WHAT IS HEALTH INSURANCE EXCESS?

When you're admitted to hospital as a private patient, your insurer pays the hospital costs (accommodation, theatre, nursing, prostheses) — but only after you pay your excess. The excess is a fixed, known amount you chose when you bought your policy.

The mechanics:

1. You're admitted to hospital (planned or emergency)
2. You pay your excess (e.g., $500) — either at admission or billed after discharge
3. Your insurer pays the remaining covered hospital costs
4. You also pay any doctor fee gaps separately (these are not part of the excess)

Key rules:

Rule	Detail
Per person, per admission	You pay excess each time you're admitted, for each person admitted
Maximum for rebate-eligible policies	$750 per person per admission (singles), $1,500 per policy per year (families)
Children on family policies	Typically no excess for children under 25 (dependants)
Day surgery counts	Excess applies even for same-day admissions (day surgery)
No excess on extras	Excess applies to hospital cover only — not dental, optical, physio claims
Can be changed	You can change your excess level at any time by contacting your insurer

Most hospital policies offer three or four excess levels. Higher excess means lower weekly premium — you're trading a higher per-admission cost for a lower ongoing cost.

Premium comparison by excess for {{PROFILE_LABEL}}:

Excess	Avg Weekly Premium	Avg Annual Premium	Saving vs $250	Annual Saving vs $250
$0 (if available)	{{PROFILE_PREMIUM_0}}/week	{{PROFILE_ANNUAL_0}}/year	N/A	N/A
$250	{{PROFILE_PREMIUM_250}}/week	{{PROFILE_ANNUAL_250}}/year	Baseline	Baseline
$500	{{PROFILE_PREMIUM_500}}/week	{{PROFILE_ANNUAL_500}}/year	{{SAVING_250_TO_500}}/week	{{SAVING_250_TO_500_ANNUAL}}/year
$750	{{PROFILE_PREMIUM_750}}/week	{{PROFILE_ANNUAL_750}}/year	{{SAVING_250_TO_750}}/week	{{SAVING_250_TO_750_ANNUAL}}/year

Averages for {{PROFILE_LABEL}} at {{PROFILE_TIER}} tier in {{PROFILE_STATE}}. Actual premiums vary by insurer and policy.

The break-even point tells you how many hospital admissions per year would make a lower excess financially worthwhile.

$250 vs $750 excess:

Factor	$250 Excess	$750 Excess
Weekly premium	{{PROFILE_PREMIUM_250}}	{{PROFILE_PREMIUM_750}}
Annual premium	{{PROFILE_ANNUAL_250}}	{{PROFILE_ANNUAL_750}}
Annual premium saving	—	{{SAVING_250_TO_750_ANNUAL}}/year
Cost per admission	$250	$750
Extra cost per admission (vs $250)	—	$500 more per admission

Break-even: $750 excess saves you {{SAVING_250_TO_750_ANNUAL}}/year in premiums. Each admission costs you $500 more than $250 excess. Break-even point:

{{SAVING_250_TO_750_ANNUAL}} ÷ $500 = {{BREAKEVEN_ADMISSIONS}} admissions per year

If you're admitted to hospital fewer than {{BREAKEVEN_ADMISSIONS}} times per year, $750 excess is cheaper overall. If you're admitted more than {{BREAKEVEN_ADMISSIONS}} times, $250 excess is cheaper.

Most young, healthy Australians are admitted to hospital less than once per year — making $750 excess the better financial choice for the majority. People with planned surgery or chronic conditions requiring frequent admissions may benefit from lower excess.

Your situation	Recommended excess	Why
Young, healthy, no planned surgery	$750	Maximum premium savings; unlikely to be admitted
Moderate risk, no immediate plans	$500	Balance of savings and per-admission cost
Planned surgery in the next 12 months	$250	Lower per-admission cost when you know you'll be admitted
Chronic condition with regular admissions	$250 or $0	Minimise per-admission cost across multiple stays
MLS avoidance only, would use public system	$750	Absolute lowest premium; unlikely to claim privately
Pregnancy planned (12-month wait served)	$250	Birth is a known upcoming admission

Strategic excess changes:

Some people adjust their excess level based on their circumstances — raising it to $750 during healthy years and lowering it to $250 before a planned admission. This is permitted by most insurers, but check the terms:

• Some insurers require you to hold the new excess level for a minimum period (e.g., {{MIN_EXCESS_HOLD_PERIOD}}) before it applies to claims
• Changing excess does not trigger new waiting periods
• The premium change typically takes effect from your next billing period
• You can change excess as often as your insurer's terms allow

These three out-of-pocket costs are frequently confused. Understanding the difference prevents bill shock.

Term	What it is	When you pay	You control it?
Excess	Fixed amount per admission, chosen when buying policy	Each hospital admission	Yes — choose $250/$500/$750
Co-payment	Daily charge during hospital stay (some policies only)	Per day of hospital stay	No — set by your policy
Gap	Difference between doctor's fee and Medicare + insurance benefit	When doctor charges above schedule fee	Partially — choose gap-participating doctors

Example hospital admission costs:

Cost component	Who pays	Typical amount
Your excess	You	$250-$750 (your choice)
Hospital accommodation	Insurer (at agreed hospitals)	$0 to you
Theatre fees	Insurer (at agreed hospitals)	$0 to you
Prostheses	Insurer (if on Prostheses List)	$0 to you
Co-payment (if your policy has one)	You	{{COPAYMENT_RANGE}}/day
Surgeon fee gap	You	{{TYPICAL_SURGEON_GAP_RANGE}}
Anaesthetist fee gap	You	{{TYPICAL_ANAESTHETIST_GAP_RANGE}}
Total out-of-pocket	You	{{TYPICAL_TOTAL_OOP_RANGE}}

Your excess is the only component you control at the time of choosing your policy. Co-payments are set by the policy terms (some policies have no co-payment). Gaps depend on your doctors' fees and whether they participate in your insurer's gap cover scheme.

Family policies have specific excess rules that differ from singles and couples:

Children: Most family policies charge no excess for children (dependants under 21, or 25 if full-time students). If your child is admitted to hospital, you pay $0 excess — only the adult excess applies to adult members.

Family annual cap: For rebate-eligible policies, the maximum excess per family per year is $1,500. This means if both adults on a family policy are admitted in the same year, the combined excess is capped — you don't pay more than $1,500 total for the year regardless of how many admissions occur.

Policy type	Max excess per admission	Annual cap
Single	$750 per admission	No annual cap (per-admission only)
Couple	$750 per person per admission	$1,500 per policy per year
Family	$750 per adult per admission, $0 children	$1,500 per policy per year
Single parent	$750 per adult admission, $0 children	$1,500 per policy per year

Some policies offer $0 excess — meaning you pay nothing when admitted to hospital (other than potential doctor gaps). These policies have higher weekly premiums.

$0 excess policies are relatively uncommon and cost approximately {{ZERO_EXCESS_PREMIUM_DIFF}}/week more than the equivalent policy with $750 excess. They suit people who want absolute cost certainty per admission — no excess charge, just the premium.

Available $0 excess policies for {{PROFILE_LABEL}}: {{ZERO_EXCESS_POLICY_COUNT}}