AIA Health offers both hospital cover and extras cover. These can be purchased as a combined hospital and extras policy, or as a hospital-only policy.
How does Hospital Cover work?
Private hospital cover is specifically designed to take care of your treatment when you’re admitted as an inpatient into private or public hospital, which means you must be officially admitted to the hospital by a healthcare professional.
Specialist consultations within a hospital don’t count as inpatient services.
When you’re treated as a private patient, Medicare will pay 75% of the Medicare Benefits Schedule (MBS) fee. This fee is the government’s approved cost for that treatment. The remaining 25% and any additional expenses, like theatre fees and accommodation, are covered by your private health insurance (where included in your cover).
Medicare will pay
75%
+
Private health insurance will pay 25%
A treating doctor in hospital may charge more than the MBS fee, which may result in out-of-pocket expenses. However, there’s a way to minimize these costs. If your treating doctors participate in AIA Health’s gap cover scheme, you can significantly reduce or even eliminate these out-of-pocket expenses.
Having hospital cover can come with great advantages:
- You get to choose your own doctor
- Stay in a private room (subject to availability)
- Avoid long wait times for elective surgeries. Receiving the treatment you need as soon as you need it.
What are Hospital Cover tiers?
The Australian Government has established four standardised tiers of hospital cover: Basic, Bronze, Silver or Gold to make it easier for you to understand what you are covered for and to compare products across different health insurers.
Health insurers may offer hospital cover that goes above and beyond the minimum standard, often identified by a “Plus”. This signals that they offer more than the minimum standard for that tier but don’t meet all the requirements for the next tier. For example, a Basic Plus Hospital product cover more clinical categories than a Basic Hospital product but does not cover all of the clinical categories needed to be considered a Bronze Hospital product.
To avoid things like the Medicare Levy Surcharge and Lifetime Health Cover loading, you’ll need valid hospital cover, an extras policy does not meet the requirements.
What is covered by AIA Health Hospital Cover?
The table below details what is and isn’t covered by AIA Health Hospital products.
| Cover Level | Basic | Basic + | Bronze | Bronze + | Silver | Silver + | Silver + | Silver + |
|---|---|---|---|---|---|---|---|---|
| Product Name | Basic Accident Only Hospital | Basic Plus Hospital | Bronze Hospital | Bronze Plus Essential | Silver Hospital | Silver Plus Hospital | Silver Plus Advanced Hospital | Silver Plus Family Hospital |
| Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | |
| Excess | $750 | $750 | $750 | $750 | $750 | $750 | $750 | $750 |
| $500 | - | $500 | $500 | $500 | - | $500 | - | |
| Excess Refund⌃ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| AIA Vitality* | Starter | Starter | Starter | Full | Full | Full | Full | Full |
| Rehabilitaton | R | R | R | R | R | ✔ | ✔ | ✔ |
| Hospital psychiatric services | R | R | R | R | R | R | R | R |
| Palliative care | R | R | R | R | R | ✔ | ✔ | ✔ |
| Brain and nervous system | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Eye (not cataracts) | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Ear, nose and throat | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Tonsils, adenoids and grommets | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Bone, joint and muscle | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Joint reconstructions | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Kidney and bladder | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Male reproductive system | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Digestive system | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Hernia and appendix | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Gastrointestinal endoscopy | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Gynaecology | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Miscarriage and termination of pregnancy | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Chemotherapy, radiotherapy and immunotherapy for cancer | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Pain management | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Skin | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Breast surgery (medically necessary) | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Diabetes management (excluding insulin pumps) | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Heart and vascular system | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ |
| Lung and chest | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Blood | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Back, neck and spine | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ |
| Plastic and reconstructive surgery (medically necessary) | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ |
| Dental surgery | ✖ | ✔ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Podiatric surgery (provided by an registered podiatric surgeon) | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Implantation of hearing devices | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ | ✔ |
| Cataracts | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ |
| Joint replacements | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ |
| Dialysis for chronic kidney failure | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ |
| Pregnancy and birth | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ |
| Assisted reproductive services | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ |
| Weight loss surgery | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ |
| Insulin pumps | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ |
| Pain management with device | ✖ | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ |
| Sleep studies | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ |
| Travel and accommodation | ✖ | ✖ | ✖ | ✖ | ✖ | ✔ | ✔ | ✔ |
| Accidental injury | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Emergency ambulance (air, land & sea) | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ |
| Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | Learn More > | Learn More > |
✔ - Covered - Indicates the clinical category is fully covered.
R - Restricted Benefit - A restricted benefit means you are partially covered for hospital costs as a private patient in a public hospital.
You may incur significant expenses in a private room or private hospital, so you should check with AIA Health for cover details.
You may incur significant expenses in a private room or private hospital, so you should check with AIA Health for cover details.
✖ - Not Covered - Indicates the clinical category is not covered.
⌃If you have held an AIA Health policy for a minimum of six months and have an AIA Vitality Status of Silver or above, we will refund your excess in the event that you're admitted to hospital. Excess Refund is not available when claiming on the following clinical categories: Cataracts, Joint replacements, Dialysis for chronic kidney failure, Pregnancy and birth, Assisted reproductive services, Weight loss surgery, Insulin pumps, Pain management with Device & Sleep Studies.
*Depending on your cover, you'll get access to AIA Vitality or AIA Vitality Starter. AIA Vitality is our science-backed health and wellbeing program that helps you learn about your health, improve it and stay motivated by earning rewards for taking care of your health.
Additional things to learn about AIA’s Health Insurance cover
AIA Health Insurance members have access to a wide range of benefits and rewards, including affordable dental care, discounts on optical products, and additional benefits unlocked through engagement with our AIA Vitality program.
Ambulance Cover
All AIA Health hospital and combined cover pay benefits towards emergency ambulance services where you’re transported by land, aid or sea directly to a hospital within Australia. AIA Health products also pay benefits towards emergency services where you only require onsite treatment. You are limited to two on-site call outs per calendar year, per insured person.
Emergencies are circumstances when immediate hospital or on-site treatment is required for a serious and acute injury or condition where the viability or function of an organ or body part is threatened. AIA Health covers you for all clinically necessary ambulance services for emergencies in Australia. AIA Health pays ambulance benefits when the service is not publicly funded.
Check with your state ambulance authority to ensure you have the right level of cover for non-emergency ambulance transport within Australia. Without the right level of cover, you may face significant out-of-pocket costs for non-emergency ambulance transport.
Note: AIA Health does not provide ambulance cover where it is provided by the state. Transfers between hospital are not covered (including in any emergency).
AIA Vitality
At AIA Health, we believe health insurance should help people live healthier, longer, better lives. That’s why we offer our policyholders (and partner where applicable) access to AIA Vitality, the science-backed health and wellbeing program that rewards you for getting to know your health and taking steps to improve it. Learn More
Access to Health Programs
Plus Additional Member Benefits
Kieser Programs
Supporting our customers with hip and knee osteoarthritis and lumbar spine conditions.
Healthy Weight For Life
Personalised weight loss programs tailored to manage heart health, osteoarthritis, and type 2 diabetes.
Universal Practice
Offering AIA Health members access to a virtual physiotherapy program.
Optical Benefits
As an AIA Health Insurance member, you can visit one of these retailers and access some fantastic member discounts.
Dental Benefits
We have partnered with smile.com.au to make dental care more affordable and accessible for our members across Australia.
My Psychologist
Take control of your mental well-being with convenient and affordable access to a psychologist.
Amplifon Hearing Services
Providing AIA Health members with offers and discounts on audiology and hearing aid services.
AIA Health may make changes to this cover from time to time, including adding or reducing the benefits or services available to you, and notice of such changes will be provided via email in accordance with the PHI Act, Code of Conduct and Australian Consumer Law. The information provided here is a guide and you should always consult your provided member guide and up-to-date fact sheets at the point of purchase and claiming or call us on 1800 333 004 for further details.
How do I choose the right hospital cover?
When considering a private health insurance policy, you should review your current and future medical needs, budget, and healthcare priorities. Having a good understanding of these will help you decide if a cover is appropriate for your personal circumstances.
Before selecting a Hospital Policy, you should review:
- What services are covered
- What waiting periods apply
- What exclusions apply
- What excess and/or co-payment you would be subject to on your hospital policy
What makes AIA Health different?
At AIA Health, we believe that health insurance should benefit you every day and not just when things go wrong. That’s why our cover comes with access to AIA Vitality, our science-backed health and wellbeing program designed to support you at every stage of your health journey.
The Private Health Insurance Code of Conduct
AIA Health is a signatory to the Private Health Insurance Code of Conduct. The code was developed by the private health insurance industry and aims to improve industry standards of practice and service. As a signatory to the Code, we ensure that:
- Information we provide to you is in plain language
- AIA Health employees are competently trained to deal with your enquiries
- AIA Health protects the privacy of your information in line with the Australian Privacy Principles.
A copy of the code is available at privatehealth.com.au/codeofconduct
New member offer!
Get up to 6 weeks premium cashback when you join AIA Health by 31 October 2026*.
Take out an eligible policy by 31 October 2026 and you’ll get up to 6 weeks premium cashback on your health insurance over your first 2 years. *Get up to 6 weeks free on eligible combined Hospital & Extras products and up to 4 weeks free on eligible Hospital only products. T&Cs apply.