Hospital cover

Fortunately, most of us are lucky enough to avoid hospital stays, however the need for hospital treatment can arise at any time, for you or your family. Our Gold Hospital Cover can give you the peace of mind to know that you are fully covered should you or your family ever need it.

How does hospital cover work?

Holding hospital cover allows you to go to hospital as a private patient for the services you are covered for.

Are you new to hospital cover?

There are waiting periods involved and a blanket 12-month waiting period for pre-existing conditions (except for rehabilitation, psychiatric services and palliative care) when you first join to protect the existing membership.

Coming to us from another health fund? Switching is easy

Switching is simpler than you think! It takes around five minutes and you can switch online or over the phone.

If you transfer from another health fund, we will make sure we recognise any waiting periods you have already served if you switch within 30 days.

To switch, simply join RBHS and we can cancel your existing cover for you. You won’t spend any time without cover that way. We send your current fund a request for details of your cover with them (this is called a Transfer Certificate) and then we will recognise the waiting periods you have already served.

Sometimes if you have used all of your annual limit with your old fund, you will have to wait for the new financial year to renew your limits.

Why should I get hospital cover?

There are plenty of reasons that we believe private hospital cover is important. Things like:

  • knowing you can have access to private hospitals with state-of-the-art facilities 
  • being able to choose your doctor
  • not having to spend months (even years) on a public hospital waiting list by going into a private hospital
  • if you earn over the threshold for Medicare Levy Surcharge (currently $90,000 for singles and $180,000 for families), you may save tax by not having to pay the Medicare Levy Surcharge. 
  • avoiding a Lifetime Health Cover loading (by having hospital cover before you turn 31)

You might be surprised by just how much it costs to enter hospital as a private patient. Here are just some of the claims we paid in 2019 and early 2020:

  • $16,700 for a teenager’s jaw surgery
  • $71,300 for a man’s heart surgery
  • $71,600 for a woman’s spinal surgery
  • $39,600 for a woman’s Cochlear implant
  • $93,200 for a woman’s leg surgery

When you think about health insurance, it is important to think about more than just the cost. Health insurance is about giving you more choice for your healthcare, less time waiting for the services you need and (most importantly) the peace of mind to know that you’ll be looked after when you need it most.

What options are available for emergency or accident?

If a member or dependant is hospitalised as a result of an emergency, it is likely admission will be to a public hospital. Members covered by our Gold Hospital Cover can choose to be admitted as a private patient, have a right to choose their preferred doctor, and are covered for single room accommodation.

Elective surgery

If a member enters hospital for a non-life-threatening procedure or for planned (elective) surgery, they can choose either a public hospital or a private hospital with their choice of doctor and are covered for private room accommodation.

Agreement hospitals

The RBHS has agreements with most private hospitals in Australia. You can search our agreement hospitals list here.

There are only a few private hospitals we do not have an agreement with.

In these cases, we may not cover the full cost of your hospitalisation, so please ensure you call us before you go into hospital so we can tell you exactly what your out-of-pocket expense will be.

What do hospitals charge?

The main costs of hospitalisation and coverage are:

  • Accommodation charges: 100% if the treatment is included on your cover
  • Theatre fees: 100% if the treatment is included on your cover
  • Intensive care and other special attention charges: 100% if the treatment is included on your cover
  • Drugs and dressings: 100% if the treatment is included on your cover
  • Prostheses charges: 100% if the treatment is included on your cover
  • Doctors/surgeons/anaesthetists fees: RBHS pays a minimum of 25% on each Medicare Benefit Schedule fee if the treatment is included on your cover (we pay more if your doctor uses our Access Gap scheme) and Medicare pays 75%. Find out more about Access Gap.

Public hospital charges are set by the various state/territory governments. Accommodation charges in private hospitals are based on:

  • The type of service provided (i.e. medical, minor surgery or advanced surgery)
  • The length of stay in hospital (generally daily charges decrease after 14 days)
  • An additional charge for a single room, when applicable

Hospitals also make other charges on top of accommodation charges. Gold Hospital covers theatre fees, intensive care, recovery ward, labour ward, special nursing, drugs, dressings and pharmaceuticals.

The RBHS does not pay for cosmetic surgery or any hospital treatment not covered by Medicare.

Where possible, we recommend that members confirm details of their level of cover, check the likely charges by the hospital and what is covered by the RBHS prior to admission. If you are unsure exactly what you’re covered for, simply give us a call before you are admitted and we can assist you.

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