What Private Health Insurance covers

A quick guide on what’s included, what’s optional, and how cover works with Medicare.

What does private health insurance cover?

Private health insurance can help with hospital treatment and healthcare services Medicare doesn’t fully cover, but what’s included depends on the type of cover you have, your policy level, and the benefits you’ve chosen.
 
This page focuses on what private health insurance pays for, what it doesn’t, and how to avoid common misunderstandings.
 
If you’re looking for a broader explanation of how private health insurance works in Australia, please visit our resource page, What is Private Health Insurance?

What does hospital cover pay for?

Hospital-only private health insurance can help when you’re admitted to hospital as a private patient.
 
Depending on your policy, cover may include:
 
  • Hospital accommodation and theatre fees
  • In-hospital treatment by doctors and specialists
  • Approved medical devices used during treatment
  • Treatment in a private hospital or as a private patient in a public hospital
Hospital cover can also mean:
 
  • Greater choice of doctor
  • More flexibility around when you’re treated
  • Access to private facilities for eligible treatments
What’s covered depends on your policy tier and inclusion, not all hospital policies cover all treatments.
 
For an overview of hospital policy tiers, please see our resource page, What is Private Health Insurance?

What treatments are covered under different hospital policy tiers?

Hospital cover in Australia is grouped into four government-defined tiers:
 
  • Basic – limited cover for a small number of treatments
  • Bronze – covers many common procedures
  • Silver – designed to suit a broad range of life stages
  • Gold – the most comprehensive cover, including pregnancy and complex care
Each tier sets minimum inclusions. Policies within the same tier can still differ in:
 
  • Excess amounts
  • Exclusions and restrictions
  • How much is paid for accommodation or treatments
Always check the specific treatments covered under your policy, not just the tier name.

What does extras cover include?

Extras cover helps with everyday healthcare services outside hospital that Medicare doesn’t usually cover.
 
Common services include:
 
  • Dental (general and major)
  • Optical (glasses and contact lenses)
  • Physiotherapy
  • Chiropractic and osteopathy
  • Podiatry and speech therapy
  • Some psychology and mental health support
Extras benefits usually:
 
  • Pay a percentage of the cost or a fixed amount
  • Are capped by annual limits
  • Reset each year
Extras cover is most valuable for people who regularly use these services.

What isn’t covered by private health insurance?

Private health insurance doesn’t cover everything.
 
It generally does not cover:
 
  • GP visits
  • Specialist appointments outside hospital
  • Blood tests, scans and pathology performed out of hospital
  • Services excluded under your policy
  • Costs above benefit limits
These services are typically covered by Medicare instead.
 
This is why private health insurance works alongside Medicare, rather than replacing it. For a more detailed explanation, head to our resource page, What is Private Health Insurance?

Does private health insurance cover ambulance services?

Ambulance cover depends on:
 
  • Where you live
  • Whether your state includes ambulance services
  • Whether your policy includes ambulance cover or requires it separately
Some people are covered through state schemes, while others need extras or standalone ambulance cover. It’s important to check what applies to you.

How do I know exactly what my policy covers?

Your insurer provides a Private Health Information Statement outlining:
 
  • Inclusions
  • Exclusions and restrictions
  • Waiting periods
  • Excesses and annual limits
It’s a summary, so it’s always worth checking details before treatment – especially for hospital admissions.

Ready to choose cover that fits your needs?

Private health insurance is most valuable when it matches how you actually use healthcare.
 
AIA Health offers hospital and extras cover designed to work with Australia’s healthcare system, with clear policy structures and support to help you understand your options.
 
Whether you’re reviewing your cover or starting fresh, understanding what’s included is the first step to choosing cover with confidence.

Frequently asked questions

No. Private health insurance covers specific services and treatments based on your policy. Medicare covers many out-of-hospital medical services.

That depends on your needs. Hospital cover protects you against larger, unexpected costs. Extras cover helps with everyday healthcare. That’s why many people choose both.

Yes. You can usually upgrade, downgrade or switch insurers as your needs change, though waiting periods may apply if you increase your level of cover.

That having cover means you’ll never pay anything. In reality, private health insurance reduces costs and increases choice – but it doesn’t eliminate all expenses.