Your domestic private hospital insurance will only provide cover when you're admitted to hospital as an 'inpatient'. This refers to a person who has been admitted into an HIF contracted hospital or day facility, allocated a bed and then discharged following treatment.
If you’re a domestic policyholder and do need to visit an emergency department in a private hospital, but are not admitted after being assessed by the doctor or nurse - you'd be considered an 'outpatient', which means you would not be covered by HIF. An outpatient refers to someone who has received medical treatment in a doctor’s surgery or emergency department and has not been admitted into the hospital.
As all Australian health insurers we're unable to pay benefits towards private or public hospital emergency department treatment, although a benefit may be payable under Medicare.
If you're significantly out-of-pocket though, you may be eligible to claim a rebate under the Medicare Safety Net. For more information on this please click here: Medicare Safety Net
Please note: If you visit an emergency department in a public or private hospital though, you can rest assured that this would be covered by Medicare. Private hospital emergency department services are claimable under Medicare from 1 March 2020.
If you're an Overseas policy holder, please visit our Overseas webpage to confirm if you're eligible to claim a benefit for outpatient services under your level of cover.
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