You are financially responsible for any health care debts you incur in Australia. We might consider any outstanding health debts you have if you apply for a visa in future.
In the majority of cases, visitors to Australia do not have access to Medicare, and are therefore responsible for all costs associated with hospital, medical and para-medical health care rendered in Australia, whether provided in a public and or private hospital setting.
Eligibility under Medicare is governed by the Health Insurance Act 1973, is generally restricted to people who are permanently residing in Australia, and are either:
- Australian citizens
- permanent visa holders
- New Zealand citizens, or in certain circumstances, applicants for permanent residence visas.
In the absence of Medicare eligibility, all visitors to Australia are strongly recommended to make their own arrangements for private health insurance (regardless of whether or not it is a visa condition) to ensure they are fully covered for any unplanned medical and or hospital care they may need while in Australia.
When in Australia and health care assistance is required, and a person is not covered by an appropriate level of private health insurance cover, as a non-resident and non-citizen of Australia, a person will be considered a private patient and will be required to pay any costs themselves at the time of treatment. This will apply whether a person seeks health care treatment in either the public and or private health care systems in Australia. For routine medical treatment in Australia, out-of-hospital treatment from a general practitioner is normally the most cost-effective solution.
While most commonly, Overseas Visitor Health Cover (OVHC) products help to provide an appropriate level of private health insurance cover, consumers are encouraged to take note of what is and is not covered under an OVHC product as not all products offer a comprehensive level of cover to meet a person’s individual health care needs.
Although we offer a guide to the minimum level of health cover that will mitigate your financial risk, your healthcare costs are unlikely to be covered completely. You may still be liable for the balance of your healthcare costs following an episode of care and, as such a person is recommended to seek Informed Financial Consent before agreeing to commence any treatment to ensure they fully understand all costs and to ensure the required treatment is covered under their respective private health insurance policy.
You can be charged a patient contribution, excess or co-payment for treatment by either or both:
- your private health insurer
- any hospital you are treated at
As a guide, you should purchase cover that provides benefits at least equivalent to the following and consider whether a higher level of cover may be more appropriate than the minimum level of health care we suggest.
For admitted patient treatment, a benefit equal to the state and territory health authority gazetted rates for ineligible patients for:
- overnight and day only hospital accommodation (all costs including: all theatre, intensive care, labour wards, ward drugs)
- emergency department fees that lead to an admission
- admitted patient care and postoperative services that are a continuation of care associated with an early discharge from hospital
This includes all admitted treatments covered by the Medicare Benefit Schedule (MBS).
Surgically implanted prostheses
For no-gap prostheses and gap-permitted prostheses as listed in the Private Health Insurance (Prostheses) Rules 2007, a benefit at least equal to 100 per cent of the minimum benefit amount listed.
For all Pharmaceutical Benefits Schedule (PBS)-listed drugs, prescribed according to PBS-approved indications, that are administered during and form part of an admitted episode of care, a benefit equal to the PBS-listed price in excess of the patient contribution.
This includes the cost of PBS-listed drugs administered post-discharge if they form part of the admitted episode of care.
For admitted medical services with an MBS item number, 100 per cent of the Medical Benefits Schedule fee or less if the patient is charged less.
100 per cent of the charge not otherwise covered by third-party arrangements for transport by ambulance provided by, or under an arrangement with, a government-approved ambulance service when medically necessary for admission to hospital, emergency treatment onsite, or inter-hospital transfer for emergency treatment.
This includes inter-hospital transfers that are necessary because the original admitting hospital does not have the required clinical facilities. It does not extend to transfers due to patient preferences.
Informed financial consent
The insurer will allow hospitals to check members' eligibility so members are able to give informed financial consent when they are admitted to hospital for medical treatment.
The Australian Government sets the maximum waiting periods that an Australian registered private health insurer can impose for hospital treatments, these include:
- 12 months for pregnancy and birth related treatments (obstetrics),
- 12 months for pre-existing conditions,
- Two months for psychiatric treatments, rehabilitation or palliative care, even for a pre-existing condition,
- Two months in all other circumstances.
Australian registered private health insurers are not required to cover the following treatments:
- assisted reproductive treatments
- elective cosmetic treatments
- stem cells, bone marrow and organ transplant
Nor are they required to provide cover for:
- treatment provided outside Australia, including necessary treatment en route to or from Australia
- treatment arranged in advance of the insured's arrival in Australia
- services and treatment which are covered by compensation or damages provisions of any kind
Global annual benefit limits
To comply with the minimum level of health insurance, the per-person, per-annum benefit must not be less than AUD1,000,000.
For out-of-hospital treatments where an MBS item number and benefit is payable, cover should include benefits up to the benefit listed in the MBS.
Except where otherwise stated, an Australian registered private health insurer can determine whether it provides cover for out-of-hospital treatments and, as such, consumers may choose to purchase additional cover to meet their individual health care needs while in Australia.
Excess, co-payment or patient contribution
Australian registered private health insurers may apply an excess, co-payment or patient contribution to their product offerings. Consumers are recommended to take note of the excess, co-payment and patient contributions that may apply in certain circumstances which can be charged on either an annual or per-separation basis.
Australian registered private health insurers are required to recognise previous length of membership on a policy held with another Australian private health insurer when determining whether the waiting period may apply in certain circumstances, specifically:
- when transferring between Australian-based insurers where the customer has been a member of the previous fund for more than 12 months, waiting periods of no longer than 12 months will apply to the higher level of benefits
- when transferring between Australian-based insurers where the customer has been a member of the previous fund for less than 12 months, any unserved waiting periods must be completed with the new fund. If increasing the level of cover or benefits, further waiting periods of no longer than 12 months will apply to the higher level of benefits. These waiting periods are to be served concurrently
Australian registered private health insurers are also required to:
- grant a member who transfers between Australia-based insurers continuity of cover for up to 30 days from the date they leave their previous insurer
- provide members who terminate their policy with a clearance certificate, approved by the Department of Home Affairs, within 14 days of the termination date or the date they were notified of the termination, whichever is later
To comply with the minimum level of health insurance, a policy must not contain a buy-out clause that would have the effect of terminating an Australian registered private health insurer’s liabilities in exchange for a predetermined lump sum payment.
The Australian registered private health insurer will allow the insured person 60 days from the last financial date of membership to pay a premium without terminating the membership.
Australian registered private health insurers are not required to pay for any treatment received during a period of arrears until and or unless the period of arrears is paid for in relation to the relevant period.
Evidence of adequate health insurance
Some Australian visas require you to provide evidence of adequate arrangements for health insurance while in Australia before we determine whether or not a visa is granted.
We might ask you to provide a copy of a current private health insurance policy held with an Australian registered private health insurer for you and any additional applicants applying for the visa with you.
Check the requirements of the visa you are applying for.
Prospective visitors to Australia are encouraged to shop around to get the best value private health insurance product for their time in Australia. Visitors to Australia are recommended to visit the Australian Government website: www.privatehealth.gov.au for further information about private health insurance in Australia to ensure they fully understand their requirements and available options. The Government website also provides a list of private health insurers operating in Australia to help consumers choose an insurer for the uptake of cover.