• Any excluded services (Silver Plus Hospital and Bronze Hospital, see table above).
• Cosmetic Surgery.
• Extra services beyond the hospital treatment plan.
• Personal expenses like phone calls, newspapers and TV rental.
• Hospital benefits where the professional service performed is not eligible for Medicare benefits.
• Pharmaceutical items supplied or prescribed on discharge.
• Medical Gap.
• Surgically Implanted Prosthesis Gap.
• Medical treatment provided in doctors’ rooms out of hospital.

It’s important to remember that as an Australian resident, Medicare covers public hospital treatment and emergency patients will normally go to a public hospital with Intensive Care Units.

With HCI hospital cover you can elect to go as a private patient into a public hospital.

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

Under the Commonwealth Medical Benefits Schedule (CMBS) 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 CMBS fee, HCI does not cover these expenses.

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

HCI has relationships with over 500 private hospitals and day hospital facilities around Australia. For a comprehensive list of our contracted hospitals in your local area click here

Should 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 Access Gap Cover?
• Will I have any out-of-pocket expenses? Please provide a formal quote of these costs.
• Will any assisting doctors also use Access Gap Cover and if so, how can I obtain a quote for their services?
• Will you to send the bill to HCI directly?

See here for participating doctors.

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 cover the cost of at least one prostheses – this is referred to as a ‘no gap’ prostheses. There are however some items listed on the Prostheses Schedule that are not or only partially covered. Please review the list with your doctor prior to surgery.

Having a hospital excess will reduce your premium, the greater the excess the lower the premium.

For Gold, Silver Plus and Bronze Hospital $750 excess products, the full excess is payable for both same day and overnight accommodation.

For Gold Hospital on excess levels Nil ($0), $250 and $500 products HCI will waive the excess for same day procedures. For Silver Plus Hospital $250, $500, $750 the full excess is payable for both same day and overnight admissions. If you have an excess option of $1000 per person you will need to pay $500 for any day admission up to the maximum payable per year.

There is no excess for dependent children under the age of 18 years.

The excess per adult is the maximum payable in any calendar year.

If a person covered is under the age of 18 but not a dependant on a single or couple policy they will be required to pay the excess.

There are no co-payments for any of our hospital benefits, you will only need to pay your excess (if applicable).

We have a range of excesses you can choose to suit your needs.