documents or the insurer’s app? Ask your insurer.
2. Is your excess capped?
Look at the policy to find out whether your excess applies per hospital treatment or per year. It’s important to know in case you need additional hospital treatments in the same year – or if someone else on the policy also gets admitted to hospital that year.
Your policy will likely include each of the below.
Policy wording
What it means
How it works
Excess per visit/ Excess per admission/Excess per stay
The amount you’ll pay every time you’re admitted to hospital as a private patient.
If your policy has a $750 excess per visit, you’ll pay $750 towards each hospital treatment as a private patient, unless there is a cap (see below)
Max excess per person per year
The maximum excess you will pay in a calendar year for hospital treatment for yourself or anyone else covered by the policy (i.e. your partner), when admitted to hospital as a private patient.
If your policy has a $750 max excess per person per year, you’ll pay $750 towards hospital treatment as a private patient. If you need additional treatments during the year, you won’t have to pay the excess again. If your partner needs hospital treatment in the same year you’ll need to pay another $750. If they need additional treatments that year, you won’t have to pay the excess again.
Max excess per policy per year
The maximum excess you will pay in a calendar year for hospital treatment for yourself or your partner when admitted to hospital as a private patient.
If your policy has a $750 max excess per policy per year, you’ll pay $750 towards hospital treatment as a private patient. If you need additional treatments during the year, or your partner is hospitalised during the year, you won’t have to pay the excess again. However if your policy has a $750 excess per visit and a $0 max excess per policy per year, you’ll need to pay the excess for every procedure, for every person on the policy.
3. Is there a same-day excess waiver?
Watch out for the ‘day surgery trap’. There’s a common belief that you won’t get charged an excess if you’re having a day procedure, such as a colonoscopy or a cataract removal (which generally takes less than 30 minutes). While some insurers do waive the excess for a day procedure (known as a same-day excess waiver), or perhaps reduce it, the majority of insurers will charge the full excess regardless of how long you spend in hospital.
Our expert analysis
We used the healthslips.com.au calculator to search for the 10 cheapest Silver tier Hospital Cover policies for a couple in Queensland. What we found:
All except one had a capped excess.
The majority of policies had an annual cap per person or per policy, providing better value for couples who expect to have multiple hospital admissions in a year.
The cheapest was a Silver Plus policy for $334.10 per month, with a $750 excess per person per year, and a $1,500 maximum excess per policy per year.
Finding a policy with a better excess
If you think you, or anyone else on your policy, is likely to need more than one hospital procedure in a year, it’s worth making sure your excess is capped per policy and per year. If your policy isn’t, look for a new policy with the healthslips.com.au calculator, which searches every policy from every insurer in Australia with unbiased comparisons. You don’t have to enter your contact details which means no spam calls or emails. And if you’re changing to a policy at the same tier or lower, you won’t have to serve waiting periods again.
To avoid the Medicare Levy Surcharge, you must choose a policy with an excess of $750 or lower (for single adults) or $1,500 or lower (for couple, single parent or family policies). Find out more about the Medicare Levy Surcharge and whether it applies to you here.
healthslips.com.au does not provide general or personalised advice. Your particular circumstances are likely to impact the accuracy, completeness and relevance of the information or results. Take this into account before making a decision and talk to an expert for financial advice.
Trudie McConnochie
Writer and Researcher
Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.
Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.
Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.
