Restricted cover explained

Here’s how to get the most from your Hospital cover on restricted services.

Specialists’ costs

It’s the same as if the service was ‘covered’. You can choose your specialist and if they agree to treat you under our Access Gap Cover scheme you’ll be, all or mostly, covered for their fee. It’s the same for any other specialists involved in your hospital care, like an anaesthetist or assistant surgeon.

Hospital costs

Your out-of-pocket expenses will depend on which type of hospital you go to (public or private), and how much that hospital charges private patients for the service.

Public hospitals

If your specialist can treat you in a public hospital as a private patient, ask if the hospital charges the government set fee for that service. If that’s the case, we pay your hospital bill (apart from your excess, if applicable).

If the hospital charges private patients more than government set fee, you’ll have to pay the difference. This can vary a lot, so be clear on this before you agree to any treatment.

At a glance

We pay – Accommodation in a shared room (up to the government fee).

You pay – Any excess on your cover and the balance of your accommodation costs.

Private hospitals

If you’re treated at a private hospital for a restricted service, you’re likely to have significant out-of-pocket costs.

As with public hospitals, we pay up to the set government fee for your hospital accommodation. But a private hospital will probably charge more than that.

At a private hospital you’ll also have to pay for any operating theatre, intensive care or neonatal intensive care costs, because they’re not included in the accommodation cost (which they are at public hospitals).

Again, you need to understand those costs before you consent to treatment to avoid bill shock later on.

At a glance

We pay – Accommodation as if staying in a shared room (up to the government fee).

You pay – Any excess on your cover, the balance of your accommodation costs, and any other costs involved in your hospital stay.