Short, scannable explainers on the rules that actually affect what you pay and what’s covered — hospital tiers, extras, the MLS, LHC loading, waiting periods, gap cover and ambulance by state.
Every hospital policy in Australia sits in one of four government tiers — Basic, Bronze, Silver and Gold — each with a minimum list of clinical categories it must cover. Funds can add benefits on top (e.g. ‘Silver Plus’), but the floor is set by the tier.
Full breakdown on the Hospital Cover page.
Extras (sometimes ‘general treatment’ or ‘ancillary’) pays a portion of the everyday health costs Medicare and hospital cover don’t — things like dental check-ups, glasses, physio, chiro and psychology.
Each service has an annual limit. If your expected rebates over a normal year add up to more than the premium, extras is worth it. The Extras Calculator does the maths for you.
The MLS is an extra 1–1.5% tax paid by higher-income earners who don’t hold an eligible hospital policy. It’s on top of the standard Medicare Levy.
| Income (singles) | Income (families) | MLS rate |
|---|---|---|
| $0 – $97,000 | $0 – $194,000 | 0% |
| $97,001 – $113,000 | $194,001 – $226,000 | 1.0% |
| $113,001 – $151,000 | $226,001 – $302,000 | 1.25% |
| $151,001+ | $302,001+ | 1.5% |
Family threshold increases by $1,500 for each dependent child after the first. Holding an eligible Basic hospital policy for the full year removes MLS liability.
If you don’t take out hospital cover by 1 July following your 31st birthday, you pay a 2% loading on top of your premium for every year you delay — up to a maximum of 70%. The loading is removed after you’ve held continuous hospital cover for 10 years.
Example: starting hospital cover at age 40 means a 20% loading for 10 years.
Waiting periods are the time you must hold a policy before you can claim. The government caps the maximum waits — funds can be shorter, never longer:
2 months
Most hospital services and extras
12 months
Pre-existing conditions
12 months
Pregnancy and birth
12 months
Major dental, orthodontics, hearing aids
Switching funds? You don’t re-serve waiting periods on equivalent benefits you’ve already cleared (‘continuity of cover’).
The ‘gap’ is the difference between what your specialist charges and what Medicare + your fund pay back. Each fund has gap-cover arrangements with doctors — under known-gap or no-gap schemes, you’ll either know the maximum cost up-front or pay nothing extra.
Always ask your specialist for ‘informed financial consent’ before any procedure.
Ambulance cover varies by state. Some governments fund it automatically; others expect you to subscribe directly or carry it on your health policy.
| State / Territory | What you need |
|---|---|
| QLD | Free for residents — covered by the state government. |
| TAS | Free for residents — covered by the state government. |
| NSW / ACT | Subscribe via Ambulance Service NSW or include on your health policy. |
| VIC | Ambulance Victoria membership or include on your health policy. |
| SA | SA Ambulance subscription or include on your health policy. |
| WA | St John WA subscription or include on your health policy. |
| NT | St John NT subscription or include on your health policy. |
An advisor will explain it for free — no obligation, no marked-up premium.
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